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      Associations between SARS-CoV-2 infection and subsequent economic inactivity and employment status: pooled analyses of five linked longitudinal surveys

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          Abstract

          Introduction

          Following the acute phase of the COVID-19 pandemic, record numbers of people became economically inactive (i.e., neither working nor looking for work), or non-employed (including unemployed job seekers and economically inactive people). A possible explanation is people leaving the workforce after contracting COVID-19. We investigated whether testing positive for SARS-CoV-2 is related to subsequent economic inactivity and non-employment, among people employed pre-pandemic.

          Methods

          The data came from five UK longitudinal population studies held by both the UK Longitudinal Linkage Collaboration (UK LLC; primary analyses) and the UK Data Service (UKDS; secondary analyses). We pooled data from five long established studies (1970 British Cohort Study, English Longitudinal Study of Ageing, 1958 National Child Development Study, Next Steps, and Understanding Society). The study population were aged 25–65 years between March 2020 to March 2021 and employed pre-pandemic. Outcomes were economic inactivity and non-employment measured at the time of the last follow-up survey (November 2020 to March 2021, depending on study). For the UK LLC sample (n=8,174), COVID-19 infection was indicated by a positive SARS-CoV-2 test in NHS England records. For the UKDS sample we used self-reported measures of COVID-19 infection (n=13,881). Logistic regression models estimated odds ratios (ORs) with 95% confidence intervals (95%CIs) adjusting for potential confounders including sociodemographic variables, pre-pandemic health and occupational class.

          Results

          Testing positive for SARS-CoV-2 was very weakly associated with economic inactivity (OR 1.08 95%CI 0.68–1.73) and non-employment status (OR 1.09. 95%CI 0.77–1.55) in the primary analyses. In secondary analyses, self-reported test-confirmed COVID-19 was not associated with either economic inactivity (OR 1.01 95%CI 0.70–1.44) or non-employment status (OR 1.03 95%CI 0.79–1.35).

          Conclusions

          Among people employed pre-pandemic, testing positive for SARS-CoV-2 was either weakly or not associated with increased economic inactivity or non-employment. Research on the recent increases in economic inactivity should focus on other potential causes.

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          Most cited references27

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          Characterizing long COVID in an international cohort: 7 months of symptoms and their impact

          Background A significant number of patients with COVID-19 experience prolonged symptoms, known as Long COVID. Few systematic studies have investigated this population, particularly in outpatient settings. Hence, relatively little is known about symptom makeup and severity, expected clinical course, impact on daily functioning, and return to baseline health. Methods We conducted an online survey of people with suspected and confirmed COVID-19, distributed via COVID-19 support groups (e.g. Body Politic, Long COVID Support Group, Long Haul COVID Fighters) and social media (e.g. Twitter, Facebook). Data were collected from September 6, 2020 to November 25, 2020. We analyzed responses from 3762 participants with confirmed (diagnostic/antibody positive; 1020) or suspected (diagnostic/antibody negative or untested; 2742) COVID-19, from 56 countries, with illness lasting over 28 days and onset prior to June 2020. We estimated the prevalence of 203 symptoms in 10 organ systems and traced 66 symptoms over seven months. We measured the impact on life, work, and return to baseline health. Findings For the majority of respondents (>91%), the time to recovery exceeded 35 weeks. During their illness, participants experienced an average of 55.9+/- 25.5 (mean+/-STD) symptoms, across an average of 9.1 organ systems. The most frequent symptoms after month 6 were fatigue, post-exertional malaise, and cognitive dysfunction. Symptoms varied in their prevalence over time, and we identified three symptom clusters, each with a characteristic temporal profile. 85.9% of participants (95% CI, 84.8% to 87.0%) experienced relapses, primarily triggered by exercise, physical or mental activity, and stress. 86.7% (85.6% to 92.5%) of unrecovered respondents were experiencing fatigue at the time of survey, compared to 44.7% (38.5% to 50.5%) of recovered respondents. 1700 respondents (45.2%) required a reduced work schedule compared to pre-illness, and an additional 839 (22.3%) were not working at the time of survey due to illness. Cognitive dysfunction or memory issues were common across all age groups (~88%). Except for loss of smell and taste, the prevalence and trajectory of all symptoms were similar between groups with confirmed and suspected COVID-19. Interpretation Patients with Long COVID report prolonged, multisystem involvement and significant disability. By seven months, many patients have not yet recovered (mainly from systemic and neurological/cognitive symptoms), have not returned to previous levels of work, and continue to experience significant symptom burden. Funding All authors contributed to this work in a voluntary capacity. The cost of survey hosting (on Qualtrics) and publication fee was covered by AA's research grant (Wellcome Trust/Gatsby Charity via Sainsbury Wellcome center, UCL).
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            A clinical case definition of post-COVID-19 condition by a Delphi consensus

