Impact of SARS-CoV-2 on healthcare and essential workers: A longitudinal study of PROMIS-29 outcomes

Importance: The mandatory service of essential workers during the COVID-19 pandemic was associated with high job stress, increased SARS-CoV-2 exposure, and limited time for recovery following infection. Understanding outcomes for frontline workers can inform planning for future pandemics. Objective: To compare patient-reported outcomes by employment type and SARS-CoV-2 status. Design: Data from the INSPIRE registry, which enrolled COVID-positive and COVID-negative adults between 12/7/2020–8/29/2022 was analyzed. Patient-reported outcomes were collected quarterly over 18 months. Setting: Participants were recruited across eight US sites. Participants: Employed INSPIRE participants who completed a short (3-month) and long-term (12–18 month) survey. Exposure: SARS-CoV-2 index status and employment type (essential healthcare worker [HCW], essential non-HCW, and non-essential worker [“general worker”]). Main outcomes and measures: PROMIS-29 (mental and physical health summary) and PROMIS Cognitive SF-CF 8a (cognitive function) scores were assessed at baseline, short-term (3-months), and long-term (12–18 months) timepoints using GEE modeling. Results: Of the 1,463 participants: 53.5% were essential workers (51.4% HCWs, 48.6% non-HCWs) and 46.5% were general workers. Most associations between outcomes and employment type became non-significant after adjusting for sociodemographics, comorbidities, COVID-19 vaccination, and SARS-CoV-2 variant period. However, among COVID-negative participants, essential HCWs had higher cognitive scores at baseline (β: 3.91, 95% CI [1.32, 6.50]), short term: (β: 3.49, 95% CI: [0.80, 6.18]) and long-term: (β: 3.72, 95% CI: [0.98, 6.46]) compared to general workers. Among COVID-positive participants, essential non-HCWs had significantly worse long-term physical health summary scores (β:-1.22, 95% CI: [−2.35, −0.09]) compared to general workers. Conclusions and relevance: Differences in outcomes by worker status were largely explained by baseline characteristics. However, compared to general workers, essential HCW status had higher cognitive function in the absence of SARS-CoV-2 infection at all timepoints, while essential non-HCWs were most vulnerable to poor recovery in long-term physical health following SARS-CoV-2 infection. Preparation efforts for future pandemics may consider enhanced protection and post-infection resources for frontline workers.