How do long COVID patients perceive their current life situation and occupational perspective? Results of a qualitative interview study in Germany

[How do people with long COVID cope with their symptoms and everyday limitations? A qualitative study with four focus groups]

BACKGROUND

The heterogenous and fluctuating intensity of long COVID symptoms poses a challenge to both patients and healthcare providers due to a lack of causal treatment options. The aim of supportive therapies is to help individuals cope with symptoms in daily life and maintain functionality. This study aims to identify coping strategies employed by those affected by long COVID and their perceived benefits.

METHODS

A qualitative study was conducted with four focus groups comprising 23 adult patients suffering from long COVID. The recorded and transcribed group discussions were analyzed using content-structuring content analysis according to Kuckartz. The results were then systematically analyzed, interpreted, and put in a theoretical context.

RESULTS

Participants utilized healthcare resources but developed their own strategies for dealing with long COVID because of their dissatisfaction with medical care. These strategies included energy and resource management, physical activity, enhancing health literacy, changing mindset and lifestyle, infection prevention, using medical aids, and dietary changes.

CONCLUSIONS

This study demonstrates that people with long COVID employ a variety of strategies to cope with impairments in everyday life. According to the interviewees, integrating these approaches into the treatment of long COVID can help to reduce the burden of symptoms on those affected, restore their everyday functionality, and improve their self-efficacy and quality of life. Established concepts like "pacing" or "shared-decision making" can serve as a starting point for developing individualized coping strategies and treatment concepts together with patients.

The Impact of Long COVID on Employment and Well-Being: A Qualitative Study of Patient Perspectives

BACKGROUND

Exploring the experiences of Long COVID patients who face challenges with employment may inform improvements in how healthcare systems can provide holistic care for this patient population.

OBJECTIVE

Understand perspectives about the impact of Long COVID on employment and well-being among patients seeking healthcare for Long COVID.

DESIGN

Qualitative study involving one-on-one interviews.

PARTICIPANTS

Eligible participants were 18 years of age or older, spoke English, self-reported as doing well in daily life before having COVID-19, and reported that COVID-19 was still having a significant impact on their life three or more months following an acute infection.

APPROACH

Participants were recruited from a post-COVID recovery clinic at an academic medical center. Interviews were conducted from August to September 2022.

KEY RESULTS

Among all participants (N = 21), most described that they were not able to work at a capacity equivalent to their norm pre-COVID-19. For those who continued working after their COVID-19 infection, the effort and energy required for work left little capacity to participate in other life activities and made it difficult to attend recommended healthcare appointments. Participants reported financial impacts of changes in employment including loss of income and changes in insurance, which were compounded by high healthcare costs. Changes in employment resulted in emotional repercussions including feelings of loss of self-identity and fear of judgement at work. Participants discussed issues surrounding access to strategies to address challenges posed by the impact of Long COVID on employment, including strategies learned from healthcare providers to cope with Long COVID symptoms at work and efforts to seek disability benefits or workplace accommodations.

CONCLUSIONS

Patients with Long COVID may face significant challenges due to changes in their ability to work. Healthcare providers can support these patients by connecting them to financial assistance resources, facilitating appropriate mental health treatment, and expediting workplace accommodation requests.

The impact of long COVID on quality of life and work performance among healthcare workers in Portugal

Background

Coronavirus disease 2019 (COVID-19) is a multisystem infectious disease which affected 5.7 million people in Portugal. A subgroup of patients experienced long-term effects from the infection, now referred to as long COVID. Long COVID can considerably reduce the quality of life (QoL) of affected patients. This study aimed to evaluate the impact of long COVID on QoL and work performance among healthcare workers (HCWs) in Portugal.

Methods

A cross-sectional correlational survey was performed in 348 HCWs employed either in hospitals, or non-hospital health facilities in Portugal. Participants completed an online survey using Google Forms between May and June 2024, which consisted of multiple-choice questions and took less than 10 min to fill out. Long COVID was considered present if the defined symptoms started at least 3 months after the primary infection of COVID-19, and persisted for at least 2 months. The outcome measures were performance at work and QoL. Performance at work was measured using a seven-point Likert scale and QoL was evaluated using the Satisfaction with Life Scale (SWLS). Data was analyzed using SPSS.

