Long COVID-Challenges in diagnosis and managing return-to-work.

OBJECTIVES: Long COVID may be a public health concern resulting in a hidden toll of the pandemic years later, on workers and their work ability in the workforce. We illustrate the challenges in diagnosing long COVID in a patient, its associated psychological impact on work and how return-to-work can be better managed and supported from an occupational health perspective. METHODS: An Occupational Health trainee working as a government public health officer experienced persistent fatigue, decreased effort tolerance, and difficulties in concentration after contracting COVID-19. There were unintended psychological effects arising from the functional limitations that were not explained with a proper diagnosis. This was further complicated with a lack of access to occupational health services for return-to-work. RESULTS: He developed his own rehabilitation plan to improve his physical tolerance. Progressive efforts to build up his physical fitness complemented with workplace adjustments helped to overcome his functional limitations and allowed him to effectively return-to-work. CONCLUSION: Diagnosing long COVID continues to remain challenging due to a lack of consensus on a definitive diagnostic criterion. This may give rise to unintended mental and psychological impact. Workers with long COVID symptoms can return-to-work, involving a complex individualized approach to the symptoms' impact on work, and workplace adjustments and job modifications available. The psychological toll on the worker must also be addressed. Occupational health professionals are best placed to facilitate these workers in their journey to return-to-work, with multi-disciplinary delivery models providing return to work services.

Is routine chest radiography necessary after ultrasonography-guided catheter thoracostomy?

INTRODUCTION: Many institutions still perform routine chest radiography (CXR) after tube thoracostomies despite current guidelines suggesting that this is not necessary for simple cases. We aimed to evaluate the usefulness of routine CXR following ultrasonography-guided catheter thoracostomies for the detection of complications of symptomatic pleural effusions in hospitalised patients. METHODS: This was a retrospective review of 2,032 ultrasonography-guided thoracostomies on hospitalised patients with symptomatic effusions at a single institution from April 2012 to May 2015. The aetiology of effusions was not systemically registered, but patient demographics, procedural details and clinical outcomes were collected. Data was analysed using descriptive statistics and chi-square test. Generalised estimating equation analysis was performed to assess the relationship between CXR findings and complications while controlling for age. RESULTS: Out of 2,032 CXRs, 92.96% (n = 1,889) were normal, 5.81% (n = 118) showed pneumothorax and 1.23% (n = 25) showed catheter kinking. 99 pneumothoraces and 24 kinked catheters were detected in the first hour post procedure. 97.40% (n = 115) of patients with pneumothorax were stable or had minor complications, such as a vasovagal event. 0.20% (n = 4) of the cases had a serious complication following chest drain insertion, resulting in cardiovascular collapse. There was no significant relationship between CXR results and occurrence of complications (p = 0.244). Amount of fluid drained or side of insertion did not affect the clinical outcome. CONCLUSION: Routine use of CXR after tube thoracostomy did not significantly change patient management, which was concordant with recent guidelines. Instead, adverse clinical outcomes or procedural factors should guide investigations.