March 6, 2023 — The impact of the long COVID – and its sometimes debilitating symptoms that can persist for more than a year – has worsened the already severe shortage of healthcare workers.
Hospitals have turned to training programs, traveling nurses and emergency room staffing services. As the shortage of clinical workers continues, support workers are also scarce, with no end in sight.
“Our clinical staff are on the front line, but behind them are several layers of people doing jobs that allow them to do their jobs,” says Joanne Conroy, MD, president of Dartmouth-Hitchcock Medical Center, a 400-bed hospital in New Hampshire. “Lab and radiology and support staff, IT, facilities and housekeeping…the list goes on and on.”
Long COVID is contributing to the labor shortage in the United States overall, research shows. But without testing for the condition and a wide range of symptoms and severity — and with some workers attributing their symptoms to something else — it’s hard to get a clear picture of the impacts on the healthcare system.
Emerging research suggests that the long COVID is hitting the healthcare system particularly hard.
The system has lost 20% of its workforce during the pandemic, with understaffing in hospitals leading to burnout and fatigue among frontline healthcare workers, according to the US Bureau of Labor Statistics. United.
Other research highlights significant impacts on healthcare workers:
- In New York, nearly 20% of long-term COVID patients are still out of work after a year, with high numbers among healthcare workers, according to a new study on workers’ compensation claims.
- A new study in the American Journal of Infection Control reports that intensive care unit nurses and non-clinical workers are particularly vulnerable. About 2% of nurses did not return to work after developing COVID-19, according to a 2022 survey by the National Nursing Association, which represents unionized workers.
- In the UK, long COVID symptoms are impacting the lives of 1.5million people, according to the Office of National Statistics, which monitors the impact of COVID. Nearly 20% say their ability to engage in daily activities has been “a lot limited,” according to data from February.
While brain fog, fatigue and other symptoms of COVID sometimes only last a few weeks or months, a percentage of those who develop the disease – on or off the job – go on to have chronic, long-lasting and debilitating symptoms. which can drag on for years.
Several recent research studies suggest that the impacts of long COVID on healthcare workers, who interact more closely with COVID patients than others at work, are greater than other professions and are likely to have ongoing impact .
About 25% of those filing COVID-related workers’ compensation claims for time lost on the job are healthcare workers, according to a study by the National Compensation Insurance Council. It was more than any other industry. Meanwhile, the study – which included data from nine states – found that workers’ compensation claims for acute COVID cases had plummeted. from 11% in 2020 to 4% in 2021.
Last year, Katie Bach wrote a study for the Brookings Institution on the impact of long COVID on the job market. She said in an email that she still thought it was an issue for healthcare staff and staff in general.
“Clearly we have a persistent pool of long-term COVID patients who are not improving,” she says.
Hospitals forced to adapt
Dartmouth-Hitchcock Medical Center is New Hampshire’s largest health care system — and one of its largest employers — with 400 beds and 1,000 employees at the flagship and affiliate hospital. Human resources staff here have been tracking COVID-19 infections among employees.
The hospital is treating fewer COVID cases, dropping from a high of around 500 per month to between 100 and 200 cases per month. But at the same time, they’re seeing an increase in staff calling in sick with a range of COVID-like symptoms or seeing the occupational health department, says Aimee M. Claiborne, human resources manager for Dartmouth Health System. .
“Part of that could be due to a long COVID; some if it might be due to the flu or RSV or other viruses,” she says. “We’re certainly looking at things like absenteeism and what people are calling it.”
They’re also looking at “presenteeism” — where workers show up when they’re not feeling well and aren’t as productive, she says.
Those returning to work can access the company’s existing disability programs to get accommodations – allowing people with low energy or fatigue or another disability, for example, to work shorter shifts or from home. Dartmouth-Hitchcock is also incorporating more remote work into its system after trying the approach during the height of the pandemic, Claiborne says.
Eventually, some workers will not be able to return to work. Those who have been infected on the job can also apply for workers’ compensation, but coverage varies from employer to employer and state to state.
