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The Last Hours Complete Collection (Boxed Set): Chain of Gold; Chain of Iron; Chain of Thorns Hardcover – May 2, 2023

• Print length 2048 pages
• Language English
• Publisher Margaret K. McElderry Books
• Publication date May 2, 2023
• Grade level 9 - 12
• Reading age 14 years and up
• Dimensions 6 x 6.4 x 9 inches
• ISBN-10 1665916842
• ISBN-13 978-1665916844
• See all details

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About the author, product details.

• Publisher ‏ : ‎ Margaret K. McElderry Books; Boxed Set edition (May 2, 2023)
• Language ‏ : ‎ English
• Hardcover ‏ : ‎ 2048 pages
• ISBN-10 ‏ : ‎ 1665916842
• ISBN-13 ‏ : ‎ 978-1665916844
• Reading age ‏ : ‎ 14 years and up
• Grade level ‏ : ‎ 9 - 12
• Item Weight ‏ : ‎ 6 pounds
• Dimensions ‏ : ‎ 6 x 6.4 x 9 inches
• #42 in Teen & Young Adult European Historical Fiction
• #284 in Teen & Young Adult Dark Fantasy
• #303 in Teen & Young Adult Fantasy Action & Adventure

About the author

Cassandra clare.

Cassandra Clare is the author of the #1 New York Times, USA TODAY, Wall Street Journal, and Publishers Weekly bestselling Mortal Instruments series and the Infernal Devices trilogy, and coauthor of the Bane Chronicles with Sarah Rees Brennan and Maureen Johnson. She also wrote The Shadowhunter’s Codex with her husband, Joshua Lewis. Her books have more than 36 million copies in print worldwide and have been translated into more than thirty-five languages. Cassandra lives in western Massachusetts. Visit her at CassandraClare.com. Learn more about the world of the Shadowhunters at Shadowhunters.com.

Customer reviews

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Customers say

Customers find the character artwork in the first edition and Chain of Thorns very good. They also say the box set is very good as well.

AI-generated from the text of customer reviews

Customers find the box set very good.

" Awesome book " Read more

" This is a great set , I really like Cassandra Clare’s stories, I love the shadow hunters series, I’ve been reading these books throughout my teenage..." Read more

" Very good box set ..." Read more

Customers find the character artwork in the book cute.

"Books feature nice artwork on the book spines , and come in a really cool box." Read more

"...Plus these hard backs are super cute ." Read more

"...set also includes two collector’s first edition and Chain of Thorns has some character artwork ." Read more

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Shops and restaurants change opening hours for Euro 2024 final

Lidl, the German-owned discount retailer, has said all of its 800 UK shops will open later on Monday regardless of the outcome of the final.

Retailers, restaurants and other businesses across the UK have revealed changes to opening hours on Sunday and Monday to help staff and customers enjoy England’s Euro 2024 final.

England will play Spain in the final of the football tournament on Sunday at 8pm in Berlin, Germany.

It's coming home and so are we… To allow our colleagues time to enjoy the game, Locals and petrol stations across England will be closing early at 7:30pm on Sunday 14th July. Come on England!🏴󠁧󠁢󠁥󠁮󠁧󠁿 — Sainsbury's (@sainsburys) July 11, 2024

It has told staff and shoppers that it will push back its opening times on Monday by an hour, with stores typically moving back from 8am to 9am, although shoppers have been advised to check with their local store.

Poundland owner says summer stock hit by Red Sea shipping delays

Kidnap plot had ‘life-changing’ impact on Holly Willoughby, court told

Elsewhere, Sainsbury’s has said it will close its convenience shops and petrol stations early to allow employees to watch the big match.

The retailer said more than a thousand branches will shut at 7.30pm on Sunday, moving forward usual closing times of 10pm or 11pm.

Clodagh Moriarty, chief retail and technology officer said, “We want to give our colleagues the chance to tune in live and cheer on England with friends and family.”

Tesco already said ahead of England’s semi-final victory against the Netherlands that it would shut its Express shops early for an England final.

More than 1,800 Express stores will close at 7.30pm instead of the usual 10pm or 11pm to allow employees to watch.

Elsewhere, many restaurants have also said they will close their doors during the game so staff can enjoy the final.

