Return to Work of Healthcare Workers after SARS-CoV-2 Infection: Determinants of Physical and Mental Health

Long COVID among healthcare workers: a narrative review of definitions, prevalence, symptoms, risk factors and impacts

INTRODUCTION

Long COVID (LC) occurs when people experience symptoms for weeks, months or even years after a COVID-19 infection. This review looks at research exploring the LC definitions, prevalence, symptoms, risk factors, and associated impacts in research on healthcare workers (HCWs).

DATA SOURCES

We systematically searched five electronic databases (CINAHL, EMBASE, Medline, PsycInfo and PubMed) and compiled a narrative literature review based on 56 relevant studies.

AREAS OF AGREEMENT

LC is prevalent among HCWs who become infected by COVID-19. Many of the most frequent symptoms associated with LC in the general population are also reported among HCWs. Some risk factors for LC are also similar to those in the general population, such as female sex, older age, and having a pre-existing respiratory illness.

AREAS OF CONTROVERSY

The mechanism(s) responsible for LC remains unknown. A variety of terms, timeframes and symptoms are used to define LC, creating difficulties in comparing results across studies. Much of the research is cross-sectional and fails to explore the impacts that prolonged symptoms have on HCWs' personal and professional lives.

GROWING POINTS

The need to support HCWs with LC is clear. Identifying the mechanism(s) responsible for LC is a key priority, as this will inform treatments.

AREAS FOR DEVELOPING RESEARCH

Future research should move towards a standard definition for LC. Greater attention should be paid to longitudinal and qualitative studies, which could give insights into prognosis, lived experience and work participation. Finally, studies evaluating treatments suitable for people with LC are timely.

Learning from an experience, challenges and approaches in the workplace during COVID-19 pandemic: a content analysis of international documents

BACKGROUND

This study aims to investigate international measures for pandemic control in the workplace based on guidelines from international organizations to learn from their experiences.

METHODS

We conducted a qualitative study using content analysis. The search method involved reviewing published guidelines on preventing and responding to the COVID-19 pandemic in workplaces. After the screening process, ten guidelines were included in the content analysis. During the analysis, 200 meaning codes, 49 subcategories, and eleven categories were identified. Trustworthiness criteria were utilized to ensure the accuracy and strength of the findings.

RESULTS

Eleven categories of international content during the COVID-19 pandemic were legal requirements and duties of employees and employers, structural and program changes, risk assessment, risk communication, information and training, internal and external consultation and cooperation, provision of facilities and tools for workplace hygiene, special conditions, special groups, closing and reopening workplaces, reducing contact and exposure and mental health.

CONCLUSIONS

Protecting employees during a pandemic requires a multifaceted approach and strong advocacy. The operational plan for pandemic control should be developed based on the level of risk, with support tailored to employees' conditions and needs. Cooperation among international organizations is essential to develop a standardized plan and issue comprehensive guidelines in response to health emergencies with a global perspective and local implementation, drawing from the lessons learned during the COVID-19 pandemic.

Factors influencing fatigue, mental workload and burnout among Chinese health care workers during public emergencies: an online cross-sectional study

OBJECTIVES

The purpose of this study was to investigate fatigue, mental workload, and burnout among health care workers (HCWs) and explore the possible underlying factors.

MATERIALS AND METHODS

An online cross-sectional survey design was used to collect data from HCWs in Chongqing, China. The online survey included the Fatigue Severity Scale, NASA Task Load Index, and Chinese version of the Maslach Burnout Inventory-General Survey to assess fatigue, mental workload, and burnout, respectively, and was conducted from February 1 to March 1, 2023.

RESULTS

In this study, the incidence of fatigue and burnout among HCWs was 76.40% and 89.14%, respectively, and the incidence of moderate to intolerable mental workloads was 90.26%. Work-family conflict, current symptoms, number of days of COVID-19 positivity, mental workload, burnout and reduced personal accomplishment were significantly associated with fatigue. Mental workload was affected by fatigue and reduced personal accomplishment. Furthermore, burnout was influenced by marital status and fatigue. Moreover, there was a correlation among mental workload, fatigue, and burnout.

CONCLUSIONS

Fatigue, mental workload and burnout had a high incidence and were influenced by multiple factors during COVID-19 public emergencies in China.

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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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.

