Long-COVID patients have higher rates of unemployment and underemployment than their recovered peers and are likely to have persistent or new-onset symptoms, disabilities, and financial problems in the 6 months after hospitalization, according to two US studies published in JAMA Network Open.
16% less likely to work full time
Researchers at Massachusetts General Hospital and Northeastern University led a 50-state online survey of 15,308 adults infected with SARS-CoV-2 at least 2 months earlier from February 2021 to July 2022. Participants completed surveys every 4 to 8 weeks. The average age was 38.8 years, 63.2% were women, and 70.0% were White. Among all participants, 14.6% reported long-COVID symptoms, including brain fog (40.7%) or memory problems (28.4%).
A total of 9.3% of respondents said they were unemployed, including 12.3% of long-COVID patients and 8.7% of those without lingering symptoms. Overall, 53.8% worked full-time, including 45.5% of long-COVID patients and 55.2% of their asymptomatic peers. Among all participants, 70.5% reported any employment, including 63.9% of long-COVID patients and 71.1% of those without persistent symptoms.
In survey-weighted regression models that excluded retired participants, long COVID was tied to a 16% reduced odds of working full time (adjusted odds ratio [aOR], 0.84) and a 23% higher probability of unemployment (aOR, 1.23). Cognitive impairment was linked to a 25% lower likelihood of working full time (aOR, 0.75).
In a subgroup analysis, long-COVID patients were more likely to have worked full time before the pandemic than those without lingering symptoms (103 of 260 respondents [39.6%] vs 306 of 1,079 [28.4%]).
"As unemployed individuals with PCC [post-COVID condition] were more likely to have been employed before the pandemic, it is unlikely that employment status simply reflects a factor associated with risk for reporting PCC (ie, reverse causation), or confounding by some characteristic that contributes to unemployment more generally," the researchers wrote.
The survey results, the authors said, highlight the importance of creating strategies to address long COVID, especially its neurocognitive symptoms.
"Whether rehabilitation strategies drawn from neurology and psychiatry can help to ameliorate the impact of such symptoms merits investigation," they wrote. "More generally, although the true economic impact of the pandemic is difficult to estimate, these results underscore the importance of considering persistent effects of lost productivity."
Heart-lung symptoms in 7 of 10 adults
A multicenter University of Michigan-led study conducted from Aug, 24, 2020, to Mar 30, 2022, analyzed rates of new or worsened heart-lung dysfunction, financial difficulties, and functional impairments among 825 adults 6 months after release from 1 of 44 hospitals.
Participants, who had no serious pre-hospitalization disabilities or cognitive dysfunction, were interviewed during at least one follow-up visit 1, 3, and 6 months after release. Average patient age was 56 years, 54.0% were men, 30.7% were Hispanic, 17.6% were Black, and 43.6% were White.
"Symptoms, disabilities, and financial problems remained highly prevalent among hospitalization survivors at month 6," the researchers wrote.
From 1 to 6 months, rates of cardiopulmonary symptoms rose from 67.3% to 75.4%, and fatigue reports climbed from 40.7% to 50.8%. But over the same period, rates of financial difficulties declined from 66.1% to 56.4%, and functional limitations fell from 55.3% to 47.3%.
Symptoms, disabilities, and financial problems remained highly prevalent among hospitalization survivors at month 6.
Patients who didn't report problems at 1 month often reported new symptoms (60.0%), financial concerns (23.7%), disabilities (23.8%), or fatigue (41.4%) at 6 months, and 18.2% reported feeling fatigued nearly every day. Overall, at 6 months, 9.7% said their health was below 50% of what it was pre-COVID. Median quality-of-life scores remained level throughout the study.
The most common cardiopulmonary problem at 6 months was chest symptoms on exposure to odors or fumes (28.2%), followed by cough (27.2%). The proportion of participants with a new or increased need for supplemental oxygen fell from 18.9% at 1 month to 11.5% at 6 months, but the proportion with new positive airway-pressure therapy rose from 5.0% to 12.7%.
More than a third depleted savings
By month 6, 34.8% of participants said they had depleted most or all of their savings, 20.4% couldn't pay for necessities, and 16.3% had been contacted by a collection agency as a result of their COVID-19 hospitalization. Of patients not reporting financial problems at 1 month, 23.7% said they had new financial problems at 6 months, especially among non-White participants.
"Many COVID-19–related economic relief efforts have focused on maintaining and reopening businesses in industries hard hit by COVID-19; such efforts may fail to reach people who cannot work as a result of their illness and resulting symptoms or disabilities, which we found to be common," the researchers said. "Extended unemployment benefits may fill this gap, but rarely last longer than 6 months, with some states providing as few as 12 weeks of benefits."
In a National Heart, Lung and Blood Institute (NHLBI) news release, first author Andrew Admon, MD, MPH, of the University of Michigan, said that his clinic patients often ask when they will recover their usual health. "Based on these data, it seems that many people hospitalized for COVID-19 should expect symptoms to last for up to six months or even longer," he said.
NHLBI Director James Kiley, PhD, who was not an author, said the results can guide the development of programs to help adults recover from severe COVID-19 and inform physician decisions about how often to see patients in the year after hospital release. "They may also help shape future clinical research studies," he said.