US veterans—COVID-infected or not—report impaired function after pandemic

Tired man in park

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Today, JAMA Network Open published a study of 372 US veterans who reported high rates of persistent fatigue, pain, and disability after the COVID-19 pandemic—regardless of infection status—suggesting that other crisis-related factors were also in play.

Led by researchers from the Veterans Affairs (VA) Center for Clinical Management Research in Ann Arbor, Michigan, the analysis was based on data on 186 veterans from across the country who had a documented COVID-19 infection from October 2020 to April 2021 and 186 matched uninfected controls. Through telephone surveys, the team obtained data on self-reported functional ability 2 years before and 18 months after infection or study enrollment.

Over 90% of participants were men, and the average age was older than 60 years.

Infection not linked to ongoing symptoms

At 18 months, 44.9% of infected veterans reported that they were unable to do as much as they did before the pandemic, compared with 35.3% of controls (within-matched pair adjusted odds ratio [OR], 1.52).

Fatigue scores were similar in the COVID-19 and control groups (54.6 vs 51.7; higher scores indicate worse fatigue). In the COVID-19 cohort, 51.1% reported moderate, severe, or extreme pain, compared with 65.7% of controls. Within–matched pair conditional logistic regressions showed no statistically significant difference in risk of fatigue or substantial pain by group (OR, 0.50).

Other adverse effects may have been due to psychological, behavioral, social, policy, and economic mechanisms.

On average, infected veterans reported 3.4 limitations, and 37.3% reported limitations in at least four activities or instrumental activities of daily living, relative to 3.0 and 30.2% in controls, but the within-pair analysis of the mean showed no significant differences. And both groups had similar findings for mobility (average mobility score, 70.4 in COVID-19 cohort vs 66.6 in controls), severely curtailed mobility (37.0% vs 41.1%, respectively), and employment status (62.6% vs 64.7%).

Role of psychological, social, economic factors

"Veterans reported high rates of ongoing fatigue, pain, and disability after the COVID-19 pandemic, regardless of history of COVID-19," the study authors wrote. "These results highlight the importance of acknowledging and addressing the broader impacts of the COVID-19 pandemic on health beyond those directly associated with documented infection."

"Other adverse effects may have been due to psychological, behavioral, social, policy, and economic mechanisms," they added. "These data cannot rule out the possibility that COVID-19–confirmed viral infection may be associated with disability among some individuals who had COVID-19."

The researchers noted the study's small sample size, which they said was partly due to lower recruitment than expected. "Future work should include larger sample sizes to better estimate the association of COVID-19 with everyday functioning," they wrote.

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