Impact of SARS-CoV-2 on healthcare and essential workers: A longitudinal study of PROMIS-29 outcomes

TL;DR

This study examines how SARS-CoV-2 affected health outcomes of essential workers compared to general workers, finding that healthcare workers had better cognitive scores, while non-healthcare essential workers had worse physical recovery.

Contribution

The study identifies distinct recovery patterns in essential workers based on job type and SARS-CoV-2 status, offering insights for pandemic preparedness.

Findings

Essential healthcare workers had higher cognitive scores at all timepoints if they were COVID-negative.

Essential non-healthcare workers had worse long-term physical health after SARS-CoV-2 infection.

Most outcome differences were explained by baseline factors like demographics and comorbidities.

Abstract

The mandatory service of essential workers during the COVID-19 pandemic was associated with high job stress, increased SARS-CoV-2 exposure, and limited time for recovery following infection. Understanding outcomes for frontline workers can inform planning for future pandemics.

To compare patient-reported outcomes by employment type and SARS-CoV-2 status.

Data from the INSPIRE registry, which enrolled COVID-positive and COVID-negative adults between 12/7/2020–8/29/2022 was analyzed. Patient-reported outcomes were collected quarterly over 18 months.

Participants were recruited across eight US sites.

Employed INSPIRE participants who completed a short (3-month) and long-term (12–18 month) survey.

SARS-CoV-2 index status and employment type (essential healthcare worker [HCW], essential non-HCW, and non-essential worker [“general worker”]).

PROMIS-29 (mental and physical health summary) and PROMIS Cognitive SF-CF 8a (cognitive function) scores were assessed at baseline, short-term (3-months), and long-term (12–18 months) timepoints using GEE modeling.

Of the 1,463 participants: 53.5% were essential workers (51.4% HCWs, 48.6% non-HCWs) and 46.5% were general workers. Most associations between outcomes and employment type became non-significant after adjusting for sociodemographics, comorbidities, COVID-19 vaccination, and SARS-CoV-2 variant period. However, among COVID-negative participants, essential HCWs had higher cognitive scores at baseline (β: 3.91, 95% CI [1.32, 6.50]), short term: (β: 3.49, 95% CI: [0.80, 6.18]) and long-term: (β: 3.72, 95% CI: [0.98, 6.46]) compared to general workers. Among COVID-positive participants, essential non-HCWs had significantly worse long-term physical health summary scores (β:-1.22, 95% CI: [−2.35, −0.09]) compared to general workers.

Differences in outcomes by worker status were largely explained by baseline characteristics. However, compared to general workers, essential HCW status had higher cognitive function in the absence of SARS-CoV-2 infection at all timepoints, while essential non-HCWs were most vulnerable to poor recovery in long-term physical health following SARS-CoV-2 infection. Preparation efforts for future pandemics may consider enhanced protection and post-infection resources for frontline workers.

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