            People with COVID-19 might have sustained postinfection sequelae. Known by a variety of names, including long COVID or long-haul COVID, and listed in the ICD-10 classification as post-COVID-19 condition since September, 2020, this occurrence is variable in its expression and its impact. The absence of a globally standardised and agreed-upon definition hampers progress in characterisation of its epidemiology and the development of candidate treatments. In a WHO-led Delphi process, we engaged with an international panel of 265 patients, clinicians, researchers, and WHO staff to develop a consensus definition for this condition. 14 domains and 45 items were evaluated in two rounds of the Delphi process to create a final consensus definition for adults: post-COVID-19 condition occurs in individuals with a history of probable or confirmed SARS-CoV-2 infection, usually 3 months from the onset, with symptoms that last for at least 2 months and cannot be explained by an alternative diagnosis. Common symptoms include, but are not limited to, fatigue, shortness of breath, and cognitive dysfunction, and generally have an impact on everyday functioning. Symptoms might be new onset following initial recovery from an acute COVID-19 episode or persist from the initial illness. Symptoms might also fluctuate or relapse over time. A separate definition might be applicable for children. Although the consensus definition is likely to change as knowledge increases, this common framework provides a foundation for ongoing and future studies of epidemiology, risk factors, clinical characteristics, and therapy.
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              Cohort profile: 1958 British birth cohort (National Child Development Study).

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                Author and article information

                Journal
                medRxiv
                MEDRXIV
                medRxiv
                Cold Spring Harbor Laboratory
                25 August 2023
                : 2023.07.31.23293422
                Affiliations
                [1 ]MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
                [2 ]Centre for Longitudinal Studies (CLS), UCL Social Research Institute, University College London, London, UK.
                [3 ]Department of Psychological Medicine, King’s College London, London, UK.
                [4 ]MRC Unit for Lifelong Health and Ageing, University College London, London, UK.
                [5 ]Centre Metices, Université libre de Bruxelles, Brussels, BE.
                [6 ]Department of Epidemiology & Public Health, University College London, London, UK.
                [7 ]Department of Twin Research and Genetic Epidemiology, School of Life Course & Population Sciences, King’s College London, London, UK.
                [8 ]AI For Science & Government, Alan Turing Institute, London, UK.
                [9 ]Division of Women’s Community and Population Health, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC, USA.
                [10 ]Scottish Centre for Administrative Data Research (SCADR), University of Glasgow, Glasgow, UK.
                [11 ]Population Health Sciences, University of Bristol, Bristol, UK.
                [12 ]Department of Primary Care and Public Health, Imperial College London, London, UK.
                Author notes

                Authors’ contributions

                RJSh, RR, RJSi, JW, JZ, OKLH, RCEB, BM, MJG, ED, FG, GBP, SVK were responsible for the conception and design. RJSh, RR, JZ, GDG, MJG, RJSi, AB, SVK were responsible for data curation and analyses. RJSh, SP created the graphs and figures. RJSh , RR, RJSi, JW, OKLH, AB, SVK, wrote the original draft of the manuscript. All authors were involved in revising the manuscript.

                Correspondence: Richard J. Shaw ( richard.shaw@ 123456glasgow.ac.uk ), MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Clarice Pears Building, 90 Byres Road, Glasgow, G12 8TB
                Article
                10.1101/2023.07.31.23293422
                10473774
                37662323
                5bc66148-80c7-4b8c-9ac3-faf209bbb6a8

                This work is licensed under a Creative Commons Attribution 4.0 International License, which allows reusers to distribute, remix, adapt, and build upon the material in any medium or format, so long as attribution is given to the creator. The license allows for commercial use.

                History
                Funding
                Funded by: UKRI-funded Longitudinal Health and Wellbeing National Core Study led by University College London
                Award ID: MC_PC_20059
                Funded by: COVID-19 Longitudinal Health and Wellbeing National Core Study, Medical Research Council
                Award ID: MC_PC_20030
                Funded by: Health Data Research UK
                Award ID: SS005
                Funded by: NRS Senior Clinical Fellowship
                Award ID: SCAF/15/02
                Funded by: Medical Research Council, Scottish Government Chief Scientist Office
                Award ID: MC_UU_00022/2
                Award ID: SPHSU17
                Funded by: Medical Research Council
                Award ID: MR/W021277/1
                Funded by: Economic and Social Research Council
                Award ID: ES/W010321/1
                Award ID: ES/S007407/1
                Funded by: Belgian National Scientific Fund (FNRS) CQ
                Award ID: n°40010931
                Funded by: Economic and Social Research Council and various Government Departments, Institute for Social and Economic Research, University of Essex, NatCen Social Research and Kantar Public
                Funded by: Economic and Social Research Council, Health Foundation
                Award ID: ES/K005146/1
                Award ID: 2076161
                Funded by: Economic and Social Research Council, Centre for Longitudinal Studies, Resource Centre 2015-20
                Award ID: ES/M001660/1
                Funded by: National Institute on Aging in the US, UK government departments: Department for Health and Social Care; Department for Transport; Department for Work and Pensions,, National Institute for Health Research
                Award ID: R01AG017644
                Award ID: 198-1074
                Funded by: UK Economic and Social Research
                Award ID: ES/V003941/1
                Categories
                Article

                uk llc,covid-19,economic inactivity,employment status,sars-cov-2

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