key: cord-0743454-aozj4lz3
authors: Pop-Vicas, Aurora E.; Osman, Fauzia; Tsaras, Geoffrey; Seigworth, Claire; Munoz-Price, L. Silvia; Safdar, Nasia
title: Predictors of persistent symptoms after severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection among healthcare workers: Results of a multisite survey
date: 2022-04-06
journal: Infect Control Hosp Epidemiol
DOI: 10.1017/ice.2022.56
sha: 069a1608813572f1febe9a610fafb57f28edd99c
doc_id: 743454
cord_uid: aozj4lz3

nan

participation sent from occupational health departments on 2 occasions, 3 weeks apart. Each site's institutional review board exempted the study from approval because it involved deidentified participants.

Functional status in everyday life at the time of the survey was assessed in relation to symptoms presence using the post-COVID-19 functional status scale described by Klok et al. 4 Respondents reporting persistent symptoms (either continued from initial illness or newly developed after initial illness) for longer than 4 weeks after initial positive test were compared with respondents who remained asymptomatic or experienced symptoms ≤4 weeks after their initial positive test. Associations between categorical variables were analyzed using χ 2 tests, and logistic regression was used to determine independent predictors for persistent symptoms. Observations with missing data resulting from unanswered survey items were excluded from the analysis of the corresponding affected variable. A 2-sided P value of .05 was considered statistically significant. All analyses were conducted in Stata version 16 SE software (StataCorp, College Station, TX).

The survey response rate was 25% (1,012 of 4,029 HCWs). Most survey participants (53%) were from the Milwaukee healthcare systems, followed by Madison (27%) and Illinois (20%) healthcare systems, respectively. Demographics, underlying comorbidities, and severity of initial illness were similar among participants, except for a slightly higher incidence of age >50 years (P = .02) and reported obesity (P = .02) among HCWs from one institution, and a higher incidence of women among participants from another institution (P = .01). Also, 701 respondents (70%) had duties that involved direct patient contact, such as nurses, nurse practitioners, and nurse aids (38%), physicians and physician assistants (6%), medical assistants (6%), and others (ie, pharmacists, medical technologists, phlebotomists, dietary specialists, ambulatory clinic personnel, environmental specialists, 20%). Most HCW respondents were female (87%), and most were aged 25-45 years (59%). The race or ethnicity of study participants was white (84%), Hispanic/Latino (6%), Black or African American (4%), or Asian (3%). For comparison, among all 33,009 HCWs employed by the participating institutions, 79% were women and 64% performed direct patient-care duties. Persistent symptoms beyond the initial 4 weeks were reported by 679 (67%) of participants and included anosmia or ageusia (36%), excessive fatigue (34%), dyspnea (24%), difficulty concentrating in (21%), insomnia (14%), anxiety (13%), memory loss (13%), palpitations or tachycardia (12%), diffuse myalgias (11%), depression (10%), and chest pain (8%). Persistent symptoms lasted up to 6 weeks in 161 survey respondents (16%), up to 3 months in 119 HCW respondents (12%), and up to 6 months in 41 HCWs (4%). Furthermore, 353 HCWs (35%) reported ongoing symptoms at the time of the survey (range, 44 days-11 months). Only 333 HCWs (33%) reported no symptoms beyond the initial 4 weeks.

Demographic and clinical characteristics between HCWs with and without persistent symptoms beyond the initial 4 weeks are summarized in Table 1 . The survey results indicated several independent predictors of persistent symptoms: ≥7 symptoms during initial infection, an initial evaluation and treatment though an inperson or a telemedicine encounter, and female sex. The area under the receiver operating curve for this model was 0.73.

After COVID-19 diagnosis, 987 HCW respondents (98%) resumed all previous duties at work; 19 HCWs (1.89%) required work duty restrictions, and 1 HCW (0.1%) who was hospitalized in the intensive care unit was not able to return to work. Functional status descriptions and scores among HCWs with and without persistent symptoms are summarized in Table 2 . None of the HCWs without persistent symptoms reported any limitations in their everyday duties or activities. Severe limitations in were not reported by any repondent.

Approximately two-thirds of HCWs in our study reported persistent symptoms consistent with PASC. This incidence was higher than the 26% reported in a Swedish HCW cohort 3 but lower than the 73% reported in a multicenter, prospective HCW cohort from Switzerland. 5 Although functional status was generally good, 9% of HCWs with PASC reported significant limitations in performing their routine daily activities, suggesting that some HCW with PASC would benefit from workplace accommodations. Developing workplace policies that are best suited to the needs of those returning to demanding healthcare professions after initial infection is particularly important in preserving the well-being of a workforce at high risk of exhaustion and burnout 5 that continues to be stressed beyond limits during this pandemic. 6, 7 Female sex and more severe initial illness (ie, ≥7 initial symptoms and need for medical evaluation and treatment via in-person or telemedicine encounters) were predictors of PASC, confirming that the previously reported model by Sudre et al, 8 which identified ≥5 symptoms during the first week of illness as a predictor of PASC for the general population is applicable to HCWs. Age ≥50 years, number of pre-existing comorbidities, 9 asthma, 8 and obesity 10 have also been identified as risk factors for PASC in recent studies. Both asthma and obesity were associated with persistent symptoms in our univariate analysis. These findings highlight a high-risk HCW subset that should be closely monitored for PASC development, with prompt evaluation and management of persistent symptoms.

Our study was limited by possible recall bias and the subjective nature of symptom reporting associated with survey design. Given the 25% response rate, selection bias was also possible, although respondent demographics reflected those of the HCWs in the region. The study was performed before HCW COVID-19 vaccination was completed and before the δ (delta) and o (omicron) pandemic waves. These latter variants may have had different epidemiologies, risk factors, clinical manifestations, and outcomes in fully vaccinated HCWs.

In summary, the PASC burden in HCWs is substantial and underscores the urgent need for interventions and resources to mitigate the persistent effects of SARS-CoV-2 infection in this critical workforce.

Risk of COVID-19 among frontline healthcare workers and the general community: a prospective cohort study

Short-term and long-term rates of postacute sequelae of SARS-CoV-2 infection: a systematic review

Symptoms and functional impairment assessed 8 months after mild COVID-19 among healthcare workers

The post-COVID-19 functional status scale: a tool to measure functional status over time after COVID-19

Symptoms compatible with long COVID in healthcare workers with and without SARS-CoV-2 infectionresults of a prospective multicenter cohort

Implications of COVID-19 sequelae for healthcare personnel

Preventing a parallel pandemic-a national strategy to protect clinicians' well-being

Attributes and predictors of long COVID

Symptom duration and risk factors for delayed return to usual health among outpatients with COVID-19 in a multistate healthcare systems network-United States

Association of obesity with postacute sequelae of COVID-19

Financial support. This study was supported by the Department of Medicine, University of Wisconsin School of Medicine and Public Health1, Madison, Wisconsin.Conflicts of interest. All authors report no conflicts of interest relevant to this article.