Manifestations of Post-COVID Syndrome in Healthcare Workers in Northeast England
Abstract
:1. Introduction
2. Methods
2.1. Participants
2.2. Ethical Approval
2.3. Data and Outcome Measures
- Participant demographics: this included gender, age, ethnicity, BMI, smoking status, and job characteristics (e.g., job title, patient contact).
- Depression and anxiety: This was captured using the Hospital Anxiety and Depression Scale (HADS) [24], a 14-item questionnaire comprising two subscales, one each for depression and anxiety. Scores (on each scale separately) of 0–7 = normal; 8–10 = borderline abnormal/mild depression/anxiety; 11–21 = abnormal/moderate–severe depression/anxiety.
- Health status: The EuroQol (EQ-5D-3L) [25] was used to examine 5 elements of general health: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Participants rate each of these dimensions based on the extent to which they feel they have problems in those areas (i.e., ranging from no problem to an inability to perform an activity/a severe problem).
- Fatigue: The Fatigue Impact Scale (FIS) [26] was used to capture the impact of fatigue on everyday functioning, including cognitive function. Participants ranked themselves as having fatigue that caused them anything from ‘no problem at all’ to ‘extreme problems’, relating to a range of activities, including workload, motivation, and decision-making. Higher scores indicated greater fatigue.
- Post-COVID syndrome: The presence of PCS was identified using the following method in the later (18 month) cohort. HCWs were asked whether they had or were experiencing long-term COVID-19 symptoms > 12 weeks following COVID-19. For all participants, using the NICE criteria for defining ‘Long-COVID’ [5], symptom duration was categorised as either acute COVID-19 symptoms (ACSs) lasting up to 4 weeks post-infection; ongoing symptomatic COVID-19 (OSC) with symptoms lasting up to 12 weeks; or post-COVID-19 syndrome (PCS), when symptoms span beyond 12 weeks—also known as Long-COVID.
2.4. Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Michelen, M.; Manoharan, L.; Elkheir, N.; Cheng, V.; Dagens, A.; Hastie, C.; O’HAra, M.; Suett, J.; Dahmash, D.; Bugaeva, P.; et al. Characterising long COVID: A living systematic review. BMJ Glob. Health 2021, 6, e005427. [Google Scholar] [CrossRef] [PubMed]
- Sudre, C.H.; Murray, B.; Varsavsky, T.; Graham, M.S.; Penfold, R.S.; Bowyer, R.C.; Pujol, J.C.; Klaser, K.; Antonelli, M.; Canas, L.S.; et al. Attributes and predictors of long COVID. Nat. Med. 2021, 27, 626–631. [Google Scholar] [CrossRef] [PubMed]
- Petersen, M.S.; Kristiansen, M.F.; Hanusson, K.D.; Danielsen, M.E.; Steig, B.Á.; Gaini, S.; Strøm, M.; Weihe, P. Long COVID in the Faroe Islands: A Longitudinal Study Among Nonhospitalized Patients. Clin. Infect. Dis. 2021, 73, e4058–e4063. [Google Scholar] [CrossRef]
- Self-Reported Coronavirus (COVID-19) Infection and Associated Symptoms, England and Scotland: November 2023 to March 2024. Office for National Statistics 2024. Available online: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/articles/selfreportedcoronaviruscovid19infectionsandassociatedsymptomsenglandandscotland/november2023tomarch2024 (accessed on 15 August 2024).
- National Institute of Clinical Excellence (NICE); the Scottish Intercollegiate Guidelines Network (SIGN); the Royal College of General Practitioners (RCGP). NICE ‘Long COVID’ Guideline. 2021. Available online: https://www.guidelines.co.uk/infection/nice-long-covid-guideline/455728.article (accessed on 11 April 2023).