Results

A total of 277 participants (79.6%) had history of SARS-CoV-2 infection, and 223 participants (64.1%) reported a history of long COVID. Extreme fatigue was reported by 158 participants (57.0%), cognitive dysfunction by 118 participants (42.6%), shortness of breath by 76 participants (27.4%), and persistent cough by 168 participants (60.6%). In the multivariate analysis, long COVID was significantly associated with lower SWLS scores indicating that long COVID negatively impacted QoL. Having two or more chronic diseases showed a trend towards lower performance, and extreme fatigue and cognitive dysfunction showed strong negative associations with performance.

Discussion

Based on a national sample of HCWs (348 individuals), a high percentage of participants (64.1%) reported a history of long COVID. These results suggest that HCWs in Portugal have a prevalence of the disease similar to that of the worldwide population. Concerning performance at work, having two or more chronic diseases showed a trend towards lower performance, as well as extreme fatigue and cognitive dysfunction. Interestingly, we found a negative association between being a clinical secretary and SWLS. This might be explained by the specific challenges or stressors faced by clinical secretaries, which could negatively impact their QoL. In conclusion, long COVID was prevalent in the studied sample of HCWs and had a negative impact on their QoL. Extreme fatigue and cognitive dysfunction were strongly negatively associated with performance. This suggests the need for targeted care for HCWs as a group. The results of this study can guide healthcare authorities in addressing important long-term consequences that should be considered in rehabilitation programs for post-COVID-19 recovery.

Navigating uncertainty: occupational therapists' experiences of Long COVID management in Germany, Austria and Switzerland

PURPOSE

Long COVID presents global challenges for healthcare professionals. Occupational therapists responded by seeking effective treatment strategies. The approaches of occupational therapists supporting long-haulers in German-speaking countries remain under-explored. The purpose of this study is to explore how occupational therapists in Germany, Austria and Switzerland navigate and apply profession-specific strategies in the new clinical landscape of Long COVID care.

MATERIALS AND METHODS

This study used qualitative-descriptive design and content analysis to extract insights from seven semi-structured interviews with occupational therapists in inpatient and outpatient settings from three countries.

RESULTS

Four overarching themes emerged: how Long COVID was encountered within the scope of occupational therapy, the multifaceted repertoire experts used to support long haulers, triumphs and challenges that emerged in Long COVID treatment, and recommendations and opportunities for occupational therapy practice. The results underscore the complex support needed for long-haulers, achieved through a multifaceted occupational therapy repertoire, incorporating client-centred, occupation-focused, and context-referencing strategies with shared decision-making and collaborative therapy planning.

CONCLUSIONS

Occupational therapy concepts, with their focus on human occupation, may offer new treatment options and strategies for managing emerging conditions such as Long COVID.

Living with Long COVID: A Narrative Study

This qualitative narrative study describes the stories of persons with Long COVID. Four individuals participated in semi-structured interviews with photo elicitation. Thematic analysis yielded six themes: symptom complexity, deep emotional impact, changes to daily life, not being believed, navigating healthcare alone, and positive influence of social support illustrating that persons with Long COVID experience major changes in their bodies, routines, and relationships. The results can inform occupational therapy services by encouraging occupational therapy practitioners to pursue updated Long COVID-specific continuing education and address the functional limitations, role competencies, support systems, and life priorities of these clients.

Care for post-COVID-19 condition in Germany from the perspectives of patients, informal caregivers and general practitioners: Study protocol for a mixed methods study

BACKGROUND

A large number of individuals suffer from post-COVID-19 condition (PCC), characterised by persistent symptoms following a SARS-CoV-2 infection with an impact on daily personal and professional activities. This study aims at examining which (health) care services are used by PCC patients in the German federal state of Lower Saxony, and how these patients manage their condition. The perspectives of patients, informal caregivers and general practitioners (GPs) will be considered.

