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Article

Long COVID-19 Symptoms among Recovered Teachers in Israel: A Mixed-Methods Study

by
Inbar Levkovich
* and
Ela Kalimi
Faculty of Graduate Studies, Oranim Academic College, Kiryat Tiv’on 36006, Israel
*
Author to whom correspondence should be addressed.
COVID 2023, 3(4), 480-493; https://doi.org/10.3390/covid3040036
Submission received: 2 March 2023 / Revised: 14 March 2023 / Accepted: 30 March 2023 / Published: 6 April 2023
(This article belongs to the Special Issue COVID and Post-COVID: The Psychological and Social Impact of COVID-19)
Browse Figure
Review Reports Versions Notes

Abstract

:
This study sought to examine the impact of long-COVID symptoms on the occupational status of teachers after recovery. A mixed-methods study was conducted in Israel in June 2022 among teachers who had recovered within the past six months. The quantitative data were collected using a self-report online survey (n = 170) based on questionnaires, and the qualitative data were based on individual semi-structured in-depth online interviews (n = 26). Participants reported the following symptoms: fatigue (43.7%), weakness (32.2%), difficulty sleeping (27.3%), pain or discomfort (22.4%), and anxiety (20.7%). Sense of control, social support, and well-being exhibited negative correlations with long-term symptoms (p < 0.001). A multivariate regression analysis revealed that the model explained 25% of the variance in long-term symptoms and that a greater sense of control and well-being predicted lower levels of long-term symptoms. In the qualitative study, the teachers reported high levels of symptoms that impaired their functioning, including guilt, despair, and lack of work motivation. Some teachers reported that the school staff helped them cope, whereas others described the staff’s alienated attitude. The research found that fatigue, weakness, and difficulty sleeping were the primary long-term symptoms that exerted a significant impact on teachers’ functioning and well-being.

