Determinants of Sickness Absence Duration After Mild COVID-19 in a Prospective Cohort of Canadian Healthcare Workers

Adisesh, Anil; Durand-Moreau, Quentin; Labrèche, France; Ruzycki, Shannon; Zadunayski, Tanis; Cherry, Nicola

doi:10.1097/jom.0000000000002945

Cited by 3 publications

(3 citation statements)

References 25 publications

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“…The data would also have been strengthened by a more complete history of mental ill-health prior to the pandemic with details of length and type of treatment including a longer time span than the 12 months used here. The belief that infection occurred at the workplace has been shown, in this cohort, to increase the length of sickness absence, 30 but without sequencing, there is little certainty that infection did indeed occur at work. 31 We have reported here only on the third component extracted from the ratings completed by the HCWs.…”

Section: Discussionmentioning

confidence: 75%

Work Characteristics, Workplace Support, and Mental Ill-Health in a Canadian Cohort of Healthcare Workers During the COVID-19 Pandemic

Cherry,

Adisesh,

Burstyn

et al. 2024

J Occup Environ Med

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Objectives To identify determinants of mental health in healthcare workers (HCW) during the COVID-19 pandemic. Methods A cohort of Canadian HCW completed four questionnaires giving details of work with patients, ratings of workplace supports, a mental health questionnaire and substance use. Principal components were extracted from 23 rating scales. Risk factors were examined by Poisson regression. Results 4854 (97.8%) of 4964 participants completed ratings and mental health questionnaires. HCWs working with patients with COVID-19 had high anxiety and depression scores. One of three extracted components, ‘poor support’, was related to work with infected patients and to anxiety, depression and substance use. Availability of online support was associated with feelings of better support and less mental ill-health. Conclusions Work with infected patients and perceived poor workplace support were related to anxiety and depression during the pandemic.

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Section: Discussionmentioning

confidence: 75%

Work Characteristics, Workplace Support, and Mental Ill-Health in a Canadian Cohort of Healthcare Workers During the COVID-19 Pandemic

Cherry,

Adisesh,

Burstyn

et al. 2024

J Occup Environ Med

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“…With very few hospitalisations, we were unable to assess the association between time since vaccination and severe disease; however, mild or moderate COVID-19 still has a substantial impact on society, with boosted individuals taking an average of 5 days sick leave to recover. [46] We lacked power in some subgroup analyses, particularly for asthma exacerbations, meaning that further study in larger populations is still needed to confirm or refute the associations reported. We did not have data on all of the eligibility criteria for the clinical risk group, potentially leading to some misclassification of vaccine eligibility, which may have attenuated some of our results.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 severity and risk of SARS-CoV-2-associated asthma exacerbation by time since booster vaccination: a longitudinal analysis of data from the COVIDENCE UK study

Vivaldi,

Talaei,

Pfeffer

et al. 2024

Preprint

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BackgroundIn several countries, COVID-19 booster vaccinations are offered annually to priority groups, but many people have not been vaccinated in over a year. We aimed to assess the association between time since booster vaccination and characteristics of breakthrough infection. We also assessed whether incident COVID-19 continued to associate with asthma exacerbations in boosted individuals, and whether risk of COVID-19-associated exacerbation was affected by time since vaccination.MethodsCOVIDENCE UK is a prospective, longitudinal, population-based study of COVID-19. We included adult participants who had received ≥1 booster vaccination. Time since vaccination was binarised at 6 months or 12 months according to vaccine eligibility subgroup. We used logistic, Cox, and linear regression to obtain adjusted estimates for the association between time since vaccination and breakthrough infection severity, symptom duration, and acute changes to health-related quality of life (measured by the EQ-5D-3L Index). We then assessed the association of incident COVID-19 with asthma exacerbations using multilevel mixed models, by time since vaccination.Results7391 boosted participants reported a breakthrough infection. Across all eligibility subgroups, greater time since vaccination associated with increased odds of infection requiring bedrest (vsmilder symptoms), with the highest odds for adults aged 65–75 years (1.83 [95% CI 1.51–2.23] when vaccinated >6 monthsvs≤6 months prior). However, we observed little evidence of association between time since vaccination and symptom duration. Vaccination >12 months prior (vs≤12 months) was associated with a small decrease in EQ-5D-3L Index among participants younger than 65 years (-0.03 points [-0.04 to -0.01]). Among 2100 participants with asthma, incident COVID-19 associated with increased risk of asthma exacerbation, both ≤12 months after vaccination (OR 5.31 [4.36–6.48]) and later (6.06 [3.23–11.38]), with a greater difference in point estimates when specifically considering severe asthma exacerbations (6.82 [4.88–9.54] for ≤12 monthsvs10.06 [3.90–25.92] for >12 months).ConclusionLonger time since booster vaccination consistently associates with more severe breakthrough infections, and may potentially increase risk of severe asthma exacerbations. These findings highlight the importance of ensuring those currently eligible receive their booster vaccinations, and the need for research on further vaccinations in people with asthma no longer eligible for boosters.