- Thompson, E.J.; Williams, D.M.; Walker, A.J.; Mitchell, R.E.; Niedzwiedz, C.L.; Yang, T.C.; Huggins, C.F.; Kwong, A.S.F.; Silverwood, R.J.; Di Gessa, G.; et al. Long COVID burden and risk factors in 10 UK longitudinal studies and electronic health records. Nat. Commun. 2022, 13, 3528. [Google Scholar] [CrossRef] [PubMed]
- Atchison, C.J.; Davies, B.; Cooper, E.; Lound, A.; Whitaker, M.; Hampshire, A.; Azor, A.; Donnelly, C.A.; Chadeau-Hyam, M.; Cooke, G.S.; et al. Long-term health impacts of COVID-19 among 242,712 adults in England. Nat. Commun. 2023, 14, 6588. [Google Scholar] [CrossRef]
- Whitaker, M.; Elliott, J.; Chadeau-Hyam, M.; Riley, S.; Darzi, A.; Cooke, G.; Ward, H.; Elliott, P. Persistent COVID-19 symptoms in a community study of 606,434 people in England. Nat. Commun. 2022, 13, 1957. [Google Scholar] [CrossRef]
- Chen, C.; Haupert, S.R.; Zimmermann, L.; Shi, X.; Fritsche, L.G.; Mukherjee, B. Global Prevalence of Post-Coronavirus Disease 2019 (COVID-19) Condition or Long COVID: A Meta-Analysis and Systematic Review. J. Infect. Dis. 2022, 226, 1593–1607. [Google Scholar] [CrossRef]
- Mizrahi, B.; Sudry, T.; Flaks-Manov, N.; Yehezkelli, Y.; Kalkstein, N.; Akiva, P.; Ekka-Zohar, A.; Ben David, S.S.; Lerner, U.; Bivas-Benita, M.; et al. Long covid outcomes at one year after mild SARS-CoV-2 infection: Nationwide cohort study. BMJ 2023, 380, e072529. [Google Scholar] [CrossRef]
- O’MAhoney, L.L.; Routen, A.; Gillies, C.; Ekezie, W.; Welford, A.; Zhang, A.; Karamchandani, U.; Simms-Williams, N.; Cassambai, S.; Ardavani, A.; et al. The prevalence and long-term health effects of Long Covid among hospitalised and non-hospitalised populations: A systematic review and meta-analysis. eClinicalMedicine 2022, 55, 101762. [Google Scholar] [CrossRef]
- Nguyen, L.H.; Drew, D.A.; Graham, M.S.; Joshi, A.D.; Guo, C.-G.; Ma, W.; Mehta, R.S.; Warner, E.T.; Sikavi, D.R.; Lo, C.-H.; et al. Risk of COVID-19 among front-line health-care workers and the general community: A prospective cohort study. Lancet Public Health 2020, 5, e475–e483. [Google Scholar] [CrossRef]
- Strahm, C.; Seneghini, M.; Güsewell, S.; Egger, T.; Leal-Neto, O.; Brucher, A.; Lemmenmeier, E.; Kleeb, D.M.; Möller, J.C.; Rieder, P.; et al. Symptoms Compatible With Long Coronavirus Disease (COVID) in Healthcare Workers With and Without Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection—Results of a Prospective Multicenter Cohort. Clin. Infect. Dis. 2022, 75, e1011–e1019. [Google Scholar] [CrossRef] [PubMed]
- Havervall, S.; Rosell, A.; Phillipson, M.; Mangsbo, S.M.; Nilsson, P.; Hober, S.; Thålin, C. Symptoms and Functional Impairment Assessed 8 Months After Mild COVID-19 Among Health Care Workers. JAMA 2021, 325, 2015–2016. [Google Scholar] [CrossRef] [PubMed]
- Sun, P.; Wang, M.; Song, T.; Wu, Y.; Luo, J.; Chen, L.; Yan, L. The Psychological Impact of COVID-19 Pandemic on Health Care Workers: A Systematic Review and Meta-Analysis. Front. Psychol. 2021, 12, 626547. [Google Scholar] [CrossRef]