METHODS

The study will employ a mixed methods design. Patients' perspective will be evaluated through an online survey of: (1) 21,000 adult individuals with a PCC diagnosis (ICD10 U09.9!) in their statutory health insurance claims data in 2022 ("AOK survey") and (2) a self-selected sample of adult individuals with a proven SARS-CoV-2 infection in 2023 and persistent symptoms ("public survey"). Additional data sources will be claims data (n = 27,275) and 25-30 semi-structured interviews. Informal caregivers' perspective will be collected through an online survey and semi-structured interviews. GPs' perspective will be evaluated through four focus groups involving six to eight participants each and an online survey of all registered and practicing GPs in Lower Saxony (approximately 5,000). All survey data will be descriptively analysed. In addition, correlation analyses and multivariable regression analyses will be conducted, for example on factors influencing affected individuals' use of medical services. Interview and focus group data will be subjected to qualitative content analysis. A health economic analysis will be used to determine the costs of PCC to health care payers, patients and society. The project will conclude with an expert workshop to discuss the results and derive recommendations.

DISCUSSION

The results of the study will provide a multidimensional description of the (health) care situation and needs of patients with PCC, and derive recommendations for improving health care.

TRIAL REGISTRATION

The VePoKaP study is registered at the German Clinical Trials Register (DRKS00032846).

Describing the Lived Experience and Resource Needs of Individuals With Long COVID

Individuals with long COVID report diverse symptoms lasting weeks or months after initial infection, causing significant psychosocial distress. Navigating health care interactions are often difficult for these individuals due to the diffuse nature of their symptoms, a lack of effective treatment options, and skepticism from some providers. To better understand these challenges, this study sought to further describe the lived experience of individuals with long COVID. A survey was conducted with individuals evaluated for long COVID at a specialty clinic (n = 200), which included questions about prior conditions, symptoms, use of medical and support services, and information and resource needs. Participants reported a mean of 10.75 persistent symptoms, the most common being fatigue and difficulty concentrating, with broad effects on daily functioning. Participants saw a mean of 5.92 providers for treatment of their symptoms, and 88.5% identified health care providers as a trusted source of information. Interest in research findings (60.5%) and opportunities for participation (47.5%) were moderate and varied by COVID vaccination status. Unvaccinated individuals (n = 27) also reported less trust in government sources of information, less college education, lower household income, and greater likelihood of having public insurance. Our findings suggest that individuals with long COVID experience many ongoing and complex symptoms with diverse effects on daily living; that health care providers are an important source for public health messaging about long COVID; and that unvaccinated individuals are likely to have differing needs and receptiveness to information than vaccinated individuals with long COVID.

The Delphi Method: Developing a Telerehabilitation Practice Guideline for Patients in Indonesia with Long COVID

Telerehabilitation has the potential to help expand the reach of rehabilitation intervention. An online questionnaire-based Delphi method set out to develop a telerehabilitation guideline for patients in Indonesia with Long COVID. A Delphi panel comprised of 24 experts was selected from all relevant disciplines. Over two rounds of Delphi testing, panelists gave opinions and indicated their level of agreement with each recommendation. Key elements of consensus for a telerehabilitation guideline for patients with Long COVID includes: the benefit of telerehabilitation, types of rehabilitation intervention needed, methods of intervention, criteria for home-based self-exercise training, set-up of rehabilitation prescription, exercise monitoring, evaluation of rehabilitation intervention and duration of rehabilitation intervention. Further research is needed to determine the feasibility and effectiveness of this guideline.

What is current care for people with Long COVID in England? A qualitative interview study

OBJECTIVE

To investigate current care for people with Long COVID in England.

DESIGN

In-depth, semistructured interviews with people living with Long COVID and Long COVID healthcare professionals; data analysed using thematic analysis.

SETTING

National Health Service England post-COVID-19 services in six clinics from November 2022 to July 2023.

PARTICIPANTS

15 healthcare professionals and 21 people living with Long COVID currently attending or discharged (18 female; 3 male).