Restaurant entrepreneur Richard Caring said he will shut Bill’s restaurants and 26 of his Ivy restaurants at 7pm on Sunday.

It said around 5,000 staff members will benefit from the early closure for the final.

A spokesman for Richard Caring said: “We are thrilled for the England team and it is a great chance for our staff, who have worked so hard through some very difficult times recently, to be able to watch the game.

“It is the first final for England outside of this country and they will now have many more voices cheering them on to what we hope will be a fantastic victory.”

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Man Dies After Placing Firework Atop His Head

It doesn't get much more American than blowing one's self up on the Fourth of July with fireworks.

Source: The Post And Courier

SUMMERVILLE — Wearing an Uncle Sam star-spangled suit and a top hat to match, Allen Ray McGrew danced around in the front yard as he smoked a cigarette on July 4th — his favorite holiday of the year. A line of smoldering firework mortars lined the edge of the street behind him. Hours later, a firework exploded on top of his head, killing him instantly. Dorchester County sheriff's deputies found the 41-year-old HVAC worker lying dead in the road after rushing to the 100 block of Cottonwood Drive, where an Independence Day Block party had come to an abrupt end around 10:30 p.m. Paige McGrew told deputies that her husband had placed the large firework on his head to "show off" after drinking for several hours, according to an incident report. “He was holding this firework over his top hat,” Paige later told The Post and Courier. “I thought he was just showboating before he set it on the ground. I didn’t realize he had already lit it.” His wife was telling McGrew to stop when the firework suddenly erupted and he collapsed, the report stated. Coroner Paul Brouthers said the exploding device caused massive head injuries that would have killed McGrew immediately. He was officially pronounced dead at the scene at 11:10 p.m. propertag.cmd.push(function () { proper_display('crooksandliars_content_1'); }); “Allen loved this holiday," she said. "He was a patriot; he was proud of his son and he was excited to have a new daughter-in-law. He was living his best life last night."

Morbid knowledge with the video, before he blew up.

This seemingly normal footage depicts 41-year-old Allen Ray McGrew in his final moments. Shortly after the video was captured, McGrew put a large firework on top of his hat and ignited it, leading to a fatal explosion. McGrew was dressed up as Uncle Sam to celebrate 4th of July… pic.twitter.com/1L99cFlbX3 — Morbid Knowledge (@Morbidful) July 6, 2024

Stephen King was intrigued by the story.

The coroner said the victim, 41-year-old Allen Ray McGrew, ignited a large firework on top of his head. Witnesses told investigators he was wearing a top hat, and put the firework on top of the hat before lighting it. The device exploded, causing “massive head injuries.” — Stephen King (@StephenKing) July 7, 2024

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• Official Shadowhunters Site
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Cassandra Clare

New York Times Bestselling Author of The Mortal Instruments

The Last Hours

The Last Hours  is a brand-new Shadowhunters series set in 1903. You don’t need to have read any other Shadowhunter books to get started with it, though if you have you may see some familiar faces!

Cordelia Carstairs is a Shadowhunter, a warrior trained since childhood to battle demons. When her father is accused of a terrible crime, she and her brother travel to London in hopes of preventing the family’s ruin. Cordelia’s mother wants to marry her off, but Cordelia is determined to be a hero rather than a bride. Soon Cordelia encounters childhood friends James and Lucie Herondale and is drawn into their world of glittering ballrooms, secret assignations, and supernatural salons, where vampires and warlocks mingle with mermaids and magicians. . .

Follow the adventures of Cordelia and her friends — James Herondale, Matthew Fairchild, Lucie Herondale, Thomas Lightwood, Anna Lightwood, and many more — through the glamour and danger of a supernatural Edwardian London. There will be three books: Chain of Gold, Chain of Iron, and Chain of Thorns  — the titles are taken from the a reference to Great Expectations, which inspired this series.

(" Imagine one selected day struck out of it, and think how different its course would have been. Pause you who read this, and think for a moment of the long chain of iron or gold, of thorns or flowers, that would never have bound you, but for the formation of the first link on one memorable day. " — Great Expectations

Chain of Gold

Chain of Iron

Chain of Thorns

Privacy overview.

