Factors influencing medium- and long-term occupational impact following COVID-19 2023 O’Sullivan et al

Background
Significant numbers of individuals struggle to return to work following acute coronavirus disease 2019 (COVID-19). The UK Military developed an integrated medical and occupational pathway (Defence COVID-19 Recovery Service, DCRS) to ensure safe return to work for those with initially severe disease or persistent COVID-19 sequalae. Medical deployment status (MDS) is used to determine ability to perform job role without restriction (‘fully deployable’, FD) or with limitations (‘medically downgraded’, MDG).

Aims
To identify which variables differ between those who are FD and MDG 6 months after acute COVID-19. Within the downgraded cohort, a secondary aim is to understand which early factors are associated with persistent downgrading at 12 and 18 months.

Methods
Individuals undergoing DCRS had comprehensive clinical assessment. Following this, their electronic medical records were reviewed and MDS extracted at 6, 12 and 18 months. Fifty-seven predictors taken from DCRS were analysed. Associations were sought between initial and prolonged MDG.

Results
Three hundred and twenty-five participants were screened, with 222 included in the initial analysis. Those who were initially downgraded were more likely to have post-acute shortness of breath (SoB), fatigue and exercise intolerance (objective and subjective), cognitive impairment and report mental health symptoms. The presence of fatigue and SoB, cognitive impairment and mental health symptoms was associated with MDG at 12 months, and the latter two, at 18 months. There were also modest associations between cardiopulmonary function and sustained downgrading.

Conclusions
Understanding the factors that are associated with initial and sustained inability to return to work allows individualized, targeted interventions to be utilized.


Key learning points
What is already known about this subject:

• Approximately 2 million individuals in the UK have post-COVID-19 syndrome, with a significant proportion of these unable to fully return or participate in the workplace.
  
  
• An inability to work can impact on individuals, employers and society, with the longer absence from the workplace associated with a lower chance of full return.
  
  
• Understanding the key restrictions or limitations preventing full return allows targeted interventions to be created to mitigate them.
  

What this study adds:

• This study identifies the factors associated with acute and prolonged ability to return to work. These include subjective post-acute symptoms (including fatigue, shortness of breath and low mood), objective cardiopulmonary function and neurocognitive impairment.
  
  
• Initial severity and symptoms of acute COVID-19, demographics and lifestyle factors, and performance on functional testing are not associated with occupational return.
  
  
• Data from this study offer the potential for different interventions at different stages of recovery.
  

What impact this may have on practice or policy:

• Understanding the key limitations and barriers to return to work is essential in creating solutions to mitigate and overcome them.
  
  
• The data from this study demonstrate the global impact of post-COVID-19 syndrome, suggesting a multifactorial approach might be indicated, such as targeted mental health or physical rehabilitation programmes.
  
  
• Those populations at high risk, such as the key worker workforce, should have active interventions created to mitigate the impact of this, and future, pandemics, in line with the Society of Occupational Medicine guidance.
  

Open access, https://academic.oup.com/occmed/advance-article/doi/10.1093/occmed/kqad041/7143746

 

Given where this is coming from I don't think we should expect any kind of balanced response. Military medicine is primarily about treat and return to duty, or treat and discharge. The UK military does have an excellent record in duty related injury rehab, less so in more general health of personnel.

There was an interesting (and not commented on) feature in table 1. where fatigue at acute stage was notablly more frequent (62%) in the non deployable group compared to the deployable group (33%). The authors also don't do much, other than give figures in the discussion, to explain recovery rates - 51% downgraded at 12 months reduces to just 31% downgraded at 18 months. Despite the author's efforts I don't think that the recognised limitations of the study really allow much in the way of application to the general population where the preponderance of work inhibiting PASC is recorded in an age group that would be past military deployment.