Prevalence and associated factors of mental health disorders among Brazilian healthcare workers in times of the COVID-19 pandemic: A web-based cross-sectional study

The COVID-19 pandemic in Brazil affected mental health among healthcare workers. To objective of this study was to evaluate the mental health of healthcare workers in in the central-west region of the Brazil, estimating the prevalence of mental health disorders, and investigating associated factors, perceptions of safety, and self-perceptions about mental health in times of the COVID-19 pandemic. The questionnaire was divided into two parts that included general information and perceptions about the work process and identified symptoms using the Depression Anxiety Stress Scale-21 (DASS-21), and multiple linear regression analysis was conducted. A total of 1,522 healthcare workers participated in the survey. Overall prevalence of symptoms was calculated for depression (58.7%), anxiety (59.7%), and stress (61.7%). Physicians had 3.75 times greater risk of depression (1.59-8.85, 95% CI). Independent variables associated with depression symptoms were not feeling safe with the way services were organized (1.12:1.03-1.21, 95% CI) and self-perception of poor mental health (8.06: 4.03-16.10% CI). Working in management was protective, and married professionals had 12% lower risk of exhibiting symptoms of depression (0.79-0.99, 95% CI). Participants with self-perception of poor mental health had 4.63 greater risk for symptoms of anxiety (2.58-8.31, 95% CI). Protective factors were not having sought support for mental health (0.90: 0.82-0.99, 95% CI), having a graduate degree (0.71: 0.54-0.94, 95% CI), and not having been diagnosed with COVID-19 (0.90: 0.83-0.98, 95% CI). Perception of poor mental health was associated with 6.95-fold greater chance of developing stress symptoms. Protective factors from stress were having a degree in dentistry (0.81: 0.68-0.97, 95% CI), residing in Mato Grosso do Sul (0.91: 0.85-0.98, 95% CI), and not having sought mental health support services (0.88: 0.82-0.95, 95% CI). The prevalence of mental health disorders is high among healthcare workers, and is associated with professional category, organization of services provided, and self-perception of poor mental health, reinforcing the need for preventative measures.

Post-COVID Symptoms in Occupational Cohorts: Effects on Health and Work Ability

Post-acute COVID-19 syndrome is frequently observed in workers and has a substantial impact on work ability. We conducted a health promotion program to identify cases of post-COVID syndrome, analyze the distribution of symptoms and their association with work ability. Of the 1422 workers who underwent routine medical examination in 2021, 1378 agreed to participate. Among the latter, 164 had contracted SARS-CoV-2 and 115 (70% of those who were infected) had persistent symptoms. A cluster analysis showed that most of the post-COVID syndrome cases were characterized by sensory disturbances (anosmia and dysgeusia) and fatigue (weakness, fatigability, tiredness). In one-fifth of these cases, additional symptoms included dyspnea, tachycardia, headache, sleep disturbances, anxiety, and muscle aches. Workers with post-COVID were found to have poorer quality sleep, increased fatigue, anxiety, depression, and decreased work ability compared with workers whose symptoms had rapidly disappeared. It is important for the occupational physician to diagnose post-COVID syndrome in the workplace since this condition may require a temporary reduction in work tasks and supportive treatment.

The relationship between psychosocial job stressors and insomnia: The mediating role of psychological capital

AIM

This study aimed to examine the association of job-related stressors and insomnia; to determine the association of psychological capital and insomnia; and to explore whether psychological capital mediates the association between job-related stressors and insomnia among Chinese nurses.

DESIGN

A cross-sectional questionnaire survey.

METHODS

The STROBE statement was utilized to guide the study. A total of 810 nurses from one tertiary grade hospital in Shan Dong Province, China, were recruited for the present study and a total of 658 valid questionnaires were obtained (effective recovery rate: 81.2%). The study survey consisted of demographic variables, psychological capital, job stress and insomnia. Descriptive analysis, independent-samples T-test, one-way analysis of variance, stratified regression analysis, Pearson correlation analyses, ordinary least-squares regression and the bootstrap method were used to analyse data.

RESULTS

Findings of the study determined that demographic, work-related, behavioural and work setting (i.e. working hours, chronic disease, negative life events, smoking behaviour and night shift) factors were differentially associated with experiences of insomnia. The empirical study showed that psychological capital had statistically significant mediating effects between job stressors and insomnia.

