Prevalence and impact of persistent symptoms following SARS-CoV-2 infection among healthcare workers: a cross-sectional survey..., 2024, Foulkes et al

[Nightsong]

Highlights
• Persistent symptoms were greater following the first SARS-CoV-2 infection.
• The most frequent persistent symptoms were fatigue, tiredness and shortness of breath.
• Proportion of persistent symptoms varied by variant of infection.
• A reduction of persistent symptoms after COVID-19 vaccination was observed.
• Persistent symptoms impacted the day-to-day and work-related activities of participants.

Abstract
Following SARS-CoV-2 infection, some patients experience a range of long-lasting symptoms, with a specific burden on their lives and ability to work. We describe the prevalence and impact of persistent symptoms pre-/post-vaccination in SIREN study participants.

A cross-sectional study of SARS-CoV-2 positive participants was carried out within SIREN, a frequently tested UK healthcare worker cohort with vaccination and demographic data available. Participants with a SARS-CoV-2 positive PCR or antiSARS-CoV-2 sample between 01 March 2020 and 31 September 2022, were asked via a questionnaire about symptoms and days absent from work following infection. Responses were excluded if infection dates were inconsistent with study records or missing key data. Symptom type/duration and whether infection occurred pre-/postvaccination and during which variant period were described. Logistic regression was used to estimate factors associated with persistent symptoms (>12 weeks), adjusting for vaccination and demographic factors. The median days absent from work was also determined.

Of 16,599 invitations, 6,677 participants responded and 5,053 were included in the analysis. The prevalence of persistent symptoms (symptoms lasting over 12 weeks) differed by infection episode; highest for first infections (32.7%; 1,557/4,767) compared to second (21.6%; 214/991) and third infections (21.6%; 16/74). Most frequently reported symptoms were fatigue, tiredness, shortness of breath and difficulty concentrating. A higher prevalence of persistent symptoms was reported during the Wild-type variant period compared to the other variant periods (52.9% Wild-type vs. 20.7% Omicron, for any symptom reported during their first infection). Overall, persistent symptoms were higher among unvaccinated participants (unvaccinated 38.1% vs vaccinated 22.0%). Multivariable analysis showed that participants were less likely to report persistent symptoms in infections occurring after vaccination compared to those with an infection before vaccination in the Alpha/Delta and Omicron periods (Alpha/Delta: adjusted Odds Ratio (aOR) 0.66, CI 95% 0.51-0.87, p= aOR 0.07, CI 95% 0.01-0.65, p=0.02).

About half of participants reported that their persistent symptoms impacted their day-today (51.8%) and work-related (42.1%) activities ‘a little’ and 24.0% and 14.4% reported that the impact was ‘A lot’. 8.9% reported they had reduced their working hours and 13.9% had changed their working pattern.

Persistent symptoms were frequent in our cohort and there was a reduction in symptom duration in those with multiple infection episodes, during later variants periods and post-vaccination. The impact of persistent symptoms resulting in reducing working hours or adjusting working patterns has important implications for workforce resilience. UK healthcare workers were highly exposed during the pandemic, demonstrating significant burden.

Journal of Infection (August 2024) | https://doi.org/10.1016/j.jinf.2024.106259 | Link | PDF

 

[Hutan]

Introduction

The clinical profile of ‘Long COVID’ is highly variable and results from multiple syndromes.

Estimates for the prevalence of persistent symptoms over 12-weeks following COVID- 19 in the UK and elsewhere are variable, complicated by the lack of standardised case definitions and reporting, and different study designs. The national UK COVID Infection Survey (CIS) reported an overall point prevalence of self-reported symptoms continuing for more than 4 weeks after confirmed or suspected SARS-CoV-2 infection of 2.9%.9 A recent international systematic review of 120 studies calculated a pooled estimate for self-reported symptoms >12 weeks to 12 months of 42.1% (95% prediction interval 6.8% to 87.9%), with the estimates from individual studies ranging from 0% to 93%.10 Another systematic review of 194 studies reported a prevalence of 45%.11 Studies in HCWs have reported similarly high prevalence of persistent symptoms.12,13

The SARS-CoV-2 Immunity and Reinfection EvaluatioN (SIREN) study is a large prospective cohort study of UK healthcare workers, with participants undergoing fortnightly PCR testing and regular serology testing continuously since June 2020.

