Return-to-work rates and predictors of absence duration after COVID-19 over the course of the pandemic

Workplace Vaccination Against COVID-19 and Seasonal Influenza in the United States: A Modeling-Based Estimation of the Health and Economic Benefits for Employers and Employees

The objectives were to assess the economic burden of COVID-19 and impact of workplace COVID-19 vaccination in the United States (US). An economic model estimated COVID-19 workplace burden (infections, long COVID, inpatient/outpatient care, absent days) with and without vaccination, compared with seasonal influenza vaccination for context, using Optum's de-identified Clinformatics® Data Mart Database. Without workplace vaccination, an average US business (with 10,000 employees), had 18,175 absent days from COVID-19 and lost productivity costs of USD 5.08 million. Implementing COVID-19 workplace vaccination (at 70% coverage) prevented approximately 3132 absent days, saving employers USD 876,453 (lost productivity) and USD 240,633 (medical costs); and saving employees USD 182,196 (medical costs) and USD 198,250 (lost wages) versus no COVID-19 workplace vaccination. The burden and vaccination impact were greater for COVID-19 versus seasonal influenza. Workplace vaccination for COVID-19 and seasonal influenza can have a significant impact for both the employer and employees through averted disease.

Long-term course and factors influencing work ability and return to work in post-COVID patients 12 months after inpatient rehabilitation

BACKGROUND

Rehabilitation plays a crucial role in restoring work ability and facilitating the reintegration of post-COVID patients into the workforce. The impact of rehabilitation on work ability and return to work (RTW) of post-COVID patients remains poorly understood. This study was conducted to assess the work ability and RTW of post-COVID patients before rehabilitation and 12 months after rehabilitation and to identify physical and neuropsychological health factors influencing RTW 12 months after rehabilitation.

METHODS

This longitudinal observational study included 114 post-COVID patients with work-related SARS-CoV-2 infection who underwent inpatient post-COVID rehabilitation with indicative focus on pulmonology and/or psychotraumatology (interval between date of SARS-CoV-2 infection and start of rehabilitation: M = 412.90 days). Employment status, work ability, and the subjective prognosis of employment (SPE) scale were assessed before rehabilitation (T1) and 12 months after rehabilitation (T4). The predictors analysed at T4 were functional exercise capacity, physical activity, subjective physical and mental health status, fatigue, depression, and cognitive function. Longitudinal analyses were performed via the Wilcoxon signed-rank test. Logistic and linear regression analyses identified predictors of work ability and return to work (RTW), whereas mediation analyses examined the relationships between these predictors and work ability.

RESULTS

At T4, the median of WAI total score indicated poor work ability, which significantly worsened over time (p < 0.001; r = 0.484). The SPE scale significantly increased from T1 to T4 (p = 0.022, r = -0.216). A total of 48.6% of patients had returned to work 12 months after rehabilitation. Fatigue was identified as the main predictor of reduced work ability and RTW, with each unit increase in fatigue severity decreasing the odds of RTW by 3.1%. In addition, physical capacity and subjective health status were significant predictors of perceived work ability.

CONCLUSIONS

The findings highlight the significant challenges that post-COVID patients face in regaining work ability and achieving successful RTW 12 months after rehabilitation. Fatigue appears to be an important predictor of work ability and RTW. To optimize recovery and enhance both biopsychosocial health and work ability, it is crucial to develop and implement personalised interventions that address fatigue, improve physical capacity, and support mental health.

TRIAL REGISTRATION

This study is registered in the German Clinical Trials Register under DRKS00022928.

Sick leave due to SARS-CoV-2 infection

BACKGROUND

Coronavirus disease 2019 (COVID-19) caused a high burden of sick leave worldwide. Long-term sick leave for COVID-19 may be longer than for other influenza-like syndromes. The real impact of long COVID on absenteeism remains uncertain.

AIMS

To investigate the burden of sick leave, especially >12 weeks, in Belgian workers with a positive polymerase chain reaction (PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from July 2020 to September 2021 and to compare these figures with sick leave for other infectious diseases.

METHODS

We coupled a database of SARS-CoV-2-positive workers and workers who were absent for other infections with objective absence data. Predictors of prolonged sickness were evaluated by negative binomial regression, Cox proportional hazards regression and ordinal logistic regression.