1. Introduction

Long coronavirus disease (COVID-19) is a condition characterized by a systemic inflammatory response, manifested by a range of symptoms that emerge during or after an infection consistent with COVID-19 and that persist for a period of 12 weeks to 12 months [1,2]. The current literature distinguishes between post-acute COVID-19 and chronic COVID-19, also known as long COVID, based on symptom duration [3]. Post-acute COVID-19 is characterized by symptoms that persist beyond a three-week period from the onset of initial symptoms, whereas long COVID refers to symptoms that endure for more than 12 weeks after the onset of initial symptoms. This categorization may appear subjective. Nevertheless, by distinguishing between post-acute and long COVID, researchers can better study the short- and long-term consequences of the virus and develop effective treatments. The United Kingdom Office for National Statistics reports that approximately 10% of individuals who contract severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) will experience long COVID after 12 weeks [4]. This condition is characterized by the persistence of symptoms for several weeks to months after the initial infection that cannot be attributed to any alternative diagnosis [5,6].
Several studies have documented prolonged symptoms among COVID-19 patients, with research focusing mainly on those who are hospitalized or discharged to outpatient settings [7,8]. A survey of hospitalized patients in Italy found that 32% reported persistent symptoms, and of these, 55% experienced three or more symptoms [9]. The most common symptoms were fatigue and dyspnea. A similar study conducted among patients in Paris revealed that most had lingering symptoms, including fatigue, dyspnea, perceived cognitive difficulties, and sleep disorders [10]. In a meta-analysis that reported follow-up data from 8591 COVID-19 survivors, the most prevalent symptoms after one year were fatigue (28%), dyspnea (18%), arthromyalgia (26%), depression (23%), anxiety (22%), memory loss (19%), concentration difficulties (18%), and insomnia (12%) [11]. Other meta-analyses indicate that fatigue (58%), headache (44%), attention disorder (27%), hair loss (25%), and dyspnea (24%) are the most frequently reported effects of long COVID among the studied populations [12].
Some survivors reported a decline in their emotional well-being and quality of life, as well as difficulties performing everyday tasks such as driving, shopping, and household chores [6]. In addition, some found family responsibilities and work-related tasks to be challenging, particularly because they experienced exhaustion and difficulty concentrating [13,14]. Such individuals may benefit from multidisciplinary treatment, including long-term symptom monitoring to identify possible complications [15]. In a study of about 2100 workers in Sweden, 12% reported long-term symptoms that negatively affected their work, personal lives, and mental well-being [16]. A cross-sectional study found that only 67% of participants fully resumed their activity levels, while 22% were only able to perform light household chores and were unable to engage in physical exercise [17].
Previous research examining the obstacles to returning to work among individuals with long-term conditions is limited, especially among teachers. These studies examined non-pain-specific obstacles, such as attitudinal barriers (e.g., being judged by employers), ability to fulfill job requirements, implications for workplace relationships, and concerns over disclosure [6,18]. Temporary workplace accommodations were documented in return-to-work plans for periodic review, which may involve changes in job roles, tasks, working patterns, or help in overcoming the identified obstacles [19]. According to an international study, 45% of patients with long COVID reduced their working hours compared to their pre-illness period, and 22% were no longer working for reasons such as sick leave, dismissal, resignation, or unsuccessful job searches [6]. Almost 25% of the participants in six studies had not returned to work after 35 months [20]. In a longitudinal cohort study in Belgium, 60% of respondents who had been employed prior to COVID-19 reported being unable to work. Among these individuals, over one-third (38%) had not yet returned to work or had returned on a reduced basis (26%) at the time of the survey. The study also found that after three months, 27% and 3% of people reported moderate or severe financial loss, respectively, compared to 19% and 2% of symptom-free individuals [8].
Teachers play a critical role in the education system, where they are exposed to significant job-related stress. Studies showed that pre-existing stressors have adverse effects on teachers’ emotional well-being [21]. Moreover, with the outbreak of the COVID-19 pandemic, teachers were exposed to new challenges that posed an increased risk of emotional distress. Research conducted globally on school closures and reopenings revealed the impact of the pandemic on teachers’ emotional state [22,23]. The findings of these studies point to a marked increase in anxiety, stress, and distress levels, demonstrating the urgency of addressing the mental health needs of teachers during these unprecedented times.
The COVID-19 pandemic has brought about significant changes in various aspects of education, particularly with the shift to online teaching and learning due to school closures [24]. A systematic review that examined the impact of health crises on various school populations found that health crises affect mental health, teaching and learning, quality of life, and physical health among school populations [25]. Hence, the psychological well-being of teachers must be considered, especially given the uncertainty surrounding school closures and the transition to reopening [26]. The US Center for Disease Control (CDC) [27] outlined five main mitigation strategies for school reopening: consistent and correct use of masks, adherence to social distancing measures, hand hygiene and respiratory etiquette, cleaning and disinfection, and contact tracing in collaboration with local health departments.
The vast changes brought on by the COVID-19 pandemic affected the education system in Israel as well [24,28]. Many teachers were diagnosed with COVID-19, and the symptoms of the disease had an impact on their occupational status and personal well-being, thereby affecting their students. Several studies examined the experiences of workers recovering from COVID-19 and the implications on returning to or remaining at work. Yet no studies have examined these consequences specifically in the case of teachers. The research literature describes the significant emotional and health consequences of the COVID-19 pandemic for teachers across the globe, mainly those related to the ongoing stress caused by the constant opening and closing of schools [24]. Teachers’ well-being is a crucial factor that affects the psychosocial climate of the school environment. Additionally, long-term symptoms may severely affect teachers’ mental health and subsequently hinder their ability to facilitate the academic success of their students [28].
The present study aimed to explore well-being, sense of control, social support associated with well-being, and long-term symptoms among teachers recovering from COVID-19. The quantitative study tested the following hypotheses:
Hypothesis 1 (H1).
Levels of well-being, sense of control and social support among teachers will be negatively associated with long-term symptoms.
Hypothesis 1 (H2).
Well-being, sense of control and social support will predict long-term symptoms among teachers.

