The association between prolonged SARS-CoV-2 symptoms and work outcomes, 2024, Venkatesh et al.

[SNT Gatchaman]

The association between prolonged SARS-CoV-2 symptoms and work outcomes
Arjun K. Venkatesh; Huihui Yu; Caitlin Malicki; Michael Gottlieb; Joann G. Elmore; Mandy J. Hill; Ahamed H. Idris; Juan Carlos C. Montoy; Kelli N. O’Laughlin; Kristin L. Rising; Kari A. Stephens; Erica S. Spatz; Robert A. Weinstein; for the INSPIRE Group

While the early effects of the COVID-19 pandemic on the United States labor market are well-established, less is known about the long-term impact of SARS-CoV-2 infection and Long COVID on employment. To address this gap, we analyzed self-reported data from a prospective, national cohort study to estimate the effects of SARS-CoV-2 symptoms at three months post-infection on missed workdays and return to work. The analysis included 2,939 adults in the Innovative Support for

Patients with SARS-CoV-2 Infections Registry (INSPIRE) study who tested positive for their initial SARS-CoV-2 infection at the time of enrollment, were employed before the pandemic, and completed a baseline and three-month electronic survey. At three months post-infection, 40.8% of participants reported at least one SARS-CoV-2 symptom and 9.6% of participants reported five or more SARS-CoV-2 symptoms. When asked about missed work due to their SARS-CoV-2 infection at three months, 7.2% of participants reported missing ≥10 workdays and 13.9% of participants reported not returning to work since their infection. At three months, participants with ≥5 symptoms had a higher adjusted odds ratio of missing ≥10 workdays (2.96, 95% CI 1.81–4.83) and not returning to work (2.44, 95% CI 1.58–3.76) compared to those with no symptoms. Prolonged SARS-CoV-2 symptoms were common, affecting 4-in-10 participants at three-months post-infection, and were associated with increased odds of work loss, most pronounced among adults with ≥5 symptoms at three months.

Despite the end of the federal Public Health Emergency for COVID-19 and efforts to “return to normal”, policymakers must consider the clinical and economic implications of the COVID-19 pandemic on people’s employment status and work absenteeism, particularly as data characterizing the numerous health and well-being impacts of Long COVID continue to emerge. Improved understanding of risk factors for lost work time may guide efforts to support people in returning to work.

Link | PDF (PLOS ONE) [Open Access]

 

[Hutan]

Looks potentially important - the authors have a lot of impressive affiliations e.g. Yale School of Epidemiology.

INSPIRE is a previously described prospective study designed to assess long-term symptoms and outcomes among persons with COVID-like illness who tested positive versus negative for SARS-CoV-2 at study enrollment [13]. Participants were enrolled virtually or in person between December 7, 2020 and August 29, 2022 across eight study sites, including Rush Uni- versity (Chicago, Illinois), Yale University (New Haven, Connecticut), the University of Wash- ington (Seattle, Washington), Thomas Jefferson University (Philadelphia, Pennsylvania), the University of Texas Southwestern (Dallas, Texas), the University of Texas, Houston (Houston, Texas), the University of California, San Francisco (San Francisco, California) and the Univer- sity of California, Los Angeles (Los Angeles, California).

Inclusion criteria included age >=18 years, fluency in English or Spanish, self-reported symptoms suggestive of acute SARS-CoV-2 infection at time of testing (e.g., fever, cough), and testing for SARS-CoV-2 with an FDA- approved/authorized molecular or antigen-based assay within the preceding 42 days.

Participants completed a baseline survey and follow-up surveys every three months for up to 18 months post-enrollment, although only baseline and three-month follow-up surveys were included in this secondary analysis.

There is a risk that people who were experiencing persisting symptoms in the first weeks might have been more likely to sign up for inclusion in the study - there was that lag between testing and the baseline survey of up to 42 days.