RESULTS

The study population involved 2569 workers who tested positive for SARS-CoV-2 and 392 workers who were absent for other infectious diseases. In total, 16% (95% CI 14-17%) of workers with a positive SARS-CoV-2 test had no sick leave registered. Fourteen out of 1000 (95% CI 9-20‰) workers with absenteeism for COVID-19 experienced sick leave >12 weeks as compared to 43 out of 1000 workers (95% CI 3-69‰) with absenteeism due to other infections. When including PCR-positive workers without sick leave, the prevalence of long-term sick leave decreased to 12 per 1000 (95% CI8-17‰). Long-term sick leave was associated with older age, high previous sick leave and low educational level.

CONCLUSIONS

The prevalence of long-term sick leave was lower than estimated in earlier investigations regardless of worrying reports about post-COVID-19 syndrome.

Cost-effectiveness analysis of COVID-19 booster doses and oral antivirals: Case studies in the Indo-Pacific

BACKGROUND

Decision-makers in middle-income countries need evidence on the cost-effectiveness of COVID-19 booster doses and oral antivirals to appropriately prioritise these healthcare interventions.

METHODS

We used a dynamic transmission model to assess the cost-effectiveness of COVID-19 booster doses and oral antivirals in Fiji, Indonesia, Papua New Guinea, and Timor-Leste. We conducted cost-effectiveness analysis from both healthcare and societal perspectives using data collated from publicly available sources. We developed an interactive R Shiny which allows the user to vary key model assumptions, such as the choice of discounting rate, and view how these assumptions affect model results.

FINDINGS

Booster doses were cost saving and therefore cost-effective in all four middle-income settings from both healthcare and societal perspectives using 3% discounting. Providing oral antivirals was cost-effective from a healthcare perspective if procured at a low generic price (US$25) or middle-income reference price (US$250); however, their cost-effectiveness was strongly influenced by rates of wastage or misuse, and the ongoing costs of care for patients hospitalised with COVID-19. The cost or wastage of rapid antigen tests did not appear strongly influential over the cost-effectiveness of oral antivirals in any of the four study settings.

CONCLUSIONS

Our results support that COVID-19 booster programs are cost-effective in middle-income settings. Oral antivirals demonstrate the potential to be cost-effective if procured at or below a middle-income reference price of US$250 per schedule. Further research should quantify the rates of wastage or misuse of oral COVID-19 antivirals in middle-income settings.

The Impact of COVID-19 on Functional Capacity and Pulmonary Outcomes in the Hail Region: A Cross-Sectional Study

Background/Objectives: COVID-19, caused by the novel coronavirus SARS-CoV-2, has had a significant impact on life worldwide since its emergence in late 2019. The virus has caused a global pandemic, leading to widespread health, social, economic, and psychological effects. COVID-19 mainly affects the respiratory system. This study aimed to compare the functional capacity and pulmonary function outcomes between COVID-19 patients and individuals who have not been infected in the Hail region. Methods: Individuals of both genders above 18 years old who had been infected with COVID-19 in the previous 6 months or had never been infected were eligible to participate. Local hospitals and social media apps were used to recruit willing participants. Heart rate, pulse oxygen saturation, blood pressure, pulmonary function test, hand grip strength, and functional tests (6 min walk test, 30 s sit-to-stand test, and timed up and go test) were measured and compared between the groups. Statistical analysis was performed using SPSS Version 25. Results: Forty individuals affected with COVID-19 and forty-one healthy individuals were recruited. Our results showed that in individuals affected with COVID-19, scores on the minute ventilation, 30 s sit-to-stand, and 6 min walk tests were significantly lower than among healthy individuals. Other outcomes did not show any statistical differences between the groups. Conclusion: This study contributes to a greater understanding of the functional capacity status of individuals with COVID-19. Patients affected by COVID-19 may develop an impaired lung capacity and a decreased function capacity. These factors may negatively affect physical and cognitive health status. Future studies should evaluate the benefits of interventions with rehabilitation exercises following COVID-19. In light of the functional capacity and pulmonary function decline in individuals affected by COVID-19, interventions encompassing pulmonary and functional rehabilitation exercises are recommended to improve physical fitness and pulmonary function post-COVID-19.