Method

An electronic questionnaire was created in SnapSurveyTM software [Appendix A]. This was sent, along with a participant information leaflet, to eligible participants on 12 September 2022 by email or text via the secure notify.gov.uk system, with a reminder sent after three weeks. For a list of 35 symptoms, there were a set of closed, mutually exclusive questions about the presence and duration of each symptom, and whether they were worse after exertion. Respondents were then asked questions relating to severity of the initial acute phase (healthcare contacts and any hospital admission), and whether there were any health care consultations for persistent symptoms, including impact on health and work. A final set of questions related to the work setting, whether there was direct patient contact and any underlying medical conditions. Participants with multiple infections were asked to complete the same questions for each episode. Participants were also asked whether they considered themselves to have experienced ‘Long Covid’.

The prevalence of persistent symptoms after an infection episode was a binary outcome for all descriptive and statistical analyses and was defined as whether any symptom was reported as lasting over 12 weeks. Symptoms were also grouped into six symptom categories, as shown in Table 1. These were typical COVID-19 symptoms, respiratory, cardiorespiratory, neurological, abdominal, systemic/inflammatory or immunological/cutaneous symptoms.

 

[Hutan]

Results

We invited 16,599 eligible participants to complete the questionnaire and received responses from 6,677 participants (40.2%). After exclusions (see Figure 1 for exclusion criteria), 5,053 participants were included in the final analysis. 4,767
provided description of their first SARS-CoV-2 infections, 991 second infections and 74 of their third infections.

Participants had a median age 49 years (interquartile range (IQR) 41-55 years), 84.3% were female

Demographic characteristics by infection episode are broadly similar. A higher proportion of nursing staff and staff with direct patient contact had three infections compared to those with one or two infections.

Just because gender ratios are top of my mind at the moment: I do think the tendency for women to be in public facing roles with a high exposure to infections, such as nursing and teaching, may influence ME/CFS sex ratios. Contrast general ME/CFS with Q fever fatigue syndrome. Farmers and abattoir workers are the main occupations exposed to Q fever, and sex ratios in Q fever fatigue syndrome are more balanced.

The prevalence of reporting persistent symptoms (defined as reporting at least one symptom lasting over 12 weeks) differed by infection episode and was highest for first infections (32.7%, 1557/4767) compared to second (21.6%, 214/991) and third infections (21.6%, 16/74).

The three most frequently reported persistent symptoms across first, second and third infection episodes respectively were: general fatigue (17.3%, 12.8%, 10.8%), tiredness (16.9%, 10.7%, 8.2%) and shortness of breath (9.5%, 6.5%, 8.1%) (Figure 2).

I think those percentages are out of the total sample e.g. 4767 for first infections. So, persisting general fatigue occurred in 17.3% of first infections (it so it was a persisting symptom in over half of the people reporting persisting symptoms).

The prevalence of persistent symptoms after first infection was higher in females (34.4%) than males (23.5%) (Supplementary Table I), and this was also the case for subsequent infections. Prevalence was lowest in the under 25-year age group (17.5%) and highest in the 45-54 year age group (35.6%) after first infection. Prevalence was also found to be higher among participants with pre-existing medical conditions, and in particular HCW occupations, namely nurses, health care assistants and estates/porters/security staff compared to other HCW.

That's a sex ratio of 1.46 (of course this is just to the 12 weeks mark for persisting symptoms).

Overall, this [reporting of at least one symptom persisting for 12 weeks] was higher among unvaccinated participants (38.1% vs 22.0%, p=<0.01) (Figure 4; Supplementary Table III) and was significantly different for all symptom groups (p=<0.01).

In multivariable analysis (for first infection only), after controlling for gender, age and ethnicity, the model showed that participants were less likely to report symptoms lasting over 12 weeks in infections occurring after vaccination compared to those with an infection before vaccination in the Alpha/Delta and Omicron periods (Alpha/Delta: adjusted Odds Ratio (aOR) 0.66, CI 95% 0.51-0.87, p=<0.01; Omicron: aOR 0.07, CI 95% 0.01-0.65, p=0.02).

I was a bit skeptical about vaccination really being protective, although lots of studies keep reporting it. It is possible that something about the earlier variants when less people happened to be vaccinated made Long Covid more likely. Possibly people who are conscientious are both more likely to be vaccinated and to respond to Long Covid surveys regardless of whether they have Long Covid , so you get more vaccinated people reporting that they are symptom free? And of course, not many studies differentiate ME/CFS-type Long Covid from persisting symptoms caused by overt tissue damage following a severe infection - so vaccination could be protecting against the latter while not protecting against the former.