Across the country, Annette Gillaspie, a nurse at a small Oregon hospital, says she caught COVID — like many other healthcare workers — early in the pandemic before vaccines were taken. available and protective measures are in place.
She says she still hasn’t fully recovered 3 years later – she still has a cough as well as POTS (postural orthostatic tachycardia syndrome), a common post-COVID-19 condition of the automatic nervous system that can cause dizziness and fatigue when a seated person gets up.
But she’s back to work, and the hospital has made some accommodations for her, like a parking spot closer to the building.
She remembers being exposed — she forgot to put on goggles. A few days later, she was in bed with COVID. She says she never quite recovered. Gillaspie says she sees a lot of other people at work who seem to have long COVID symptoms.
“Some of them know it’s COVID-related,” she says. “They do exactly like me – they succeed.”
They do it because they love their job, she says.
Shortages span the country
Millions of people live in what the federal government calls “areas of shortage of health practitioners » without enough dental, primary and mental health practitioners. In hospitals, vacancies for nurses and respiratory therapists increased by 30% between 2019 and 2020, according to a American Hospital Association (AHA) survey.
Hospitals will need to hire up to 124,000 doctors and at least 200,000 nurses a year to meet increased demand and replace retiring nurses, according to the AHA.
When the pandemic hit, hospitals had to bring in expensive traveling nurses to deal with shortages caused by successive waves of COVID surges. But as the AHA notes, staffing shortages in health care existed before the pandemic.
The federal government, StatesAnd health care systems have programs to address the shortage. Some hospitals are training their own staff, while others are considering expanding the “scope of care” for existing providers, such as physician assistants. Still others seek to support existing staff who may be suffering from burnout and fatigue – and now, long overdue COVID.
Long COVID numbers — like the condition itself — are difficult to measure and constantly changing. Between 10% and 11% of those who have had COVID have long COVID, according to the Household Pulse Survey, an ongoing Census Bureau data project.
A doctor in the UK recently wrote that she and others initially kept working, believing they could overcome the symptoms.
“As a doctor, the system in which I worked and the martyr complex instilled by the medical culture enabled this vision. In medicine, being sick, being human and taking care of oneself is still too often experienced as a kind of failure or weakness,” she wrote anonymously in February in the journal BMJ.
Jeffrey Siegelman, MD, a physician at Emory University Medical Center in Atlanta, also wrote a journal article about his experiences with the long COVID in 2020 in JAMA. More than 2 years later, he still has COVID for a long time.
He was out of work for 5 months, returned to practicing part-time and was exempt from night work – “a big ask”, he says, for an ER doctor.
In general, he feels the hospital has “bent over backwards” to help him get back to work. He is set to return to full-time work with accommodations.
“I was really lucky in this job,” says Siegelman. “That’s not what most long COVID patients are dealing with.”
He led a support group for hospital workers who had long COVID – including clerks, technicians, nurses and doctors. Many people were trying to overcome their symptoms to do their job, he says. A few people who exhausted their disability coverage were laid off.
He acknowledges that as a doctor he had better disability coverage than others. But without a diagnostic test to confirm long COVID, it is not free from self-doubt and stigma.
Siegelman was one of the doctors who questioned the physiological basis of ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome), a condition that reflects the long COVID and commonly appears in those with persistent symptoms of an infection. He doesn’t do that anymore.
Researchers are beginning to link ME/CFS and other long-term issues to COVID and other infections, and research is underway to better understand what is called post-infection illness.
Hospitals process so many things, Siegelman says, that he understands if there’s a reluctance to acknowledge that people are working at reduced capacity.
“It’s important for hospital managers to talk about this with their employees and allow people to recognize if they are taking longer than expected to recover from an illness,” he says.
In medicine, he says, you’re expected to show up for work unless you’re on a stretcher yourself. Now people are much more open to calling if they have a fever – a good development, he says.
And as he prepared to return to work, the symptoms persisted.
“I can’t taste it yet,” he said. “It’s a pretty constant reminder that there’s something real going on here.”