Work ability and return-to-work of patients with post-COVID-19: a systematic review and meta-analysis

BACKGROUND

In addition to several sequelae of post-COVID-19, individuals also experience significant limitations in work ability, resulting in negative consequences for the return-to-work (RTW) process. This systematic review and meta-analysis were conducted to assess the impact of post-COVID-19 on work ability and RTW of individuals previously infected with SARS-CoV-2.

METHODS

Studies on the work ability and RTW of patients with post-COVID-19 (more than 12 weeks after an acute SARS-CoV-2 infection) were regarded eligible for inclusion. Systematic search of literature was performed up to March 2023 using five databases (MEDLINE, EMBASE, CINAHL, CENTRAL and WHO COVID 19). Study selection followed the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) Statement. A meta-analysis estimated the overall success rate of RTW. The risk of bias of the included studies was evaluated with the Newcastle Ottawa Scale (NOS).

RESULTS

19 relevant studies, published between 2021 and 2023, were included in the systematic review, involving 21.155 patients from 14 different countries. The findings indicate that a significant proportion of individuals with post-COVID-19 experience persistent symptoms and functional impairments, with fatigue being the most prominent symptom. These persistent symptoms can have a considerable (negative) impact on individuals' physical and psychological capacity to participate in work-related activities, leading to lower work ability and increased absenteeism. The RTW for post-COVID-19 patients is complex, with approximately 60.9% of patients successfully returning to work after 12 or more weeks following SARS-CoV-2 infection. Among those who successfully returning to work, a considerable number need modifications in their work duties or hours to cope with residual impairments. Factors such as workplace accommodations, supportive policies, and occupational rehabilitation programs play a crucial role in facilitating successful RTW.

CONCLUSIONS

The systematic review underscores the substantial impact of post-COVID-19 on work-related outcomes. The implications of this research highlight the need for healthcare providers, employers, and policymakers to collaborate in creating inclusive work environments and implementing tailored rehabilitation programs to support individuals recovering from post-COVID-19. Further research should focus on long-term follow-up studies with mixed methods to gain a more comprehensive understanding of the long-term consequences of post-COVID-19 on work ability and RTW outcomes.

PROSPERO REGISTRATION NUMBER

CRD42023385436.

The contribution of SARS-CoV-2 to the burden of acute respiratory infections in winter season 2022/2023: results from the DigiHero study

OBJECTIVES

In winter of 2022/2023 SARS-CoV-2 had developed into one of many seasonal respiratory pathogens, causing an additional burden of acute respiratory infections (ARIs). Although testing was still widely used, many positive tests were not reported for the official statistics. Using data from a population-based cohort, we aimed to investigate the contribution of SARS-CoV-2 to the burden of ARI.

METHODS

Over 70,000 participants of the German population-based DigiHero study were invited to a questionnaire about the number and time point of ARI and SARS-CoV-2 test results in winter 2022/2023. We calculated the incidence of non-severe acute respiratory syndrome (SARS) ARI, the additional contribution of SARS-CoV-2, and extrapolated the age-specific estimates to obtain the total burden of SARS-CoV-2 in Germany.

RESULTS

For the winter of 2022/2023, 37,708 participants reported 54,813 ARIs, including 9358 SARS-CoV-2 infections. This translated into a cumulative incidence of 145 infections/100 persons for all ARIs, 120 infections/100 persons for non-SARS ARI, and 25 infections/100 persons for SARS ARI (+21%).

CONCLUSIONS

Our estimate for ARI related to SARS-CoV-2 is consistent with the difference in all ARI between pre-pandemic years and 2022/2023. This additional burden should be considered, particularly, with respect to the implications for the work force.

