Veterans Reported Loss of Everyday Functioning After COVID-19 Pandemic


Researchers aimed to address the adverse effects of veterans with COVID-19 diagnoses 18 months after infections were documented.

In a cohort study comparing veterans diagnosed with COVID-19 with those not diagnosed, all participants reported a substantial loss of day-to-day functioning.1

“The World Health Organization’s clinical case definition of post COVID-19 condition specifies that an impact on everyday functioning is essential to the diagnosis. However, many studies describing the high burden of symptoms and accumulation of new diagnoses following COVID-19 infection have failed to capture function,” wrote authors of the study.

Post COVID-19 condition, more commonly known as “long COVID,” is when an individual’s symptoms persist, or new symptoms arise, 3 months after an initial COVID-19 diagnosis.2

Key Takeaways

  • Researchers aimed to compare the daily functions of veterans both infected and not infected by COVID-19 starting 18 months after self-reporting their diagnosis.
  • Results of the survey were staggered and there was no correlation to COVID-19 infection and reduced daily functioning.
  • The authors concluded that COVID-19 may have had a greater effect on both the population's mental and physical health.

Researchers aimed to compare the daily functions of veterans both infected and not infected by COVID-19 starting 18 months after self-reporting their diagnosis. When they reported their infection, researchers quickly found a “comparator” participant without COVID-19 to secure the closest match to the infected individual.1

Participants were sent a survey to record levels of pain, fatigue, activities of daily living, mobility, and overall quality of life. Results of this study were published in the JAMA Network Open.1

A Loss of Functioning Among Most Veterans

Using data from the United States Veterans Affairs (VA), 186 veterans who tested positive for COVID-19 were included in the study (mean age 60.4; 90.4% men). They were then matched with the exact number of comparators (mean age 61.1; 90.4% men), totaling 372 participants in the entire sample.

Older veteran saluting | image credit: Lydia -

Older veteran saluting | image credit: Lydia -

“In this cohort study, veterans reported high rates of ongoing fatigue, pain, and disability after the COVID-19 pandemic, regardless of history of COVID-19. There were no statistically significant results between these symptoms and COVID-19 illness,” wrote the authors.

Indeed, results of the survey were staggered and there was no correlation to COVID-19 infection and reduced daily functioning.1

Regarding daily activities, veterans with COVID-19 reported a mean of 3.4 limitations and 37.3% reported 4 or more limitations. Their matched comparators reported a mean of just 3 limitations and 30.2% reported 4 or more limitations.1

However, of veterans diagnosed with COVID-19, just 51.1% reported moderate, severe, or extreme pain 18 months after infection, compared with 65.7% of those not infected.1

Participants were also asked about their overall quality of life on a scale of 1 to 100; the higher the score, the closer they were to the everyday functionality experienced prior to the pandemic in 2020.

“Of the veterans in the COVID-19 cohort, 44.9% reported they could do less than 75% of what they felt they could do at the beginning of 2020, in contrast with 35.3% of their comparators,” wrote the authors.

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Analyzing Long-Term Health Burdens of the COVID-19 Pandemic

Reporting that there were no statistically significant results observed in the study, researchers concluded that the pandemic as a whole, whether individuals were infected with COVID-19 or not, had adverse effects on the population.

“These data are consistent with an interpretation that the COVID-19 pandemic has had adverse effects outside of solely infectious or post-infectious mechanisms,” wrote the authors.1 “Other adverse effects may have been due to psychological, behavioral, social, policy, and economic mechanisms.”

While researchers did not find a significant difference between veterans infected and their comparator cohort, they were still sure to point out study limitations and the need for further research on the effects of long COVID.

Since all data came from the VA with just 2 cohorts of 186 participants, researchers stated that the results should not be generalized to the population. They also mentioned that a greater sample size could assess differences in sex since the study’s female population was just 9.6% in both cohorts.

“These data cannot rule out the possibility that COVID-19-confirmed viral infection may be associated with disability among some individuals who had COVID-19,” they continued.1

Researchers concluded the study by identifying the need for more research on both post-COVID-19 condition and the non-physical burdens associated with the pandemic.

“Future work with larger samples is needed to validate the estimated associations,” the authors concluded.1

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1. Iwashyna TJ, Smith VA, Seelye S, et al. Self-reported everyday functioning after COVID-19 infection. JAMA Netw Open. 2024;7(3):e240869. doi:10.1001/jamanetworkopen.2024.0869
2. World Health Organization. Post COVID-19 condition (long COVID). Published December 7, 2022.
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