- Greenberg, N.; Weston, D.; Hall, C.; Caulfield, T.; Williamson, V.; Fong, K. Mental health of staff working in intensive care during COVID-19. Occup. Med. 2021, 71, 62–67. [Google Scholar] [CrossRef]
- Xiaoming, X.; Ming, A.; Su, H.; Wo, W.; Jianmei, C.; Qi, Z.; Hua, H.; Xuemei, L.; Lixia, W.; Jun, C.; et al. The psychological status of 8817 hospital workers during COVID-19 Epidemic: A cross-sectional study in Chongqing. J. Affect. Disord. 2020, 276, 555–561. [Google Scholar] [CrossRef]
- Pappa, S.; Ntella, V.; Giannakas, T.; Giannakoulis, V.G.; Papoutsi, E.; Katsaounou, P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain Behav. Immun. 2020, 88, 901–907. [Google Scholar] [CrossRef]
- Huang, Y.; Zhao, N. Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: A web-based cross-sectional survey. Psychiatry Res. 2020, 288, 112954. [Google Scholar] [CrossRef] [PubMed]
- Maunder, R.G.; Heeney, N.D.; Kiss, A.; Hunter, J.J.; Jeffs, L.P.; Ginty, L.; Johnstone, J.; Loftus, C.A.; Wiesenfeld, L.A. Psychological impact of the COVID-19 pandemic on hospital workers over time: Relationship to occupational role, living with children and elders, and modifiable factors. Gen. Hosp. Psychiatry 2021, 71, 88–94. [Google Scholar] [CrossRef]
- Spoorthy, M.S.; Pratapa, S.K.; Mahant, S. Mental health problems faced by healthcare workers due to the COVID-19 pandemic–A review. Asian J. Psychiatry 2020, 51, 102199. [Google Scholar] [CrossRef]
- Amin-Chowdhury, Z.; Ladhani, S.N. Causation or confounding: Why controls are critical for characterizing long COVID. Nat. Med. 2021, 27, 1129–1130. [Google Scholar] [CrossRef]
- Ballering, A.V.; van Zon, S.K.R.; Hartman, T.C.O.; Rosmalen, J.G.M.; Lifelines Corona Research Initiative. Persistence of somatic symptoms after COVID-19 in the Netherlands: An observational cohort study. Lancet 2022, 400, 452–461. [Google Scholar] [CrossRef] [PubMed]
- Zigmond, A.S.; Snaith, R.P. The Hospital Anxiety and Depression Scale. Acta Psychiatr. Scand. 1983, 67, 361–370. [Google Scholar] [CrossRef] [PubMed]
- Dolan, P. Modeling Valuations for EuroQol Health States. Med. Care 1997, 35, 1095–1108. [Google Scholar] [CrossRef]
- Fisk, J.D.; Ritvo, P.G.; Ross, L.; Haase, D.A.; Marrie, T.J.; Schlech, W.F. Measuring the functional impact of fatigue: Initial validation of the fatigue impact scale. Clin. Infect. Dis. 1994, 18 (Suppl. 1), S79–S83. [Google Scholar] [CrossRef] [PubMed]
- JASP Team. JASP (Version 0.18.2) [Computer Software]. 2023. Available online: https://jasp-stats.org/ (accessed on 15 August 2024).
- Jones, K.H.; Ford, D.V.; Jones, P.A.; John, A.; Middleton, R.M.; Lockhart-Jones, H.; Osborne, L.A.; Noble, J.G.; Reindl, M. A Large-Scale Study of Anxiety and Depression in People with Multiple Sclerosis: A Survey via the Web Portal of the UK MS Register. PLoS ONE 2012, 7, e41910. [Google Scholar] [CrossRef]