PUBLIC CONTRIBUTION

This study explored the factors associated with nurses' psychological job stressors and insomnia. Some of the associated factors could be used for the prevention and mitigation of psychosocial dysfunction among nurses. This study found nurses in surgery, emergency department, ICU, working >40 h a week, with chronic illness, experiencing negative life events, shift work and high effort, high overcommitment and low reward had higher scores of insomnia respectively. The results of this study also showed that reward was correlated with the increase of psychological capital, and the increase of psychological capital was correlated with the decrease of insomnia in nurses. On the contrary, effort and overcommitment decreased psychological capital, and then increased insomnia among nurses. These findings have important implications for future research and policy interventions to improve sleep quality of nurses and enhance nurses' health and patients' safety. This study significantly suggests that improving nurses' psychological capital is a potential way to help nurses improve sleep quality when psychosocial job stressors are difficult external environment to change.

Physical Impact of SARS-CoV-2 Infection in a Population of Italian Healthcare Workers

SARS-CoV-2 infection often causes symptoms and illness that can last for months after the acute phase, i.e., so-called "Long COVID" or Post-acute COVID-19. Due to the high prevalence of SARS-CoV-2 infection among Healthcare Workers (HCWs), post-COVID-19 symptoms can be common and threaten workers' occupational health and healthcare systems' functioning. The aim of this cross-sectional, observational study was to present data related to post-COVID-19 outcomes in a population of HCWs infected by COVID-19 from October 2020 to April 2021, and to identify possible factors associated with the persistence of illness, such as gender, age, previous medical conditions, and features of acute illness. A total of 318 HCWs who had become infected by COVID-19 were examined and interviewed approximately two months after their recovery from the infection. The clinical examinations were performed by Occupational Physicians in accordance with a specific protocol at the Occupational Medicine Unit of a tertiary hospital in Italy. The mean age of the participants was 45 years old, and 66.7% of the workers were women while 33.3% were men; the sample mainly consisted of nurses (44.7%). During the medical examination, more than half of the workers mentioned that they had experienced multiple residual bouts of illness after the acute phase of infection. Men and women were similarly affected. The most reported symptom was fatigue (32.1%), followed by musculoskeletal pain (13.6%) and dyspnea (13.2%). In the multivariate analysis, dyspnea (p < 0.001) and fatigue (p < 0.001) during the acute stage of illness and the presence of any limitation in working activities, in the context of fitness for a work evaluation performed while the occupational medicine surveillance program was being conducted (p = 0.025), were independently associated with any post-COVID-19 symptoms, which were considered final outcomes. The main post-COVID-19 symptoms-dyspnea, fatigue, and musculoskeletal pain-showed significant associations with dyspnea, fatigue, and musculoskeletal pain experienced during the acute stage of infection, with the presence of limitations in working activities, and pre-existing pneumological diseases. A normal weight according to body mass index was a protective factor. The identification of vulnerable workers as those with limitations in working activities, pneumological diseases, a high BMI, and of an older age and the implementation of preventive measures are key factors for preserving Occupational Health. Fitness-to-work evaluations performed by Occupational Physicians can be considered a complex index of overall health and functionality that can identify workers who may suffer from relevant post-COVID-19 symptoms.

The impact of COVID-19 pandemic on well-being of Italian physicians: a report from the Italian Society of Internal Medicine (SIMI) national survey

Over the past few years, COVID-19 pandemic has imposed a high toll worldwide, with a high burden of morbidity and mortality. Healthcare practitioners (HCPs) have been in the frontline since the beginning of the outbreak, and the high level of stress have affected their physical and mental status, as well as their relationships. We aimed at exploring the self-reported changes in comprehensive well-being in a cohort of Italian physicians. An online-based survey was administered to the members of the Italian Society of Internal Medicine (SIMI) between March and June 2021. The survey was based on 32 multiple-choice questions exploring self-reported physical and mental well-being, as well as changes in workloads, work-related feelings and physicians' relationship with patients, colleagues and families. 228 physicians (mean age: 35.7 ± 9.8 years) participated in the survey; 120 (52.6%) were residents, 196 (86.0%) worked in COVID-19 units and 65 (28.5%) had COVID-19 during the pandemic. A significant proportion of respondents reported to have experience onset or worsening of physical and mental symptoms, with insomnia/sleep disorders (58.3%) and mood swings (47.8%) being the most common, respectively. The burden of physical and mental consequences was broadly higher among residents compared to specialists, with the former reporting more frequently an increase in the number of worked hours (p = 0.020) and being more frequently infected with COVID-19 (35.0% vs. 21.3, p = 0.032). Moreover, familiar and doctor-patient relationships were also considerably affected. Physicians have been suffering a wide spectrum of physical, mental and relational consequences during COVID-19 pandemic, with youngest doctors being more likely to present several physical and mental health symptoms. Further studies are needed to evaluate long-term consequences of COVID-19 pandemic on the well-being of HCPs, and potential preventive strategies.