2. Materials and Methods

2.1. Study Design

The current study employed a mixed-methods design that combined a qualitative interview study with a quantitative survey [29] to connect and embed the data and gain additional insights [30]. Prior to the study, approval was obtained from the Ethics Committee of Oranim College (Authorization No. 115/2022). The study recruited participants in June 2022. Only teachers employed by the Ministry of Education (MoE) who worked during the COVID-19 crisis in Israel (2020–2022 school years) and had recovered from COVID-19 during the past six months were eligible for inclusion in the study. Teachers who taught less than one-third of a full-time job, substitute teachers, and teachers doing internships were excluded from the study (Figure 1). Participants were recruited via a link to the electronic survey distributed via FacebookTM. Prior to completing the survey, participants were asked to read and sign an informed consent form. For the qualitative study, potential participants were recruited through social media advertisements and invited to participate in a personal Zoom interview for research purposes. Interested individuals were instructed to email the researcher, who provided further information about the study and arranged a Zoom interview for those who agreed to participate. Prior to the interview, participants were informed about the study and read a consent form aloud, after which they provided their informed consent.

2.2. Sample

A total of 170 teachers from schools across the country who had contracted COVID-19 participated in the quantitative study. Most of the participants were women (85.3%) ranging in age from 23 to 69 years, with an average age of 40.16 years and average teaching seniority of 12.51 years (Table 1).
A total of 26 teachers participated in the qualitative study; their average age was 45 years. Most participants were women without underlying health conditions, and most had been vaccinated against COVID-19 (Table 2).

2.3. Measures

2.3.1. Dependent Variables

Well-being was assessed by the WHO-5 Well-Being Index developed by Topp [31], which measures an individual’s level of well-being. The questionnaire consists of five statements rated on a 6-point Likert scale, ranging from 0 (“once”) to 5 (“all the time”). (Sample item: “Rate how you felt during the last two weeks: I felt calm and relaxed.”) A higher score on the questionnaire indicates a higher level of well-being. The internal reliability of the questionnaire in the current study as measured by Cronbach’s alpha was α = 0.90.
Sense of control was assessed by the Sense of Mastery questionnaire [32], which measures people’s sense of control over their life. The questionnaire consists of seven sentences, each rated on a 7-point Likert scale ranging from 1 (“strongly disagree”) to 7 (“strongly agree”). (Sample item: “I have little control over the things that happen to me”). A higher score on the questionnaire indicates a greater sense of control. The internal reliability of the questionnaire in the current study as measured by Cronbach’s alpha was α = 0.85.
Social support was assessed by the Multidimensional Scale of Perceived Social Support (MSPSS) [33]. This measure consists of 12 items that assess the perceived adequacy of social support from 3 sources: family members, friends, and other significant individuals. Participants were asked to rate each item on a 7-point Likert scale, ranging from 1 (indicating strong disagreement) to 7 (indicating strong agreement). (Sample item: “My family really tries to help me”). A higher score on the questionnaire indicates a higher degree of perceived social support. The internal reliability of the questionnaire in the current study as measured by Cronbach’s alpha was α = 0.96.
The personal details questionnaire included the following variables: age, sex, religion, marital status, number of children, subjective health status, and vaccination status against COVID-19.

2.3.2. Independent Variable

Long-term symptoms were assessed by the Long COVID questionnaire [34], which measures the degree to which participants experience long-term symptoms. The questionnaire contains 16 items rated according to duration and severity of appearance that participants rate on an 11-point Likert scale, ranging from 0 (“absence of symptoms”) to 10 (“very severe symptoms”). Sample items include “shortness of breath” and “persistent cough.” The overall score is calculated as the average of the responses. A higher score on the questionnaire indicates a higher degree of long-term symptoms. The internal reliability of the questionnaire in the current study as measured by Cronbach’s alpha was α = 0.90.

2.3.3. Qualitative Study

In this study, qualitative data were gathered using semi-structured interviews, which provide an opportunity to gain insights and understand the participants’ experiences. Based on the literature review, a guide for the interviews was developed that contained essential areas for exploration while also allowing for flexibility in the conversation between interviewer and interviewee. All interviews were conducted by the second author. The average duration of each interview was 60 min. All interviews were audio-recorded and transcribed.
This approach facilitates a significant degree of personal expression [30]. Sample questions from the interview guide include: What were the main symptoms you experienced after recovery? How did these find expression in your everyday life? What were the main difficulties you faced when you returned to school after recovering from COVID-19?

