The report is a product of the VA/HSR&D Evidence Synthesis Program.
Evidence Brief: Employment, Education, and Continuing Care Outcomes among Individuals Following COVID-19
Takeaway: A history of COVID-19 (2020 to early 2021) was associated with negative impacts on employment and post-hospitalization continuing care needs with insufficient evidence on education outcomes. Effects varied widely but appeared to be associated with disease severity and symptom persistence.
As of October 2022, there have been more than 97 million reported cases of COVID-19 in the United States and over 781,000 among U.S. Veterans. However, the burden of COVID-19 remains unclear. After recovery from acute infection, some individuals may have difficulty completing daily activities, including work or secondary education, due to ongoing symptoms. Recovery from infection may also result in increased healthcare needs, including greater dependence on both formal and informal care partners. As of July 2021, “Long COVID” can be considered a disability under the Americans with Disabilities Act. The first federal National Research Action Plan on Long COVID, issued in August 2022, found that there was a lack of representative data to inform guidelines or policies related to educational outcomes, employment, and long-term disabilities.
VA’s Evidence Synthesis Program (ESP) Center in Minneapolis, MN conducted a review that focused on three main outcomes in adults with a history of COVID-19: 1) employment, 2) education, and 3) discharge disposition and continuing care needs. The investigators’ interest was in long-term outcomes of COVID-19 regardless of whether individuals had persisting symptoms. For this reason—and because of variability in the definition and diagnosis of Long COVID over time—they did not limit study eligibility to research among patients with Long COVID or similar diagnoses. ESP investigators searched Ovid MEDLINE, Ovid PsycINFO, CINAHL, and Embase, as well as ERIC and EconLit through May 26, 2022. From 17,634 potentially relevant articles, they used 50 studies for this report.
Summary of Findings
A history of COVID-19 (2020 to early 2021) was associated with negative impacts on employment and post-hospitalization continuing care needs with insufficient evidence on education outcomes. Effects varied widely but appeared to be associated with disease severity and symptom persistence. Other findings include:
- Return to work and the inability to work due to illness following COVID-19 varied widely and were likely associated with disease severity, symptom persistence, and time since infection.
- Employment outcomes were worse for patients who had spent time in the ICU (among adults admitted to ICUs, only 50% to 64% returned to work at 6 months) compared to hospitalized patients who had not been admitted to the ICU (53%-92% of survivors were back to work by 6 months). Employment outcomes were best for patients who were not hospitalized.
- Information was insufficient to determine the effect of COVID-19 on post-secondary education.
- Limited data suggested ICU survivors were more likely to be discharged to a skilled nursing facility or equivalent and less likely to be discharged home than patients who survived without an ICU stay.
- Among ICU survivors, 20%-94% were discharged to home (estimated mean: 37%); nearly all studies reported ≥60% of patients hospitalized but not admitted to ICUs were discharged home.
- Data were lacking on longer-term care needs, including use of caregiver services.
Results ranged widely, few studies had comparators, and most did not report health complications during hospitalization, discharge health status, or pre-COVID-19 care needs. No studies enrolled a representative sample of all individuals who have had COVID-19. Most studies occurred prior to the Delta and Omicron variants, vaccine availability, and currently available treatments. Changes have also occurred in public health recommendations and employment and education policies.
Implications for VA
This report provides a broad framework, overview, and estimates of COVID-19 infection on employment, education, and care needs occurring in the early COVID-19 era. Findings can be used to guide policy and resource planning. However, more up-to-date and higher-quality estimates that assess the current and future impacts of COVID-19 infection on employment, education, and long-term care needs should be obtained and continually re-evaluated to reflect changes in the biomedical and societal landscape with respect to COVID-19.
In addition to evidence limitations that make drawing firm conclusions and policy implications challenging, dramatic changes have occurred from early 2021 to the present regarding natural immunity, vaccination availability, at-home self-testing use, treatment options, and SARS-CoV-2 variants. The employment, education, and healthcare environment, as well as public health recommendations and social practice norms have also changed over time. Current outcomes and resource needs likely differ and are probably considerably better from those reported here. Therefore, VHA policy decisions and care needs should be responsive to new findings.
The SARS-CoV-2 virus will likely remain a significant threat to human health for the foreseeable future. Findings in this Evidence Brief highlight an important gap in the current understanding of the impacts of COVID-19 on these important outcomes. Robust, standardized, longitudinal assessments of health and well-being across systems and settings, especially in VHA, that include pre-morbid evaluation, are needed to facilitate real-time monitoring of trends. This is particularly important given the rapidly changing medical, public health, and societal landscape and the lack of information in Veterans and VHA.
Gustavson AM, Greer N, Wilt TJ, Sowerby K, Ahmed Z, Diem SJ. Evidence Brief: Employment, Education, and Continuing Care Outcomes Among Individuals Following COVID-19. Washington, DC: Evidence Synthesis Program, Health Services Research and Development Service, Office of Research and Development, Department of Veterans Affairs. VA ESP Project #09-009; 2022.
To view the full report, go to https://vaww.hsrd.research.va.gov/publications/esp/post-covid-brief.cfm
ESP is currently soliciting review topics from the broader VA community. Nominations will be accepted electronically using the online Topic Submission Form. If your topic is selected for a synthesis, you will be contacted by an ESP Center to refine the questions and determine a timeline for the report.
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