The relationship between perceived organizational support and insomnia in Chinese nurses: The Serial multiple mediation analysis

Background

Nurses are in high-pressure, high-load, and high-risk environment for a long time, and their insomnia cannot be ignored. Insomnia not only has a negative impact on the physical and mental health of nurses, but also on the efficiency and quality of nursing work.

Objective

The purpose of this study was to investigate the multiple mediating effect of psychological capital, effort-reward ratio, and overcommitment in the relationship between perceived organizational support and insomnia among Chinese nurses.

Methods

A cross-sectional study has been carried out in a tertiary grade A hospital in Shandong Province, China from March 2021 to May 2021. The demographic questionnaire, Perceived Organization Support Questionnaire, Psychological Capital Questionnaire, Chinese version Effort-Reward Imbalance, Questionnaire and Athens Insomnia Scale were used for data collection. SPSS PROCESS 3.4 macro program developed by Hayes was used to test the serial multiple mediation. Descriptive analysis, independent-samples t-test, one-way analysis of variance, Pearson's correlation analyses, ordinary least-squares regression, and the bootstrap method were used for data analysis.

Results

658 valid questionnaires were collected (81.2%). Nurses' perceived organizational support was positively correlated with psychological capital (r = 0.455, p < 0.001), and was significantly negatively correlated with effort-reward ratio (r = -0.318, p < 0.001), overcommitment (r = -0.328, p < 0.001), and insomnia (r = -0.358, p < 0.001); Psychological capital was negatively correlated with effort-reward ratio (r = -0.275, p < 0.001), overcommitment (r = -0.339, p < 0.001), and insomnia (r = -0.402, p < 0.001), respectively; effort-reward ratio and overcommitment were significantly positively correlated with insomnia (r = 0.379, p < 0.001; r = 0.466, p < 0.001), respectively. In the model of perceived organizational support-psychological capital-effort-reward ratio-insomnia, the overall mediating effect was -0.080 (95%CI: -0.109 ~ -0.058), and the mediating effect of psychological capital was -0.050, accounting for 34.30% of the total effect; the mediating effect of effort-reward ratio was -0.024, accounting for 16.49% of the total effect; the chain mediating effect of psychological capital and effort-reward ratio was -0.007, accounting for 4.49% of the total effect. In the model of perceived organizational support-psychological capital-overcommitment-insomnia, the overall mediating effect was -0.085 (95%CI: -0.109 ~ -0.064), and the mediating effect of psychological capital was -0.042, accounting for 28.64% of the total effect; the mediating effect of overcommitment was -0.029, accounting for 19.81% of the total effect; the chain mediating effect of psychological capital and overcommitment was -0.015, accounting for 10.14% of the total effect.

Conclusion

Perceived organizational support had direct negative influence on insomnia. Psychological capital and effort-reward ratio/overcommitment acted as chained mediating factor could partially relieve insomnia symptoms related to perceived organizational support. It is suggested to improve the level of organizational support and psychological capital of nurses, and reduce the effort-reward imbalance and overcommitment of nurses, so as to effectively decline and deal with nurses' insomnia.

Post-Acute COVID-19 Sequelae in a Working Population at One Year Follow-Up: A Wide Range of Impacts from an Italian Sample

Long COVID-19 is a term used to describe the symptomatic sequelae that develop after suffering from COVID-19. Very few studies have investigated the impact of COVID-19 sequelae on employment status. The aim of this research was to characterise sequelae of COVID-19 in a population of workers who tested positive for COVID-19, with a follow-up within one year of the acute illness, and to analyse the possible association between this and changes in the workers' occupational status. In this retrospective cohort study, a questionnaire was administered to 155 workers; descriptive, univariate (chi-square tests), and multivariate (logistic regression model) analyses were carried out. The mean age was 46.48 years (SD ± 7.302); 76 participants were males (49.7%), and 33 participants reported being current smokers (21.3%). Overall, 19.0% of patients reported not feeling fully recovered at follow-up, and 13.7% reported a change in their job status after COVID-19. A change in occupational status was associated with being a smoker (OR 4.106, CI [1.406-11.990], p = 0.010); hospital stay was associated with age > 46 years in a statistically significant way (p = 0.025) and with not feeling fully recovered at follow-up (p = 0.003). A persistent worsening in anxiety was more common in women (p = 0.028). This study identifies smoking as a risk factor for workers not able to resume their job; furthermore, occupational physicians should monitor mental health more closely after COVID-19, particularly in female workers.