2.4. Statistical Analyses

Quantitative study: The data were analyzed using Statistical Package for Social Sciences (SPSS27) software [35]. The analysis included calculating Cronbach’s alpha to measure the internal reliability of the research tools, as well as calculating averages, standard deviations, and distributions of demographic and research variables. A Pearson test was conducted to test the relationships between the research variables. Additionally, a linear regression test was conducted to test the prediction variable.
Qualitative study: The interviews were recorded and transcribed. After that, they underwent thematic analysis using the methodology of Braun and Clark [36], which involves six stages: (i) becoming familiar with the data; (ii) generating codes; (iii) identifying themes; (iv) reviewing themes; (v) defining and naming themes; and (vi) producing a report. During the initial stage of open coding, the data were divided into smaller segments, and a descriptor or ‘code’ was attached to each segment. This was followed by axial coding, in which the codes were grouped into similar categories. These categories were then examined for emerging patterns, variability, consistency, and commonalities across participants until saturation was achieved.

3. Results

3.1. Quantitative Study

The symptoms most commonly reported by teachers were fatigue (43.7%), weakness (32.2%), difficulty sleeping (27.3%), pain or discomfort (22.4%), anxiety (20.7%), dizziness (20.3%), palpitations (18%), depression (17%), difficulty performing daily activities (16.5%), and cognitive difficulties (16.2%) (Table 3).
In support of Hypothesis 1, a significant negative correlation was found between long-term symptoms and sense of control (r = −0.43, p < 0.001). Long-term symptoms also exhibited a negative correlation with the social support variable (r = −0.29, p < 0.001) and with the well-being variable (r = −0.40, p < 0.001). This finding suggests that an increase in long-term symptoms is linked to reduced levels of control, social support, and well-being (Table 4). A positive correlation emerged (r = 0.43, p < 0.001), indicating that increased social support is linked to a greater sense of control. Additionally, well-being exhibited a significant positive correlation with sense of control (r = 0.40, p < 0.001) and with social support (r = 0.31, p < 0.001).
A positive correlation was found between long-term symptoms and the influence of chronic illness (r= 0.32, p < 0.001) while no correlation was found between long-term symptoms and vaccinations (n.s).
Next, a multivariate regression analysis was conducted to examine what the independent variables (well-being, sense of control, and social support) predicted with respect to long-term symptoms (to test Hypothesis 2). The results are shown in Table 5.
The research model was found to be significant [F(3,166) = 18.96, p < 0.001], explaining 25% of the variance in long-term symptoms. Further analysis of the data revealed that the significance of the model resulted from two variables: sense of control (t = −3.65, p < 0.001) and well-being (t = −3.58, p < 0.001), such that a greater sense of control and well-being predicted lower levels of long-term symptoms. No significance impact was found for social support.
To summarize the quantitative findings, sense of control and social support showed significant negative associations with the outcome variable of long-term symptoms. In the prediction model, an increase in sense of control and well-being predicted a decrease in long COVID symptoms.