RESULTS

Health professionals and people with lived experience highlighted the multifaceted nature of Long COVID, including its varied symptoms, its impact on people's lives and the complexity involved in managing this condition. These impacts encompass physical, social, mental and environmental dimensions. People with Long COVID reported barriers in accessing primary care, as well as negative general practitioner consultations where they felt unheard or invalidated, though some positive interactions were also noted. Peer support or support systems proved highly valuable and beneficial for individuals, aiding their recovery and well-being. Post-COVID-19 services were viewed as spaces where overlooked voices found validation, offering more than medical expertise. Despite initial challenges, healthcare providers' increasing expertise in diagnosing and treating Long COVID has helped refine care approaches for this condition.

CONCLUSION

Long COVID care in England is not uniform across all locations. Effective communication, specialised expertise and comprehensive support systems are crucial. A patient-centred approach considering the unique complexities of Long COVID, including physical, mental health, social and environmental aspects is needed. Sustained access to post-COVID-19 services is imperative, with success dependent on offering continuous rehabilitation beyond rapid recovery, acknowledging the condition's enduring impacts and complexities.

Evaluating the Feasibility, Acceptance, and Beneficial Effects of Online Occupational Therapy for Post-COVID-19 Condition: Protocol for a Randomized Controlled Trial (ErgoLoCo Study)

BACKGROUND

Post-COVID-19 syndrome (PCS; also known as "long COVID") is a relatively novel disease comprising physical, psychological, and cognitive complaints persisting several weeks to months after acute infection with SARS-CoV-2. Approximately 10% of patients with COVID-19 are affected by long-term symptoms. However, effective treatment strategies are lacking. The ErgoLoCo (Occupational Therapy [Ergotherapie] for Long COVID) study was designed to develop and evaluate a novel occupational therapy (OT) concept of online delivery of therapy for long COVID.

OBJECTIVE

The primary study objective is to assess the feasibility of the online OT intervention in PCS. Secondary aims include the evaluation of online OT concerning cognitive problems, occupational performance, and social participation.

METHODS

This randomized controlled interventional pilot study involves parallel mixed methods process analyses and a realist evaluation approach. A total of 80 clients with PCS aged at least 16 years will be recruited into two interventional groups. The control cohort (watch and wait) comprises 80 clients with long COVID. Treatment is provided through teletherapy (n=40) or delivery of prerecorded videos (n=40) using the same standardized OT concept twice weekly over 12 weeks. Analyses of quantitative questionnaires and qualitative interviews based on the theoretical framework of acceptability will be performed to assess feasibility. Focus group meetings will be used to assess how acceptable and helpful the intervention was to the participating occupational therapists. Standardized tests will be used to assess the initial efficacy of the intervention on neurocognitive performance; limitations in mobility, self-care, and everyday activities; pain; disabilities; quality of life (QoL); social participation; and anxiety and depression in PCS, and the possible effects of online OT on these complaints.

RESULTS

The German Ministry of Education and Research provided funding for this research in March 2022. Data collection took place from October 2022 to August 31, 2023. Data analysis will be completed by the end of April 2024. We anticipate publishing the results in the fall of 2024.

CONCLUSIONS

Despite the enormous clinical need, effective and scalable treatment options for OT clients who have PCS remain scarce. The ErgoLoCo study will assess whether online-delivered OT is a feasible treatment approach in PCS. Furthermore, this study will assess the effect of the intervention on cognitive symptoms, QoL, and occupational performance and participation in everyday life. Particular emphasis will be placed on the experiences of clients and occupational therapists with digitally delivered OT. This study will pave the way for novel and effective treatment strategies in PCS.

TRIAL REGISTRATION

German Clinical Trial Registry DRKS00029990; https://drks.de/search/de/trial/DRKS00029990.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/50230.