- Matta, J.; Wiernik, E.; Robineau, O.; Carrat, F.; Touvier, M.; Severi, G.; de Lamballerie, X.; Blanché, H.; Deleuze, J.-F.; Gouraud, C.; et al. Association of self-reported COVID-19 infection and SARS-CoV-2 serology test results with persistent physical symptoms among french adults during the COVID-19 pandemic. JAMA Intern. Med. 2021, 182, 19–25. [Google Scholar] [CrossRef]
- Fogh, K.; Larsen, T.G.; Hansen, C.B.; Hasselbalch, R.B.; Eriksen, A.R.R.; Bundgaard, H.; Frikke-Schmidt, R.; Hilsted, L.M.; Østergaard, L.; Johansen, I.S.; et al. Self-Reported Long COVID and Its Association with the Presence of SARS-CoV-2 Antibodies in a Danish Cohort up to 12 Months after Infection. Microbiol. Spectr. 2022, 10, e02537-22. [Google Scholar] [CrossRef]
- Mittermeier, I.; Merlic, D.; Braschl, S.; Sealtiel, L.; Weilnhammer, V.; Quartucci, C.; Weinmann, T.; Adorjan, K.; Gerstner, D.; Heinze, S.; et al. Mental health and work-related factors in healthcare workers in a pandemic—Meta-analysis. Psychol. Health Med. 2023, 28, 3005–3051. [Google Scholar] [CrossRef]
Early Pandemic Cohort (Baseline) | Late Pandemic Cohort (18 mth) | ||||||
---|---|---|---|---|---|---|---|
COVID-19 Negative (n = 205) | COVID-19 Positive (n = 174) | Total (n = 379) | COVID-19 Negative (n = 90) | COVID-19 Positive (n = 160) | Total (n = 250) | ||
Mean age (SD) | 46.19 (10.84) | 46.08 (11.60) | 46.14 (11.18) | 45.54 (16.61) | 47.66 (10.53) | 46.9 (13.06) | |
Gender | Female (%) | 88.8 | 83.3 | 86.2 | 83.3 | 88.1 | 86.4 |
Male (%) | 11.2 | 16.7 | 13.8 | 16.7 | 11.9 | 13.6 | |
Mean BMI (SD) | 26.9 (5.5) n = 17 | 27.2 (5.7) n = 63 | 27.1 (5.6) | - | - | - | |
Ethnicity | White (%) | 190 (93%) | 166 (96%) | 357 (95%) | - | - | - |
Non-white (%) | 15 (7%) | 9 (4%) | 22 (5%) | ||||
Smoker (%) | No 148 (72%) | No 133 (76%) | No 281 (74%) | - | - | - | |
Yes 44 (21%) | Yes 40 (23%) | Yes 84 (22%) | |||||
Post-COVID syndrome # (%) | - | - | - | 15 (17%) | 20 (12.5%) | 35 (14%) | |
Patient contact ~ (%) | Yes 171 (83%) | Yes 134 (77%) | Yes 305 (81%) | - | - | - | |
No 34 (17%) | No 40 (23%) | No 74 (19%) | |||||
EQ-5D | 1.55 (0.77) | 1.48 (0.74) | 1.51 (0.75) | 1.46 (0.67) | 1.47 (0.86) | 1.46 (0.81) | |
HADS Anxiety | 5.51 (3.65) | 5.33 (3.76) | 5.43 (3.70) | 6.18 (3.59) | 5.81 (4.35) | 5.94 (4.09) | |
HADS Depression | 5.44 (2.77) | 5.45 (2.86) | 5.45 (2.81) | 3.49 (3.48) | 3.51 (3.79) | 3.50 (3.67) | |
Fatigue | 3.90 (5.10) | 4.98 (5.94) | 4.40 (5.52) | 4.53 (5.83) | 5.83 (6.45) | 5.36 (6.25) | |
Mobility | 1.12 (0.41) | 1.14 (0.42) | 1.13 (0.41) | 1.22 (0.54) | 1.23 (0.67) | 1.23 (0.62) | |
Pain | 1.52 (0.70) | 1.36 (0.64) | 1.45 (0.67) | 1.51 (0.69) | 1.50 (0.90) | 1.50 (0.83) | |
Self-care | 1.02 (0.14) | 1.02 (0.13) | 1.02 (0.13) | 1.02 (0.15) | 1.00 (0.28) | 1.01 (0.24) |
No Prolonged Symptoms (n = 111) | Ongoing Symptoms—5–12 Weeks (n = 27) | Post-COVID Syndrome (n = 35) | |
---|---|---|---|
Gender (% Female) | 84.7% | 100% | 80% |
Age (Years) | 48.82 (11.95) | 47.78 (10.78) | 49.03 (11.49) |
COVID-19-positive (%) | 62.2% | 70.4% | 65.7% |
EQ-5D Anxiety and Depression Score | 1.41 (0.82) | 1.44 (0.80) | 1.71 (0.89) |