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The Last Hours

The Last Hours is a trilogy written by Cassandra Clare and is the sequel series to The Infernal Devices . It is the fourth series published in The Shadowhunter Chronicles , but is the second chronologically. Its export rights were acquired by Walker Books .

Set in Edwardian London , Will and Tessa Herondale's children James and Lucie are continuing the fight against evil alongside their parabatais , Cordelia Carstairs and Matthew Fairchild , and more offspring of The Infernal Devices characters.

• 1.2 Audiobook editions
• 4 References
• Chain of Gold
• Chain of Iron
• Chain of Thorns

Audiobook editions [ ]

• Chain of Gold , Chain of Iron , and Chain of Thorns are all narrated by Finty Williams.

Gallery [ ]

• The series and book titles were taken from the Charles Dickens' classic novel Great Expectations , of which the series is a loose form of retelling (with there being parallels among characters: James like Pip and Grace as Estella (with many readers assuming that Cordelia is like Biddy in the situation), Matthew like Herbert, and Tatiana as Miss Havisham). [1] [2] [3] [4]
• According to Cassandra Clare : "The books will interconnect with The Dark Artifices trilogy as two separate trilogies that are also the stories of the Blackthorns, Herondales and Carstairs, much like The Mortal Instruments and The Infernal Devices interconnected despite taking place in different time periods and locations." [5] The story is also meant to connect in some way with The Wicked Powers series specifically. [6]
• The series was originally set to be released alternately with The Dark Artifices , [7] before Chain of Gold was delayed until after The Dark Artifices finale. [8] [9]
• Cassandra Clare released ten short stories ( vignettes ) revolving around the characters from The Last Hours , including Matthew Fairchild , Thomas Lightwood , James Herondale , Lucie Herondale , Cordelia Carstairs , Anna Lightwood , and more. They were released online to be read for free each month leading up to the release of Chain of Gold .
• Between the initial conception of the series and its publication, a large number of details were changed or removed; such as: Cordelia and Alastair are no longer white, Charlotte and Henry don't have young daughters, [10] a baby was supposed to need adopting, [11] the ending was originally much more tragic, [12] and even the character's personalities were different. [13] Also, Woolsey Scott , [14] Camille Belcourt , [15] Catarina Loss , [16] and Church [17] were all going to appear and we were meant to learn how Belial impregnated Elizabeth Gray despite not being able to walk the Earth. [18]

References [ ]

• ↑ "The Midnight Heir" — Cassandra Clare on Tumblr
• ↑ "Matthew [is Herbert]" — Cassandra Clare on Twitter
• ↑ "You're right [James is Pip, Grace is Estella and Tatiana is Miss Havisham]" — Cassandra Clare on Twitter
• ↑ "Last Hours is a retelling of Great Expectations — Cassandra Clare on Twitter
• ↑ Walker acquires new Cassandra Clare trilogy
• ↑ "TLH and TWP are especially connected." Cassandra Clare in a comment on Instagram
• ↑ "TDA will be alternate with TLH as TMI and TID? Say yes, Cassie, pretty please." "yes."
• ↑ Tentative book release schedule in 2017 — Cassandra Clare on Tumblr
• ↑ Cassandra Clare Newsletter from September 2017
• ↑ "They also have very young daughters." Cassandra Clare on Tumblr
• ↑ "There's an even more surprising baby that needs adopting in TLH." Cassandra Clare on Twitter
• ↑ Chain of Thorns cover reveal on SimonTeen's Instagram Live
• ↑ "None of the characters that you know are the characters as I would have constructed them" — Cassandra Clare on Instagram
• ↑ "Woolsey does appear in TLH" — Cassandra Clare on Tumblr
• ↑ "Very likely!" Cassandra Clare on Twitter
• ↑ "TLH gives me a chance to do Warlock Reunion," Cassandra Clare on Tumblr
• ↑ "During TLH, he lives in the London Institute," Cassandra Clare on Tumblr
• ↑ "This will get explained" — Cassandra Clare on Tumblr

• Shadowhunters
• 1 Jace Herondale
• 2 Clary Fairchild
• 3 Alec Lightwood

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07-11-2024 NEWS

Slurpee Day 2024: How to get your free frozen treat at 7-Eleven, Speedway, and Stripes today

The convenience store chain, which dates back to 1927, is celebrating its birthday on Thursday, July 11. That means the return of its annual promotion.