Management of cognitive impairment associated with post-COVID-19 syndrome: recommendations for primary care

Introduction: Although post-COVID-19 syndrome (PCS) with cognitive impairment is increasingly encountered in primary care, evidence-based recommendations for its appropriate management are lacking. Methods: A systematic literature search evaluating the diagnosis and treatment of cognitive impairment associated with PCS was conducted. Practical recommendations for the management of PCS-associated cognitive impairment in primary care are summarized, based on an evaluation of pharmacological plausibility and clinical applications. Results: Currently, the pathology of cognitive impairment associated with PCS remains unclear with no high-quality data to support targeted interventions. Existing treatment approaches are directed towards symptom relief where counseling on the chronicity of the disease and regular reassessments at 4- to 8-week intervals is considered reasonable. Patients should be informed and encouraged to adopt a healthy lifestyle that centers around balanced nutrition and appropriate physical activities. They may also benefit from the intake of vitamins, micronutrients, and probiotics. The administration of Ginkgo biloba extract could offer a safe and potentially beneficial treatment option. Other non-pharmacological measures include physiotherapy, digitally supported cognitive training, and, if indicated, ergotherapy or speech therapy. In most patients, symptoms improve within 8 weeks. If serious, ambiguous, or when new symptoms occur, specialized diagnostic measures such as comprehensive neurocognitive testing or neuroimaging should be initiated. Very few patients would require inpatient rehabilitation. Conclusion: PCS with cognitive impairment is a debilitating condition that could affect daily functioning and reduce work productivity. Management in primary care should adopt a multidisciplinary approach, centering around physical, cognitive, and pharmacological therapies.

[Experiences of people with Long COVID in their medical accompaniment and in the social environment]

BACKGROUND

Permanent health impairments after a COVID-19 infection can lead to a lack of social participation and pronounced emotional stress. The aim of this study was to find out how Long COVID affects the social activities of those affected and understand the role that medical support and the immediate social environment play in this.

METHODS

Between January and May 2022, 25 participants with long COVID were interviewed about their health situation, their perception of health care in Germany, and their social and professional context. The interviews, which were mainly conducted online, were analyzed for content, and the results were assessed using lifeworld-theoretical approaches.

RESULTS

The participants reported a variety of health symptoms such as fatigue, shortness of breath, and cognitive impairments. The majority of respondents had a pessimistic attitude toward a timely recovery. Most participants perceived the medical support for long COVID as inadequate. Long waiting times for specialist appointments and the lack of acceptance of the health impairment by some doctors lead to an increase in existing uncertainties. Long COVID also had a major impact on respondents' social life. Many participants referred to a burdensome decline in the number of meetings with family and friends. Many respondents avoided physical contact with friends and family members due to a high level of fear of infection. Some participants explained that they separated themselves from people in their environment because they did not take their precarious situation seriously. However, an important resource was the close circle of family and friends from whom the majority of the interviewees received support.

DISCUSSION

While other research studies particularly emphasize the comprehensive psychological and emotional consequences of long COVID, such as identity conflicts, existential angst, or depression, the present study shows that a lack of understanding from medical professionals as well as heavily delayed treatment leave the interviewees in a state of emotional void.

CONCLUSIONS

The findings show a considerable need for support among people with health impairments after a COVID-19 infection. Empathic and empirically based counseling and support by general practitioners as well as improvement of access to rehabilitative services can provide substantial support for people with long COVID.

Constitution of Long COVID illness, patienthood and recovery: a critical synthesis of qualitative studies

OBJECTIVES

To investigate the lived experiences of Long COVID.

DESIGN

Critical interpretive synthesis of qualitative research.

DATA SOURCES

PubMed and Web of Science databases were searched on 14 September 2023.

ELIGIBILITY CRITERIA

Original peer-reviewed qualitative studies describing the experiences of Long COVID were eligible for inclusion.

DATA EXTRACTION AND SYNTHESIS

We used established qualitative synthesis methods to search, screen and manually code the included studies. Critical interpretation methods were used to analyse the data and develop synthetic constructs.

RESULTS

68 articles were identified in the first phase of sampling, with 16 studies and 879 participants included in the final synthesis. The analysis of these studies was organised into three thematic constructions of Long COVID: (1) the illness, (2) the patient and (3) recovery. Long COVID was diversely characterised across study approaches, designs and findings but was underpinned by shared diagnostic logics, which shaped the identification and measurement of symptoms. The boundaries between different constitutions of Long COVID in qualitative accounts of illness experience were often imprecise. Slippages between different definitions of Long COVID had implications for patient experiences in relation to diagnosis, help-seeking and care, and expectations of recovery.

