Long COVID in Healthcare and Essential Workers: A Mixed-Methods Study from the REACT Cohort

Abstract Background Essential workers, particularly healthcare workers (HCWs) faced significant occupational exposure to COVID-19, making them potentially more vulnerable to long COVID and its impact on job performance. Aim to assess the impact of long COVID among HCWs with and without patient contact compared to other essential workers, using data from the Real-time Assessment of Community Transmission (REACT) study. Methods A mixed-method approach was used, analysing data from 123,463 participants in the English population-based REACT study. Participants were categorized as patient-facing HCWs, non-patient-facing HCWs and Other essential workers. Descriptive statistics and logistic regression (odds ratios [OR] and 95% confidence interval [CI 95%]) were applied. Qualitative data from 9 online semi-structured interviews with healthcare-based employees were analysed using thematic analysis. Results Long COVID prevalence was highest among patient-facing HCWs (11%, 95% CI: 10.3-11.7%), followed by non-patient-facing HCWs (9.5%, 95% CI: 8.4-10.7%) and other essential workers (7%, 95% CI: 6.8-7.2%). Female gender, older age, and comorbidities were associated with higher prevalence, with comorbidities being the strongest predictor for poor health. One-third of HCWs reported changes in work hours or duties due to ongoing symptoms, compared to one in five other essential workers. Less than 25% of patient-facing HCWs reported full recovery. Qualitative analysis identified 4 themes: difficulty accessing medical care, transitioning from HCWs to patient, job performance challenges and the significance of long COVID. They reported affected work life and forcing themselves to return to work despite ongoing symptoms. Conclusions Long COVID significantly burdens HCWs and essential workers, especially patient-facing HCWs. Findings highlight the need for tailored occupational health support, improved diagnostics, and workplace adaptations to aid recovery and retention. Key messages • Patient-facing HCWs show the highest long COVID rates, with major impacts on job duties, recovery, and access to care. • Long COVID disrupts HCWs’ work lives, highlighting the need for job adaptations and better occupational health responses.