Long COVID symptom profiles, workforce participation, and working hours among adults in England: a population-based cohort study

Background Long COVID, marked by ongoing multi-systemic symptoms following COVID-19 infection, can impair ability to maintain employment. However, its relationship to workforce retention and working hours remains unclear. Methods Long COVID was defined as symptoms lasting ≥12 weeks post-infection. We analysed data from a late-2022 follow-up survey involving 45,864 participants of the Real-time Assessment of Community Transmission (REACT) Study in England (median follow-up: 23 months). Hierarchical clustering identified symptom groups. Multivariable regressions examined associations between Long COVID, being in paid work, and changes in working hours. Findings Of 45,864 participants employed at recruitment, 86% (N = 39,341) remained in paid work at follow-up and 11% (N = 4877) changed work hours. Approximately 4% (N = 1967/45,864) had unresolved Long COVID. Compared with participants with no/short (<4 weeks) symptoms, those with unresolved Long COVID had lower odds of being in paid work at follow-up (adjusted odds ratio [aOR]: 0.62, 95% confidence interval [CI]: 0.55, 0.70), and higher odds of changing work hours (aOR: 4.34, 95% CI: 3.88, 4.85). Three clusters were identified: multisystem severe, fatigue-predominant and anosmia-predominant Long COVID. Compared with the fatigue-predominant cluster, participants with multisystem severe Long COVID had lower odds of paid work (aOR: 0.63, 95% CI: 0.47, 0.84) and higher odds of changing work hours (aOR 2.76, 95% CI 2.21, 3.46). Interpretation Unresolved Long COVID was associated with worse employment outcomes. Symptom clusters highlighted the importance of considering heterogeneity in Long COVID when assessing workforce impacts and designing public health responses. Fundings National Institute for Health and Care Research, UK Research and Innovation.