CONCLUSIONS

Long COVID is a site of multiple and diverse qualitative interpretation. Accounts of lived experience emphasise the constitutions of illness, patienthood and recovery as situated and emergent. The ongoing context-based negotiation of Long COVID is a defining qualitative feature of the condition. Approaches to researching, diagnosing and developing health interventions must be as adaptive as the varieties of Long COVID lived experience.

How do people with long COVID utilize COVID-19 vaccination and rehabilitation services and what are their experiences with these services? results of a qualitative study with 48 participants from Germany

BACKGROUND

Studies estimate that at least 7.5% of adults are affected by long-term symptoms such as fatigue or cognitive impairment after the acute phase of COVID-19. COVID-19 vaccination may reduce the risk of long COVID. Rehabilitation can have a positive impact on recovery. This study aims to present the experiences of people with long COVID with COVID-19 vaccination and rehabilitation. Such research is important because perceptions of these measures can impact healthcare utilization and health status.

METHODS

48 adults with long COVID participated in this qualitative study, 25 of them in one-on-one interviews and 23 in focus groups. Participants were recruited via calls for participation on the websites and social media channels of two university hospitals and with the help of respondents' networks. The conversations were audio-recorded, transcribed, and analyzed using qualitative content analysis. Subsequently, the results were compared, interpreted, and discussed by scientific literature.

RESULTS

35 study participants reported that they had received a COVID-19 vaccination and 16 of them stated that they had utilized a rehabilitation service. These participants had varying experiences with COVID-19 vaccination and rehabilitation. Nine of them stated that they developed long COVID despite vaccination before COVID-19. Ten participants reported vaccine reactions, and two participants reported severe side effects. Two participants reported persistent deterioration of their long COVID symptoms after vaccination. This led to uncertainty about the safety, benefits, and handling of COVID-19 vaccination. However, most participants perceived the vaccine as effective regarding milder COVID-19 sequelae. Four participants felt their rehabilitation was helpful and four participants felt it was unhelpful. Two persons found the combination of inpatient rehabilitation and rehabilitation sport helpful.

CONCLUSIONS

Several implications can be derived from this study: (1) researchers should explore the effects of COVID-19 vaccination on long COVID symptoms; (2) vaccination campaigns should be more responsive to the perspectives of people with long COVID on vaccination; (3) care planners should build rehabilitation facilities specialized in long COVID; (4) rehabilitation providers should train their professionals regarding long COVID and develop rehabilitation programs tailored to different clinical pictures.

TRIAL REGISTRATION

German register for clinical trials DRKS00026007, 09 September 2021.

Parenting and Gender as Impact Factors for Social Participation, Quality of Life, and Mental Health in Long COVID

OBJECTIVES

This study aims to investigate the impact of gender and parental tasks on social participation, health-related quality of life (hrQoL), and mental health in persons with long COVID.

METHODS

A mixed-methods approach was followed including a cross-sectional web-based survey and semi-structured interviews. Multivariable linear regressions were used to quantify the effect of gender and parenting tasks on social participation, hrQoL, and mental health. Qualitative data from interviews with participants experiencing long COVID symptoms was analyzed using content analysis.

RESULTS

Data from 920 participants in the quantitative study and 25 participants in the qualitative study was analyzed. Parenting tasks were associated with increased impairments in family and domestic responsibilities in persons with long COVID compared to lower impairments in persons without long COVID (P = .02). The qualitative data indicate that coping with long COVID and pursuing parenting tasks limit participants' ability to perform leisure activities and attend social gatherings. In long COVID, men had higher anxiety symptoms than women, and in those without long COVID, the opposite was observed (P < .001). In the qualitative study, participants expressed feelings of dejection and pessimism about their future private, occupational, and health situations. No differences between the genders could be observed.