3.2. Qualitative Study

Three major themes emerged from the qualitative study:
(1)
“I Am Neither Here nor There”
The participating teachers described many symptoms that impaired their functioning. Most described severe fatigue that disrupted their ability to function. They stressed the helplessness and uncertainty they felt regarding how long the symptoms would continue.
I mainly remember the intense feeling of weakness accompanied by dizziness and fatigue. All I wanted to do was sit down; even the smallest action sapped my energy. I didn’t even have the strength to carry the groceries up the stairs. Standing in front of the class for an entire lesson was hard for me; I was completely worn out.
The teachers also described problems concentrating and headaches that affected their ability to function at school. Some described feeling like they were “in a fog” and being unable to remember what they had intended to do or say. They felt frustrated and helpless in this situation.
I had problems concentrating that I had not experienced previously. I felt myself forgetting words in mid-sentence and not remembering what I wanted to say. You feel like you are not yourself, not who you used to be.
(2)
“I Try to Do Things Differently, but I don’t Succeed”
The teachers described feelings of guilt and lack of motivation to work at school. They described a period of complex adaptation after their recovery from COVID, during which they experienced both physical and emotional difficulties. Despite their symptoms, they were required to return to work full time.
I felt like everyone had been on standby waiting for me to return, and when I returned they all jumped on me. But my body had not yet returned to normal, and it was impossible for me to go immediately from nothing to one hundred percent. Doing all the work of a teacher—functioning in class, calling parents in the evening, checking homework—without any start-up or adjustment time was impossible.
The teachers reported feeling guilty about their time away from their students and frustrated that they still felt tired and unmotivated when they returned to work.
I was absent for two weeks. And I’m a teacher who was almost never absent. For two weeks the children did not have a homeroom teacher. I simply disappeared. The fact that they had missed out was really difficult for me. Now I need to invest major efforts in “rehabilitating” them from the behavioral, emotional, and academic perspective. Moreover, I find it embarrassing that I have so little energy to invest. I am not the enthusiastic teacher I once was.
The teachers also described their efforts to cope with these difficulties to return to their normal work routine. They felt a need to please the principal, the parents, and the students and to maintain the image they had built for themselves. New teachers were particularly concerned about how they functioned upon returning to work because they were worried that their status at school was not sufficiently secure. For the most part, their efforts did not succeed. They continued to experience many symptoms, primarily intense fatigue, and felt they were not at their best.
In educational work there is no substitute for the classroom teacher. Children are not paperwork that piles up on a desk in an office. The days go by and the children demand a response. It’s impossible to put them (and their parents) on hold. I made colossal efforts to ensure that everyone was satisfied and no one sensed what I was going through. For quite a long period I dealt with intense fatigue and a heavy work load.
(3)
“Sometimes a Hug Can Help and Sometimes You Feel You’re Alone in the Battle”
The teachers described receiving help in coping from the school staff. They reported that they needed help when they returned to school after recovering from COVID-19, particularly given their remaining symptoms. Some noted that they received assistance from their colleagues that included both emotional support and help with teaching hours and study materials. In particular, these teachers felt that the educational staff enveloped and contained them without being judgmental. They described this help as healing and empowering, stating that their colleagues served as a shoulder they could lean on while coping with their post-COVID-19 symptoms. This support from their colleagues helped them feel more determined and needed and contributed to their sense of closeness and significance.
The amazing staff of the school was what helped me. We have a really unified staff, like a family. Everyone pitched in to help and to replace me when I was absent, and upon my return they showed me a great deal of consideration. I felt they’re aware of me and my difficulties, see when I’m tired and in pain. Everyone pitched in to help. This really warms my heart.
In contrast, some teachers were critical of the administration’s distant and demanding approach. They felt that the school administration was demanding a great deal of them while disregarding the difficulties that remained after their recovery and providing very little reinforcement for their significant efforts. As a result, the teachers were very frustrated with the administration, who they saw as indifferent to their situation; they even lost face in the administration because of their lack of leadership and support. They felt that the administration was making things more difficult for them rather than supporting them.
It’s like a bottomless pit. It doesn’t matter how difficult things are for you, how fatigued you feel, that you are unable to concentrate and can barely hold your head up—they suck more and more out of you. The demands are endless, and no matter what you do you will not get any support.
Other teachers reported that their work colleagues were also not sensitive to their needs. They felt alienated and detached from the teaching staff as well and were very disappointed when they were not offered any help.
Everyone was carrying a different burden and experiencing difficulties, whether with their children or their spouses. “Dog eat dog” was the norm, and that saddened me in particular. I always try to help, but when I was in need of help and no one came to my assistance I discovered who my colleagues really are.

