Long COVID and the Challenge of Long-Term Employment: An Ecological, Sequential Explanatory Mixed-Methods Approach

Area of Science:

• Public Health
• Occupational Health
• Health Services Research

Background:

• Long COVID presents multifaceted challenges impacting individuals' long-term health and financial stability.
• Understanding the determinants of sustained employment post-infection is critical for effective recovery strategies.

Purpose of the Study:

• To identify and contextualize the factors influencing long-term employment, health, and financial outcomes in individuals with Long COVID.
• To explore the multilevel determinants affecting sustained employment after returning to work.

Main Methods:

• A sequential explanatory mixed-methods study guided by the social-ecological model.
• Recruitment of adults with Long COVID who were employed pre-infection and returned to work, using surveys and semi-structured interviews.
• Quantitative analysis of validated surveys and qualitative content analysis of interviews.

Main Results:

• 58% of participants remained employed after a mean follow-up of 1,077 days; those no longer employed experienced worse health and financial hardship.
• Qualitative findings revealed nonlinear return-to-work trajectories influenced by fluctuating symptoms and multilevel barriers.
• Identified barriers include functional capacity-demand misalignment, accommodation challenges, stigma, policy limitations, and labor market issues.

Conclusions:

• Employment sustainability for individuals with Long COVID is hindered by complex, multilevel barriers.
• Job loss exacerbates health and financial difficulties, underscoring the need for integrated support.
• Recommendations include investment in multidisciplinary care, vocational rehabilitation, clinician/employer education, and policy reform.