CONCLUSIONS

Long COVID is associated with impairments in family and domestic responsibilities in individuals who have parenting tasks. Among participants with long COVID, anxiety symptoms are higher in men than women.

Return-to-work with long COVID: An Episodic Disability and Total Worker Health® analysis

A growing number of working individuals have developed long COVID (LC) after COVID-19 infection. Economic analyses indicate that workers' LC symptoms contribute to workforce shortages. However, factors that affect return-to-work from perspectives of people with LC remain largely underexplored. This qualitative study of people with LC conducted by researchers living with LC aimed to identify participants' return-to-work experiences using Total Worker Health® and Episodic Disability frameworks. 10% of participants who participated in a mixed-method global internet survey, had LC symptoms >3 months, and responded in English were randomly selected for thematic analysis using NVivo12. 15% of responses were independently double-coded to identify coding discrepancies. Participants (N = 510) were predominately white and had at least a baccalaureate degree. Four primary work-related themes emerged: 1) strong desire and need to return to work motivated by sense of purpose and financial precarity; 2) diverse and episodic LC symptoms intersect with organization of work and home life; 3) pervasiveness of LC disbelief and stigma at work and in medical settings; and 4) support of medical providers is key to successful return-to-work. Participants described how fluctuation of symptoms, exacerbated by work-related tasks, made returning to work challenging. Participants' ability to work was often predicated on job accommodations and support. Non-work factors were also essential, especially being able to receive an LC medical diagnosis (key to accessing leave and accommodations) and help at home to manage non-work activities. Many participants described barriers accessing these supports, illuminating stigma and disbelief in LC as a medical condition. Qualitative findings indicate needs for workplace accommodations tailored to fluctuating symptoms, continuously re-evaluated by workers and supervisors together. Reductions in medical barriers to access work accommodations is also critical since many medical providers remain unaware of LC, and workers may lack a positive COVID test result.

"There is no one who helps you with it": experiences of people with long COVID regarding medical care, therapeutic measures, and barriers in the German healthcare system: results of a qualitative study with four focus groups

BACKGROUND

Many people experience long-term symptoms such as fatigue, cognitive problems, or shortness of breath after an acute infection with COVID-19. This emerging syndrome, known as long COVID, is new and complex in many aspects. This study aims to collect the experiences of people with long COVID with ambulatory healthcare structures.

METHODS

Four focus groups were conducted with a total of 23 adults with long COVID in June and July 2022. These discussions were audio-recorded, subsequently transcribed, and analyzed using the qualitative content analysis of Mayring and Kuckartz.

RESULTS

Fourteen out of 19 participants who had a primary care encounter regarding their long COVID symptoms did not perceive it as helpful. Many respondents reported that their general practitioners did not take their long COVID symptoms seriously and did not refer them to specialists or made therapeutic recommendations. However, some participants reported that they were prescribed non-pharmaceutical therapies (e.g., group meetings supported by psychotherapists, occupational therapy, etc.) that improved their condition. 14 of 23 respondents perceived care barriers such as providers' lack of awareness of long COVID, poor access to specialists, a lack of specialized care (e.g., long COVID clinics), or high bureaucratic hurdles for specific healthcare services. To improve medical care, participants suggested campaigns to raise awareness of long COVID among healthcare providers and the general population, increase research and government investments regarding the development of treatment structures for long COVID, expanding existing therapeutic services, and establishing one-stop shops for integrated specialist healthcare for people with long COVID.

CONCLUSIONS

Several implications for healthcare professionals and policymakers can be derived from this study: (1) general practitioners should take the symptoms of long COVID seriously, assume a care coordinating role, make referrals, and establish contact with long COVID clinics; (2) care planners should focus on developing interprofessional evidence-based care and treatment approaches for long COVID; (3) existing care structures such as long COVID outpatient clinics should be expanded. The overarching goal must be to develop consistent guidelines for long COVID diagnosis, care, and treatment.

TRIAL REGISTRATION

The study is registered in the German register for clinical trials (DRKS00026007, first registration on 09/09/2021).