The prevalence, determinants, and consequences of post-COVID in healthcare workers: A cross-sectional survey

Data on post-coronavirus disease (COVID) in healthcare workers (HCWs) are scarce. We aimed to assess prevalence, determinants, and consequences of post-COVID in HCWs. In fall 2022, we performed a cross-sectional survey in a tertiary care hospital with a web-based questionnaire sent to HCWs. Post-COVID was defined as persistent/new symptoms 3 months after acute COVID. Propensity score weighting was performed to assess the impact of post-COVID on return-to-work. 1062 HCWs completed the questionnaire, 713 (68%) reported at least one COVID, and 109 (10%) met the definition for post-COVID, with workplace contamination reported in 51 (47%). On multivariable analysis, risk factors for post-COVID were female gender (p = 0.047), ≥50 years (p = 0.007), immunosuppression (p = 0.004), ≥2 COVID episodes (p = 0.003), and ≥5 symptoms during acute COVID (p = 0.005). Initial sick leave was prescribed for 94 HCWs (86% post-COVID), for a median duration of 7 [7-9] days, and extended for 23. On return-to-work, 91 (84%) had residual symptoms, primarily asthenia/fatigue (72%) and cognitive impairment (25%). Cognitive impairment at return-to-work was associated with post-COVID. Ten HCWs (9%) received a medical diagnosis of post-COVID, 8 consulted the occupational physician, and four required work adaptation. Post-COVID affected 10% of HCWs. Long-term consequences included repeated sick leaves and residual symptoms on return-to-work.

Post-COVID syndrome and work ability 9-12 months after a SARS-CoV-2 infection among over 9000 employees from the general population

Objectives

Evidence on the work-related societal impact of long-term health-related consequences following SARS-CoV-2 is emerging. We characterize the modified work ability index (mWAI) of employees 6 to 12 months after an acute infection compared to pre-infection.

Methods

Analyses were based on a population-based, multi-center cross-sectional study including employees aged 18-65 years with positive SARS-CoV-2 polymerase chain reaction (tested between October 2020-April 2021 in defined geographic regions in Germany). Prevalences and results of adjusted logistic regression analyses were given.

Results

In 9752 employees (mean age 45.6 years, 58% females, response 24%), n = 1217 (13.1%) participants were regarded as having low mWAI compared to pre-infection. Outpatient medical treatment, inpatient treatment, and admission to intensive care during infection were associated with mWAI <15th percentile (P15, each odds ratio [OR] >3.0). Post-COVID symptom clusters most strongly linked to mWAI

Conclusion

Our findings revealed risk factors of mWAI Collapse

Key Words

• Employment
• Long Covid
• Mental Health
• Post Covid
• SARS-CoV-2
• Work Ability

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Affiliation(s)

Stefanie Braig Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
Raphael S. Peter Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
Alexandra Nieters Institute for Immunodeficiency, Medical Centre and Faculty of Medicine, Albert-Ludwigs-University, Freiburg, Germany
Hans-Georg Kräusslich Institute of Virology, Department of Infectious Diseases, University Hospital Heidelberg, Heidelberg, Germany
Stefan O. Brockmann Department of Health Protection, Infection Control and Epidemiology, Baden-Wuerttemberg Federal State Health Office, Ministry of Social Affairs, Health and Integration Stuttgart, Stuttgart, Germany
Siri Göpel Division of Infectious Diseases, Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany
Gerhard Kindle Institute for Immunodeficiency, Medical Centre and Faculty of Medicine, Albert-Ludwigs-University, Freiburg, Germany
Uta Merle Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany
Jürgen M. Steinacker Division of Sports and Rehabilitation Medicine, Department of Medicine, Ulm University Hospital, Ulm, Germany
Winfried V. Kern Division of Infectious Diseases, Department of Medicine II, Medical Centre and Faculty of Medicine, Albert-Ludwigs-University, Freiburg im Breisgau, Germany
Dietrich Rothenbacher Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany

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Assessment of search strategies in Medline to identify studies on the impact of long COVID on workability

Objectives

Studies on the impact of long COVID on work capacity are increasing but are difficult to locate in bibliographic databases, due to the heterogeneity of the terms used to describe this new condition and its consequences. This study aims to report on the effectiveness of different search strategies to find studies on the impact of long COVID on work participation in PubMed and to create validated search strings.

Methods

We searched PubMed for articles published on Long COVID and including information about work. Relevant articles were identified and their reference lists were screened. Occupational health journals were manually scanned to identify articles that could have been missed. A total of 885 articles potentially relevant were collected and 120 were finally included in a gold standard database. Recall, Precision, and Number Needed to Read (NNR) of various keywords or combinations of keywords were assessed.