[Photos: 7-Eleven]

BY  Michael Grothaus 1 minute read

If the summer heat is getting to you, a delicious way to cool down is by grabbing a frozen beverage, like 7-Eleven’s iconic Slurpee.

And today, you can get the drink for free.

July 11 is when 7-Eleven celebrates its birthday (7/11, get it?). The convenience store chain turns 97 today. It was originally founded in 1927 as the Southland Ice Company in Dallas, and from 1928 to 1946, it was known as Tote’m Stores, before becoming the convenience store brand we’re all familiar with now.

7-Eleven also calls its birthday “ Slurpee Day ” since that’s the day it gives away its iconic drink as a gift to customers.

What are the rules of Slurpee Day and where can I get a free one?

Slurpee Day 2024 will see customers being able to grab a free small Slurpee of any flavor when they go to a participating 7-Eleven store.

There is no purchase necessary to get the free Slurpee. 

But 7-Eleven stores aren’t the only ones giving out free Slurpees today. The company’s two other brands, Speedway and Stripes Convenience Stores, will also be offering customers a free small Slurpee at participating locations.

How many free Slurpees can I get today?

If one free Slurpee isn’t enough, you can actually get a second small Slurpee for free if you are a 7REWARDS or Speedy Rewards loyalty program member. The second free Slurpee for members can be redeemed at the same time as you get the first free Slurpee, or you can wait to redeem the second free Slurpee until any time between now and July 31.

Finally, 7-Eleven has also announced that in celebration of Slurpee Day 2024, the company is offering a limited-edition MTN DEW Freedom Fusion Slurpee flavor, which you can choose as your free Slurpee—or opt for any other flavor you desire.

Recognize your technological breakthrough by applying to this year’s Next Big Things in Tech Awards! Deadline to Apply: Friday, July 12.

ABOUT THE AUTHOR

Michael Grothaus is a novelist and author. He has written for Fast Company since 2013, where he's interviewed some of the tech industry’s most prominent leaders and writes about everything from Apple and artificial intelligence to the effects of technology on individuals and society.   More

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Internet and Cable TV in Moscow

High-speed internet, 4g and wimax in moscow.

The modem and SIM can be bought at any telecom shop, such as Euroset, Svyaznoy, etc – there are plenty of them everywhere in Moscow.

Otherwise, you've also got high-speed internet connection in Moscow provided by local area networks (LAN), ADSL (Broadband), or cable TV. LAN's prices are often OK, but their service is not so good and the connection may sometimes go off. However, when it works, it is the fastest option (speed ~ 8Mb/sec).  ADSL (Broadband)  is provided by a few companies, such as MTU-Intel,  Comstar  (tel. +7 (495) 956-0000),  Combellga  (tel. +7 (495) 931-9950). The latter two offer good packages for businesses, however, if you just want high speed internet in your flat, the  Stream  (tel.: +7 (495) 105-5545) service is the best choice. They offer flatrate for about €30 / month with no contract, the connection speed is up to 3 Mb / sec, the setup costs wouldn't be more than $100 (including equipment) or free if there's a promotion. By the way, Yota (see above) also offers routers, which could be used at home, but you need to check the coverage first. Some  cable TV  providers offer internet in addition to their TV packages, but their prices and speed is not so good. In any case, you can try to Google Kosmos TV or Divo and see what they have on the offer.

Dial-Up Internet

Wi-fi (wireless internet) access points - wifi hotspots - in moscow:.

All you need is a special wireless internet adaptor card (already installed on Apple Macbook computers (airport) or PCs with Intel Centrino technology, otherwise available at any computer shop for about $30-$50). Wireless internet connection is free at most cafes and restaurants in Moscow, but some greedy places charge you about $10 per hour . It can be purchased online on the spot or at the counter (special pre-paid cards).  Free WiFi Internet Access Points in Moscow:

American Bar & Grill: American-style restaurant chain, average bill: $20 per person. 1st Tverskaya-Yamskaya, #1 (metro Mayakovskaya), Opened 24 hours. And Zemlyanoy Val, #59 (metro Kurskaya, Taganskaya), Opened 12.00-2.00 (until 5.00 on sunday). Provider: Yandex , Price: Free