4. Discussion

The objective of this mixed-methods study was to investigate the impact of the long-term symptoms of COVID-19 on the occupational outcomes of teachers who recovered from COVID-19. Our results revealed that social support and sense of control exhibited a significant negative association with long COVID symptoms.
The teachers participating in the current study reported that their most common symptoms were fatigue, weakness, difficulty sleeping, pain or discomfort, anxiety, dizziness, palpitations, and depression This finding is in line with other studies describing the many challenges faced by individuals after recovery from COVID-19 [7,8,9,10,11,12]. In two meta-analyses examining COVID-19 survivors, the most prevalent symptoms were fatigue/weakness, dyspnea, arthromyalgia, depression and anxiety, insomnia, and headaches [10,11]. These findings suggest that a significant number of COVID-19 survivors experience persistent long-term symptoms that can affect their mental and physical health as well as their quality of life and work [18]. A study of healthcare workers upon return to work three months after recovery from COVID-19 found that the perceived physical and mental health status of female workers was worse than that of male workers [37]. Note that most of the teachers participating in the current study were women, middle-aged, and had few or no other chronic conditions before the infection, further emphasizing the significant damage to their occupational status, as highlighted in the qualitative research.
The results of our qualitative research added an observation regarding the sense of challenge these teachers felt upon returning to work. The results also point to the complexity of their situation as a result of their need to function at school as well as their desire to satisfy those around them. Studies show that, despite being able to return to work after their recovery, a significant number of employees (83%) reported moderate to poor health [38]. Additionally, almost half of returning employees reported functional limitations that could negatively impact their ability to perform work-related tasks effectively [6]. In one study, two-thirds of the participants described a “loss of energy”, fatigue, or other complaints that persisted throughout the workday [39]. These limitations can lead to a loss in work productivity, potentially causing further financial and economic hardship. In addition to functional limitations and loss in work productivity, approximately a quarter of the participants reported impaired quality of life [6]. This finding indicates that the impact of COVID-19 extends beyond physical limitations and can have a significant effect on teachers’ mental and emotional well-being [20].
The current study found a negative association between well-being and the presence of long COVID symptoms. Several studies from different countries report lowered well-being among individuals who have recovered from COVID-19 [40,41]. Participants in a study conducted over the course of two years exhibited lower well-being, decreased exercise capacity, more mental health abnormalities, and increased healthcare utilization. Moreover, they reported more pain or discomfort and more anxiety or depression than those without long COVID symptoms [42]. A study conducted in China found lower well-being among COVID-19 survivors due to stigmatization, negative social judgments, anxiety, and fear of social interactions [43]. This outcome is supported by another study that found lowered perceptions of well-being among COVID-19 survivors up to six months after recovery [44]. Physical symptoms, such as fatigue, cognitive deficits, pain, insomnia, anxiety, and depression, generally contribute to the decline in the quality of life of individuals with COVID-19 [40,41,44]. The findings of the current study suggest that several factors exert a significant impact on the well-being of COVID-19 survivors with long COVID symptoms.
Both the quantitative and the qualitative results indicate the importance of social support in dealing with long-term symptoms. This result is consistent with previous research that established a link between social support and optimal recovery from COVID-19 [45]. That study highlighted the significance of support from friends, family members, and colleagues during the recovery process, showing that this support can alleviate long-term symptoms [46]. Prior research has indicated that social support functions as a protective element, whereas a dearth of support networks, including familial and friend connections, has been linked to adverse symptoms and unfavorable well-being outcomes [46,47]. In a qualitative investigation, recovered employees reported that they expected care and consideration from their employers and hoped for an environment in which they were acknowledged and listened to [47]. Instead, they felt they were being overlooked at work [48]. This findings of this study suggest that support from employers and colleagues in the workplace may aid female employees in better managing work-related role conflicts and facilitate more efficient management of familial and professional responsibilities [48]. Another study found that quality of life among COVID-19 survivors is related to social support, along with demographic factors such as sex, age, profession, and level of education, with social support being the most significant predictor of improved quality of life [49]. This finding emphasizes the crucial role of families and communities in the recovery process.
Research also revealed a positive relationship between social support and long-term symptoms of the disease. Specifically, recovering individuals who reported high social support experienced higher levels of mental well-being and fewer physical symptoms, whereas those without social support experienced the symptoms of COVID-19 more intensely [49]. These findings underscore the importance of social support in managing long-term symptoms of the disease and suggest that healthcare providers should consider social support as part of their treatment plan for COVID-19 patients. Overall, the results of multiple studies highlight the critical role of social support in improving recovery and quality of life among COVID-19 patients.
The findings of the present study suggest that sense of control can predict a lower level of long-term symptoms. These results support earlier studies conducted during the pandemic and other crisis situations [50,51], showing that a higher sense of internal control can exert a positive impact on mental well-being during such times and has the potential to reduce symptoms of depression and anxiety that can otherwise exert a negative impact on physical health [52]. Furthermore, a study conducted in Israel found that teachers who reported a higher sense of control also reported better mental and physical health [21]. Similarly, a study conducted among teachers in Italy found that a higher sense of control was associated with lower levels of depression and anxiety [53]. These findings are further reinforced by additional studies suggesting that a high sense of control can improve teachers’ satisfaction with their work, increase their work involvement, and have positive effects on their physical health [54,55,56]. Overall, results from multiple studies indicate that sense of control can have a beneficial impact on mental and physical well-being, particularly during times of crisis.
Examination of the findings of our research model suggests that a high sense of control and well-being predicts low levels of long-term symptoms among teachers. This is consistent with the resource conservation model [57], which assumes that people strive to preserve and protect their resources and are threatened by the potential loss of these resources [57]. According to the resource conservation theory, stress is caused mainly by threatened or actual loss of resources. Sense of control as an internal resource has been found to serve as a protective factor in emergencies and traumatic events [51]. Studies conducted among teachers during the COVID-19 pandemic further strengthen this research model. These studies suggest that when teachers have high levels of resources such as control, they experience an increase in mental well-being and a decrease in long-term symptoms and diseases [52,54,55,56]. The COVID-19 pandemic represents a unique case of prolonged stress, which can have both physiological and psychological effects on teachers. This type of stress may trigger the development of new mental health symptoms or exacerbate existing difficulties [45].