 

[Hutan]

To establish baseline employment status, the baseline survey asked, “Were you employed before the coronavirus outbreak?”, with the following response options: Yes; No. To establish return to work status following a SARS-CoV-2 infec- tion, the three-month survey asked, “Did you return to work after your COVID-19 like symp- toms?”, with the following response options: Yes, full-time; Yes, part-time or modified work; No; Not applicable. To establish workdays missed due to SARS-CoV-2 infection, the three- month survey asked, “Since before you had COVID-19 like symptoms, how many workdays or weeks did you miss because of health reasons?”, with the following response options: I don’t work; 0–5 workdays; 6–10 workdays; 10–20 workdays; up to 4 weeks.

I note that non-return to work could be due to a range of factors, not just personal health status. The health of a family member, changed life priorities/assessment of risk and the ongoing presence of the job could all affect work return rate. Future work could look at the impact of the workforce of family care responsibilities - are people having to give up or reduce paid work hours to care for a loved one?

Consistent with prior work [14–18], we administered the Centers for Disease Control and Prevention Persons Under Investigation symptom list to assess SARS-CoV-2 symptoms within both the baseline and three-month surveys, asking, “Do you currently have any of the follow- ing ongoing symptoms? (Select all that apply)”, with the following response options: fever; feel- ing hot or feverish; chills; repeated shaking with chills; more tired than usual; muscle aches; joint pains; runny nose; sore throat; a new cough, or worsening of a chronic chough; shortness of breath; wheezing, pain or tightness in your chest; palpitations; nausea or vomiting; head- ache; hair loss; abdominal pain; diarrhea (>3 loose/looser than normal stools/24 hours); decreased smell or change in smell; decreased taste or change in taste; none of the above.

That's quite a limited list of symptoms. There's nothing there about muscle weakness, PEM, orthostatic intolerance or cognitive dysfunction, and there's nothing about severity. A person with ME/CFS might only report 2 or 3 symptoms, so I think the analysis with days lost versus number of symptoms doesn't mean much.

This analysis was restricted to COVID-positive participants who responded “yes” to being employed prior to the pandemic on the baseline survey and completed the three-month sur- vey. To categorize missed workdays, we established a cutoff of greater than or equal to ten days based on the original design of survey response options.

Restricting the analysis to people who were in paid employment at the time of the infection and using a fixed number of missed workdays would tend to under-estimate the impact of illness on people with part-time paid work and those temporarily out of the paid workforce e.g. young people; women caring for young children.

Among 8,950 individuals who completed informed consent, 6,075 were eligible for follow-up (Fig 1). A total of 4,588 participants completed the three-month survey, with survey comple- tion rates varying slightly between the COVID-positive (77%) and COVID-negative (71%) groups. Among COVID-positive three-month survey respondents only (n = 3,533), we ana- lyzed data from the 2,939 participants (83.2%) who responded “yes” to being employed prior to the pandemic on the baseline survey.

At nearly 3000 people, it's a decent sized study. However, there were significant dropout losses. It's likely that people experiencing ongoing health issues were more likely to choose to participate at both the baseline and 3 month followup.

 

[Hutan]

We observed the five most prevalent symptoms among individuals missing >=10 workdays and not returning to work were “more tired than usual”, “headache”, “muscle aches”, “joint pains” and “shortness of breath”, which also had the largest difference in symptom prevalence from those who experienced work loss and those who did not.

 

[Kitty]

Another way to do this might be to survey people who have been out of regular employment for more than six months since March 2020, for any reason other than redundancy, dismissal, end of contract, failure of a business or retirement. And whether they're still out of work or have had to reduce their hours.

It wouldn't show the proportion of the workforce affected, of course, but it could tell us something about the numbers of people who've been forced out of a previous role directly due to Covid-19, as opposed to other illnesses, disabilities, etc. It would matter less that it'd be a self selecting group if it weren't intended to reflect a proportion of the total workforce; if it's a large enough sample, raw numbers are still potentially useful.