HADS Anxiety | 5.55 (4.30) | 6.59 (4.36) | 6.91 (2.78) |
HADS Depression | 2.95 (3.41) | 3.56 (3.02) | 7.20 (4.05) |
Fatigue score | 4.15 (5.58) | 5.96 (5.47) | 11.51 (8.29) |
Mobility score | 1.14 (0.56) | 1.22 (0.58) | 1.63 (0.84) |
Pain score | 1.40 (0.81) | 1.52 (0.89) | 2.09 (0.95) |
Self-care score | 0.98 (0.19) | 0.93 (0.27) | 1.43 (0.43) |
No Prolonged Symptoms (n = 111) | Ongoing Symptoms—5–12 Weeks (n = 27) | Post-COVID Syndrome (n = 35) | |
---|---|---|---|
Gender (% Female) | 84.70% | 100% | 80% |
Age (Years) | 48.82 (11.95) | 47.78 (10.78) | 49.03 (11.49) |
COVID-19-Positive (%) | 62.20% | 70.40% | 65.70% |
EQ-5D Anxiety and Depression | |||
No Problem | 79 (71%) | 16 (59%) | 18 (51%) |
Slight Problem | 20 (18%) | 8 (30%) | 11 (31%) |
Moderate Problem | 9 (8%) | 3 (11%) | 4 (11%) |
Severe Problem | 2 (2%) | 0 (0%) | 2 (6%) |
Extreme Problem | 1 (1%) | 0 (0%) | 0 (0%) |
HADS Anxiety | |||
Normal | 80 (72%) | 15 (56%) | 21 (60%) |
Mild | 16 (14%) | 4 (15%) | 11 (31%) |
Moderate/Severe | 15 (14%) | 8 (30%) | 3 (9%) |
HADS Depression | |||
Normal | 97 (87%) | 24 (89%) | 18 (51%) |
Mild | 10 (9%) | 2 (7%) | 9 (26%) |
Moderate/Severe | 4 (4%) | 1 (4%) | 9 (23%) |
Fatigue Score | |||
Normal | 107 (96%) | 27 (100%) | 31 (89%) |
Mild to Moderate | 4 (4%) | 0 (0%) | 4 (11%) |
Severe | 0 (0%) | 0 (0%) | 0 (0%) |
Mobility Score | |||
No Problem | 100 (90%) | 19 (70%) | 21 (60%) |
Slight Problem | 5 (4.5%) | 8 (30%) | 6 (17%) |
Moderate Problem | 5 (4.5%) | 0 (0%) | 8 (23%) |
Severe Problem | 1 (1%) | 0 (0%) | 0 (0%) |
Extreme Problem | 0 (0%) | 0 (0%) | 0 (0%) |
Pain Score | |||
No Problem | 81 (73%) | 16 (59%) | 12 (34%) |
Slight Problem | 16 (14%) | 6 (22%) | 10 (29%) |
Moderate Problem | 11 (10%) | 5 (19%) | 11 (31%) |
Severe Problem | 3 (3%) | 0 (0%) | 2 (6%) |
Extreme Problem | 0 (0%) | 0 (0%) | 0 (0%) |
Self-Care Score | |||
No Problem | 110 (99%) | 27 (100%) | 31 (89%) |
Slight Problem | 1 (1%) | 0 (0%) | 3 (9%) |
Moderate Problem | 0 (0%) | 0 (0%) | 1 (3%) |
Severe Problem | 0 (0%) | 0 (0%) | 0 (0%) |
Extreme Problem | 0 (0%) | 0 (0%) | 0 (0%) |
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Raw, R.K.; Rees, J.; Wilson, D.; Gowans, S.; Ee, N.C.; Chadwick, D. Manifestations of Post-COVID Syndrome in Healthcare Workers in Northeast England. COVID 2025, 5, 91. https://doi.org/10.3390/covid5060091
Raw RK, Rees J, Wilson D, Gowans S, Ee NC, Chadwick D. Manifestations of Post-COVID Syndrome in Healthcare Workers in Northeast England. COVID. 2025; 5(6):91. https://doi.org/10.3390/covid5060091
Chicago/Turabian StyleRaw, Rachael K., Jon Rees, Deborah Wilson, Sharon Gowans, Ng Cho Ee, and David Chadwick. 2025. "Manifestations of Post-COVID Syndrome in Healthcare Workers in Northeast England" COVID 5, no. 6: 91. https://doi.org/10.3390/covid5060091
APA StyleRaw, R. K., Rees, J., Wilson, D., Gowans, S., Ee, N. C., & Chadwick, D. (2025). Manifestations of Post-COVID Syndrome in Healthcare Workers in Northeast England. COVID, 5(6), 91. https://doi.org/10.3390/covid5060091