5. Practical Implications

The presence of long COVID symptoms among teachers who have recovered from COVID-19 has a range of concrete implications that must be addressed to ensure the well-being of teachers and the students they serve. First, educational institutions and schools should establish specialized support programs to help these teachers manage their symptoms. These programs should provide ongoing support, including workshops led by educational psychologists and coping strategies aimed at improving teachers’ mental and emotional well-being.
Second, it is essential to raise awareness among school principals, administrators, and professional teams regarding the symptoms of long COVID and their potential impact on recovered teachers’ occupational functioning. Given the challenges associated with returning to work, administrators and professional teams should demonstrate sensitivity to these symptoms and recognize the difficulties teachers may face. This will enable them to provide the necessary support to affected teachers, including making necessary accommodation to ensure that these teachers can perform their duties effectively.
Third, the well-being of recovered teachers should be assessed and monitored on a regular basis to ensure that their symptoms are being addressed effectively. Schools and educational institutions should implement assessment research to monitor the well-being of recovered teachers over time and adjust support programs accordingly. Finally, providing recovered teachers with the necessary resources, accommodations, and support to manage long COVID symptoms can ultimately benefit their students by ensuring that students receive high-quality education from teachers who are functioning at their best.

6. Limitations

This study has several limitations. First, the study is based on a convenience sample, which may affect its validity and its generalizability to the wider population of teachers in Israel. In addition, our study is limited by the small sample size. We recommend expanding it to include a larger number of participants. Second, the data were collected at a specific point in time during the COVID-19 pandemic, without prior knowledge of the participants’ pre-existing health conditions due to the dynamic nature of this period; longitudinal data would be useful for assessing the participants’ long-term health. A third limitation is related to sex; the majority of participants were women, reflecting the sex distribution in the education system. Another limitation is the lack of a comparison group. Finally, in this study, medical variables that may be related to long-term symptoms were not examined. We recommend examining in follow-up studies whether the participants were hospitalized due to the coronavirus, whether they received drug treatment, and if so, what type of treatment they received.

7. Conclusions

The findings of this mixed-methods study clearly demonstrate that, six months after being infected with COVID-19, teachers are still affected by symptoms such as fatigue, weakness, difficulty sleeping, pain or discomfort, anxiety, and dizziness. Long-term symptoms among teachers recovering from COVID-19 exhibited statistically significant negative associations with well-being, sense of control, and social support. The qualitative study highlighted the difficulties these teachers faced at school when they experienced symptoms. They were forced to adapt to a new situation; some received support from their peers, whereas others were disappointed by the demands placed on them by the administration and by the reactions of their colleagues on the educational staff. These symptoms seriously impaired their work. This study underscores the intricacy of addressing the symptoms experienced by teachers and highlights the importance of providing support and of enhancing available resources to enable teachers to manage their well-being effectively. The study’s findings emphasize the importance of comprehending the long-term symptoms experienced by teachers and how these symptoms affect their work. Addressing the challenges that teachers face due to these symptoms is crucial to ensuring their overall well-being. The results of this study could inform the development of interventions aimed at mitigating the impact of symptoms on teachers’ performance and work satisfaction. This, in turn, can promote a better working environment for teachers, which can lead to improved academic outcomes for students.

