More than half of people in a cross-sectional study reporting on post-COVID condition (PCC) symptoms, or long COVID, in 2021 said their ability to work was poor, yet most were still working, suggesting a substantial burden of “presenteeism,” or reduced productivity while on the job.

The study, led by researchers from Lund University in Lund, Sweden, drew on survey data from the Life After COVID-19 (LAC) in Sweden project and included 608 adults recruited via social media in October and November 2021. Participants self-reported symptoms lasting more than two months (meaning inclusion was not based on a specific set of symptoms), and 85% had not been hospitalized for COVID. The participants’ mean age was 47.3 years, and 87% were women. 

Fatigue often reported

Using the Work Ability Score, which asked participants to rate their current ability to work compared with their lifetime best ability to work on a 0-to-10 scale, the researchers found that 51% of respondents fell in the “poor” range (0 to 5). Despite that, 70% said they were still working, and only 18% reported being on sick leave.

Eighty-three percent experienced mental fatigue, and 86% experienced physical fatigue. Dizziness was reported by 83%, and 55% reported balance disturbances. Most respondents reported that they did not need extra help with everyday life tasks, and their physical strength was generally good.

“In the present study, mental fatigue was the strongest associated factor with poor work ability,” note the authors. The finding is in line with previous studies that showed that fatigue is strongly associated with reduced work ability and delayed return to work. 

Workplace adjustments sometimes possible 

More than half of respondents said workplace adjustments were possible sometimes (29%) or often (26%), while 28% reported that no adjustments were possible. Most participants reported no or only one workplace accommodation. The most common adjustments were the ability to work from home, postpone work, or work at a slower pace. 

While there is limited evidence for how to treat fatigue in people with PCC, the authors note that mindfulness exercises and pulmonary rehabilitation are promising interventions. And because fatigue is common in the general population, especially among women, the researchers argue that special attention should be paid to the sex distribution when interpreting fatigue levels in people with long COVID.

Perceived poor work ability common

The study has several strengths, including a large number of participants, a valid questionnaire, and very little missing data. But because participants self-reported the data, the findings may be vulnerable to recall bias. 

And while the researchers collected data on education level (73% of participants had a college or university degree), they did not collect information on participants’ occupations, which could have helped interpret the results. In addition, the overrepresentation of educated women raises questions about how broadly the results can be generalized.

Despite those limitations, the findings suggest that poor work ability is common among people with PCC, and mental fatigue appears to be the strongest contributing factor. As the authors conclude, “Perceived poor work ability is common among people with PCC,” and given the complexity of symptoms and their real-world consequences, “it is crucial to implement individually tailored interventions to support individuals towards increased activity and participation in all aspects of life, including work.”