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“…Our model suggests that high levels of vaccination coverage might dilute the effect of testing on reducing absenteeism, which could be attributed to the vaccine’s efficacy in blocking infections/transmissions and resultant changes in isolation policies (after vaccination the isolation period following a positive test result could be shortened) [35]. An observational study involving a prospective cohort of 4964 HCWs in Canada showed that vaccination was strongly related to shorter absences due to COVID-19-related illness [36].…”

Section: Discussionmentioning

confidence: 99%

Assessing the impact of testing for COVID-19 using lateral flow devices in NHS acute trusts in England

Chen,

Hounsell,

Cantrell

et al. 2024

Preprint

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BackgroundTwice-weekly lateral flow device (LFD) testing was introduced for routine asymptomatic testing of healthcare workers (HCWs) in the National Health Service (NHS) in England in November 2020, with the primary aim of reducing nosocomial infections among staff and patients and a secondary aim of reducing absenteeism among HCWs. Here, we describe the burdens of HCW absenteeism and nosocomial infections in NHS acute trusts and the reported testing intensity of LFDs and associated costs from October 2020 to March 2022 and assess the impact of LFD testing on reducing these burdens.Methods and FindingsWe collected 16 million LFD testing results (total cost GBP 1.64 billion) reported in NHS acute trusts through England’s Pillar 1 and 2 testing programmes from 1 October 2020 to 30 March 2022. We estimated the prevalence of nosocomial COVID-19 infections in NHS acute trusts using data from the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC). Testing data were linked with nosocomial infections and full-time equivalent (FTE) days lost by trust for NHS acute trusts.We used a mixed-effects linear model to examine the association between FTE days lost and LFD test coverage. The relationship between weekly prevalence of nosocomial infections and LFD test coverage in the previous week was modelled using logistic regression weighted by the number of new COVID-19 cases reported in the ISARIC dataset for that week. We adjusted both models for community prevalence of COVID-19 infections, average income deprivation score, prevalence of variants of concern and LFD test positivity.FTE days lost among HCWs varied considerably by trust type, staff group, geographical location of trusts, and progress of the pandemic in England. Increased LFD test coverage was associated with decreases in FTE days lost due to COVID-19 from November 2020 to July 2021, with no association observed from August 2021 to March 2022. Higher community prevalence levels were associated with significant increases in FTE days lost due to COVID-19 in all periods except the pre-vaccination period (last two months of 2020). The model predicted that changes in testing levels (50–150%) would have resulted in modest changes in FTE days lost due to COVID-19 for all time periods.We identified 3,794 nosocomial infections (if patients developed COVID-19 symptoms 7 days or more after their hospital admission) among 106,377 hospitalised COVID-19 patients in 136 NHS acute trusts. The proportion of nosocomial infections among new weekly cases in hospitalised patients was negatively associated with reported LFD testing levels. The strength of the association varied over time and was estimated to be highest during the Omicron period, although no effect of testing on HCW absenteeism was found. The observed HCW testing/reporting was estimated to be associated with a 16.8% (95% confidence interval 8.2%, 18.8%) reduction in nosocomial infections compared with a hypothetical testing scenario at 25% of actual levels, translating to a cost saving per quality-adjusted life-year (QALY) gained of GBP 18,500–46,400.ConclusionsLFD testing was an impactful public health intervention for reducing HCW absenteeism and nosocomial infections in NHS acute trusts and was cost effective in preventing nosocomial infections.Author SummaryWhy was this study done?In any pandemic response, mass diagnostic testing plays a key role.We sought to evaluate the burdens of healthcare worker absenteeism and nosocomial infections in NHS acute trusts, the reported testing intensity using lateral flow devices (LFDs) and associated costs, and the impact of LFD testing on reducing these burdens.What did the researchers do and find?We collected 16 million LFD testing results and full-time equivalent (FTE) days lost due to COVID-19, obtained from healthcare workers (HCWs) in NHS acute trusts in England between 1 October 2020 and 30 March 2022.We estimated the number of nosocomial COVID-19 infections in NHS acute trusts using data from the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC).Testing data were linked with nosocomial infections and FTE days lost due to COVID-19 by trust for NHS acute trusts.We used a mixed-effects linear model to examine the association between FTE days lost due to COVID-19 and LFD test coverage and applied a logistic regression to assess the association between nosocomial infections and LFD test coverage.We found that LFD testing in the healthcare setting was an impactful public health intervention.LFD testing reduced HCW absenteeism and nosocomial infections in NHS acute trusts; it was also cost effective in preventing nosocomial infections.What do these findings mean?Our analysis of the available data indicated that testing HCWs had varying impacts (on both nosocomial infections and HCW FTE days lost due to COVID-19) throughout the pandemic, possibly influenced by external factors such as community prevalence and vaccination.In any future pandemic, HCW testing interventions should incorporate collection of and/or timely access to relevant data, including HCW absenteeism, routine test results, community prevalence, and hospitalisation and mortality data.The lessons learnt from this study could be used by relevant authorities to support the real-time assessment of any testing service and adjustment of the testing regimen; they could also be used to help develop more targeted and agile testing systems, which operationally would require the ability to turn mass testing off and on as an epidemic progressed.

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Determinants of Sickness Absence Duration After Mild COVID-19 in a Prospective Cohort of Canadian Healthcare Workers

Cited by 3 publications

References 25 publications

Work Characteristics, Workplace Support, and Mental Ill-Health in a Canadian Cohort of Healthcare Workers During the COVID-19 Pandemic

Work Characteristics, Workplace Support, and Mental Ill-Health in a Canadian Cohort of Healthcare Workers During the COVID-19 Pandemic

COVID-19 severity and risk of SARS-CoV-2-associated asthma exacerbation by time since booster vaccination: a longitudinal analysis of data from the COVIDENCE UK study

Assessing the impact of testing for COVID-19 using lateral flow devices in NHS acute trusts in England

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