Results

Overall, 123 search-words alone or in combination were tested. The highest Recalls with a single MeSH term or textword were 23 and 90%, respectively. Two different search strings were developed, one optimizing Recall while keeping Precision acceptable (Recall 98.3%, Precision 15.9%, NNR 6.3) and one optimizing Precision while keeping Recall acceptable (Recall 90.8%, Precision 26.1%, NNR 3.8).

Conclusions

No single MeSH term allows to find all relevant studies on the impact of long COVID on work ability in PubMed. The use of various MeSH and non-MeSH terms in combination is required to recover such studies without being overwhelmed by irrelevant articles.

Sustaining work ability amongst female professional workers with long COVID

BACKGROUND

Long COVID (LC) compromises work ability (WA). Female worker WA has been more adversely impacted than WA in men. Exploration of lived experiences could elucidate the WA support required.

AIMS

To explore the working conditions and circumstances experienced as affecting sustained WA amongst female workers with LC, to help mitigate worklessness risks.

METHODS

Online semi-structured qualitative interviews were conducted with 10 female workers self-reporting or formally diagnosed with LC who had made some attempt to return to work (RTW). Interviews were analysed using template analysis to map themes informing WA enablers and obstacles onto a biopsychosocial model of rehabilitation.

RESULTS

All participants were professionals working in an employed or self-employed capacity. Key themes reflecting circumstances that afforded sustained WA included the autonomy over where, when and how to work indicated as facilitated by a professional role, rapid health care access, predominantly sedentary work, competent colleagues able to cover for transient reduced WA, a strong interface between specialist health and management support, and accessible organizational policies that steer health management according to equity rather than equality. Highly flexible, iterative, co-produced RTW planning, tolerant of fluctuating symptom expression appears vital. In return for providing such flexibility, participants felt that employers' workforce diversity and competence would be protected and that workers would need to reciprocate flexibility.

CONCLUSIONS

These qualitatively derived findings of workers' lived experiences add to existing guidance on supporting WA for people struggling with LC. Moreover, the same principles seem appropriate for tackling worklessness amongst working-age adults with complex long-term health conditions.

Determinants of Sickness Absence Duration After Mild COVID-19 in a Prospective Cohort of Canadian Healthcare Workers

OBJECTIVE

The aim of the study is to identify modifiable factors associated with sickness absence duration after a COVID-19 infection.

METHODS

Participants in a prospective cohort of 4964 Canadian healthcare workers were asked how many working days they had missed after a positive COVID-19 test. Only completed episodes with absence ≤31 working day and no hospital admission were included. Cox regression estimated the contribution of administrative guidelines, vaccinations, work factors, personal characteristics, and symptom severity.

RESULTS

A total of 1520 episodes of COVID-19 were reported by 1454 participants. Days off work reduced as the pandemic progressed and were fewer with increasing numbers of vaccines received. Time-off was longer with greater symptom severity and shorter where there was a provision for callback with clinical necessity.

CONCLUSIONS

Vaccination, an important modifiable factor, related to shorter sickness absence. Provision to recall workers at time of clinical need reduced absence duration.

Factors Contributing to Delayed Return to Work among French Healthcare Professionals Afflicted by COVID-19 at a Hospital in the Rhône-Alpes Region, 2021

COVID-19 is an emerging disease whose impact on the return to work of hospital staff is not yet known. This study was aimed at evaluating the prevalence of delayed return to work associated with medical, personal, and professional factors in hospital staff who tested positive for COVID-19 during the second epidemic wave. A descriptive, analytical observational study was conducted. The source population consisted of all staff of a French University Hospital Center who had an RT-PCR test or an antigenic test positive for SARS-CoV-2 during the period from 6 September to 30 November 2020. A delayed return to work was defined as a return to work after a period of at least 8 days of eviction, whereas before the eviction period decided by the French government was 14 days. Data collection was carried out through an anonymous online self-questionnaire. The participation rate was 43% (216 participants out of 502 eligible subjects). Moreover, 40% of the staff had a delayed return to work, and 24% of them reported a delayed return to work due to persistent asthenia. Delayed return to work was significantly associated with age, fear of returning to work, and persistent asthenia, but the number of symptoms lasting more than 7 days was the only factor that remained significantly associated after multivariate analysis. From this study, it appears that interest in identifying the number of persistent symptoms as a possible indicator of delayed work emerges. Moreover, persistent asthenia should be given special attention by practitioners to detect a possible long COVID.