Author Contributions

Conceptualization, I.L. and E.K.; Methodology, I.L.; Formal Analysis, I.L.; Resources, E.K.; Data Curation, E.K.; Writing—Original Draft Preparation, I.L.; Writing—Review and Editing, I.L. All authors have read and agreed to the published version of the manuscript.

Funding

This research was supported by Oranim College of Education.

Institutional Review Board Statement

The study received ethical approval from Ethics Committee of Oranim College (approval number. 115/2022).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

None.

Conflicts of Interest

The authors declare no conflict of interest.

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Covid 03 00036 g001 550
Figure 1. Flowchart of inclusion of participants in the study.
Figure 1. Flowchart of inclusion of participants in the study.
Covid 03 00036 g001
Table
Table 1. Participants in the quantitative study (N = 170).
Table 1. Participants in the quantitative study (N = 170).
N%
SexMale2514.7
Female14585.3
Marital statusSingle 16 9.4
Married13277.6
Divorced1710
Widowed 1 0.6
Separated42.4
Health conditionVery Good90 53
Good58 34.1
Average1710.0
Not so good52.9
School typeElementary5733.5
Middle school5230.5
High school6136
Chronic diseasesNo14786.5
Yes 23 13.5
VaccinatedNo10 5.9
1 shot 16 9.4
2 shots 32 18.8
3 shots106 62.4
4 shots 6 3.5
MeanSD
Age 40.161.02
Number of children 2.583.00
Teaching seniority 12.518.77
Table
Table 2. Participants in the qualitative study (N = 26).
Table 2. Participants in the qualitative study (N = 26).
N%
SexMale27.6
Female2492.4
Health conditionVery Good13 50
Good12 46.1
Not so good13.9
School typeElementary726.9
Middle school1142.3
High school1030.8
Chronic diseasesNo2284.6
Yes 4 15.4
VaccinatedNo2 7.6
Yes 24 92.4
MeanSD
Age 45.57 8.88
Teaching Seniority 17.69.34
SD = Standard Deviation.
Table
Table 3. Frequency of long-term symptoms (N = 170).
Table 3. Frequency of long-term symptoms (N = 170).
%
Fatigue43.7
Weakness32.2
Sleep difficulties27.3
Pain or discomfort22.4
Anxiety20.7
Dizziness20.3
Heart palpitations18.0
Depression17.0
Difficulty performing daily activities16.5
Cognitive difficulties16.2
Long-term cough15.4
Need for personal care15.0
Difficulty with social interaction12.0
Communication difficulties9.1
Post-traumatic stress disorder9.0
Difficulty with mobility5.4
Participants had the option to mark several symptoms.
Table
Table 4. Correlations between the study variables (N = 170).
Table 4. Correlations between the study variables (N = 170).
1234
1. Well-being-
2. Long Covid−0.40 ***-
3. Sense of control0.40 ***−0.43 ***-
4. Social support0.31 ***−0.29 ***0.43 ***-
*** p < 0.001.
Table
Table 5. Multivariate regression analysis for prediction of long-term symptoms (N = 170).
Table 5. Multivariate regression analysis for prediction of long-term symptoms (N = 170).
BSE BβtR2F Model
Sense of control−0.890.24−0.28−3.65 ***0.2518.96 ***
Social support−0.190.17−0.08−0.109
Well-being−0.470.13−0.26−3.58 ***
*** p < 0.001.
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Levkovich, I.; Kalimi, E. Long COVID-19 Symptoms among Recovered Teachers in Israel: A Mixed-Methods Study. COVID 2023, 3, 480-493. https://doi.org/10.3390/covid3040036

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Levkovich I, Kalimi E. Long COVID-19 Symptoms among Recovered Teachers in Israel: A Mixed-Methods Study. COVID. 2023; 3(4):480-493. https://doi.org/10.3390/covid3040036

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Levkovich, Inbar, and Ela Kalimi. 2023. "Long COVID-19 Symptoms among Recovered Teachers in Israel: A Mixed-Methods Study" COVID 3, no. 4: 480-493. https://doi.org/10.3390/covid3040036

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