Physical, Psychological, and Cognitive Profile of Post-COVID Conditions in Healthcare Workers, Quebec, Canada

  1. Sara Carazo
  2. Danuta M Skowronski
  3. Robert Laforce
  4. Denis Talbot
  5. Emilia L Falcone
  6. Denis Laliberté
  7. Geoffroy Denis
  8. Pierre Deshaies
  9. Sandrine Hegg-Deloye
  10. Gaston De Serres

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Abstract

Background

The prevalence of post-COVID conditions (PCC) and associated physical, psychological, and cognitive symptoms was assessed among Quebec healthcare workers (HCWs) with coronavirus disease 2019 (COVID-19).

Methods

This case-control study compared 6061 symptomatic HCWs with polymerase chain reaction–confirmed COVID-19 between July 2020 and May 2021 with a random sample of 4390 symptomatic HCWs who were test-negative controls. The prevalence of physical symptoms lasting ≥4 weeks (PCC4w) or ≥12 weeks (PCC12w) was estimated among hospitalized and nonhospitalized cases. In multivariate models, sociodemographic and clinical characteristics, as well as vaccine history, were evaluated as potential risk factors. Prevalence ratios compared 4 aspects of self-reported cognitive dysfunction among PCC cases to controls, adjusting for psychological distress and fatigue.

Results

PCC4w and PCC12w prevalences of 46% (2746/5943) and 40% (653/1746), respectively, were observed among nonhospitalized cases and 76% (90/118) and 68% (27/37), respectively, among hospitalized cases. Hospitalization, female sex, and age were associated with higher PCC risk. A substantial proportion of nonhospitalized PCC4w cases often or very often reported cognitive dysfunction, including concentration (33%) or organizing (23%) difficulties, forgetfulness (20%), and loss of necessary items (10%). All 4 aspects of cognitive dysfunction were associated with PCC4w symptoms, psychological distress, and fatigue.

Conclusions

PCC may be a frequent sequela of ambulatory COVID-19 in working-age adults, with important effects on cognition. With so many HCWs infected, the implications for quality healthcare delivery could be profound if cognitive dysfunction and other severe PCC symptoms persist in a professionally disabling way. Further evaluation of PCC prevalence and prognosis is warranted.

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  1. Version published to 10.1093/ofid/ofac386
  2. ScreenIT

    SciScore for 10.1101/2022.03.08.22272057: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: Ethical aspects: This study was approved by the research ethics committee of the Centre hospitalier universitaire de Québec–Université Laval.
    Consent: All participants gave verbal consent during the phone contact and electronic consent at the beginning of the survey.
    Sex as a biological variablenot detected.
    RandomizationA random sample of HCWs who were similarly tested for COVID-19-compatible symptoms between November 14, 2020 and May 29, 2021, but who were PCR-negative and not previously infected, served as test-negative controls.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Analysis were performed using SAS version 9.4 (SAS Institute Inc).
    SAS Institute
    suggested: (Statistical Analysis System, RRID:SCR_008567)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    As may be expected in the evaluation of a novel and heterogeneous condition, our study has several limitations. Using CDC and WHO case definitions for PCC based on 4-week or 12-week duration may have overestimated the prevalence of clinically-significant PCC. Clinical significance may be improved by requiring longer duration, but remains suboptimal in allowing any symptom of any intensity. Temporal patterns were identified using a single-time survey completed at different moments since illness onset and asking only about ongoing symptoms. This may have underestimated the prevalence of symptoms for shorter intervals but avoided recall bias and the selective attrition of less symptomatic patients in follow-up studies.3,15 We did not collect information on some potentially relevant risk factors, such as comorbidity or initial COVID-19 symptoms and their severity.14,15,25,32,34 Our questionnaire, designed in the fall 2020, did not collect data on insomnia or post-exertional malaise later also considered to be PCC-qualifying symptoms.21 Cognitive functions were not formally measured with the validated instruments neurologists use to investigate patients, and self-reporting might have over-estimated their prevalence. Physical symptoms among non-COVID-19 controls were not collected. Comparing the prevalence but also the severity of symptoms among cases and controls would have allowed better characterization of PCC and should be considered in future research. Our participants were mo...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  3. Version published to 10.1101/2022.03.08.22272057 on medRxiv