Santa Fe Restaurants: Mexican cuisine. Mitulinskaya st., #5/1, bld 6 (metro Ulitsa 1905 Goda). Opened 12.00-24.00, and until 3.00am on thursday, friday, saturday. Provider: Yandex , Price: Free

TGI Friday's: A typical American restaurant famous for its cocktails. Lunchs for $10. Tverskaya #18/2 (next to Kodak Cinema, metro Pushkinskaya or Tverskaya - center), Leninsky prospekt #1/2, 1 (metro Oktyabrskaya - center), Zemlyanoy Val, #33, Garibaldi, #23 (metro Novye Cheremushki - south Moscow). Opened 12.00 to 24.00 daily. Provider: Yandex , Price: Free

Il Patio Restaurants: a chain of Italian restaurants in Moscow. (#1 - metro Kropotkinskaya, Volkhonka st., #13a - near Christ the Saviour church, #2 - metro Smolenskaya, Smolenskaya street, #3). Provider: Yandex , Price: Free

Starina Myuller Restaurant : Beer restaurant. Shmitovsky proezd, #2 / 1 (metro Ulitsa 1905 Goda). Provider: Yandex , Price: Free

Grand Imperial Restaurant: Russian cuisine, average bill: $30 per person. metro Kropotkinskaya, Gagarinsky pereulok, 9/5, opened 12.00 till the last visitor. Provider: Yandex , Price: Free

Boarhouse: A popular hang-out for expats. Zemlyanoy Val, 26A (opposite metro Kurskaya). Provider: EWi-Fi.Net , Price: Free

Wireless Internet at Moscow Airports.

TGI Friday's restaurant at Shermetyevo 2 airport (2nd floor, departures hall), Opened 24 hours. Provider: Tascom , Price: $10 / hour

Domodedovo airport (international departures hall, 2nd floor, VIP hall), opened 24 hours . Provider: Tascom , Price: $10 / hour

Wireless Internet at Moscow Hotels.

Mariott Hotels (the access is purchased at the reservation desk, access available in all Mariott hotels, reception, lobby, rooms). Provider: Moscom

Wireless Internet at Moscow Cafes.

Coffee Shops Coffemania (trendy coffee-shops chain). Provider: Moscom Price: $10 / hour, $70 for 300Mb or $110 for 1.5Gb 1. Rozhdestvenka street, building 6/9/20 2. Bolshaya Nikitskaya street, building 13/6 3. Kudrinskaya Plozhad', building 46/54.

Starlite Diner (American-style cafes and restaurants). Provider: Moscom Price: $10 / hour, $70 for 300Mb or $110 for 1.5Gb 1. m. Mayakovskaya, Bolshaya Sadovaya, 16; 2. m. Dobryninskaya, Koroviy Val, 9;

Delifrance Cafe: Mayakovskaya Metro, conservatory. Provider: EWi-Fi.Net Price: from $10 / hour

Shokoladnitsa coffee chain (metro Barrikadnaya, Bolshaya Gruzinskaya st., 2/12, opened 24 hours . Provider: Tascom , Price: $10 / hour

Metropolis (Cafe): Sadovaya Triumfalnaya 4-10. Provider: EWi-Fi.Net Price: from $10 / hour

Wireless Internet at Moscow Restaurants.

Scandinavia Restaurant (an upscale and expensive restaurant). Provider: Moscom , Price: $10 / hour, $70 for 300Mb or $110 for 1.5Gb. Palashevsky per, #7. (metro Tverskaya)

La Gateau (a French restaurant) Tverskaya St., #27 (metro Tverskaya, Pushkinskaya)

Restaurant SNOBBS , 1rst Obydenskiy pereulok, building 3, 4th floor. (this restaurant is for stuck-up snobbish creatures, so use it only in emergencies or if you are a snob yourself :). Provider: Moscom , Price: $10 / hour, $70 for 300Mb or $110 for 1.5Gb Bakhus: Malaya Bronnaya St, 20A (metro Mayakovskaya or Pushkinskaya). Provider: EWi-Fi.Net Price: from $10 / hour

Etazh: Tverskaya Street 14 (metro Tverskaya). Provider: EWi-Fi.Net Price: from $10 / hour

Hard Rock Cafe: Stary Arbat 44 (metro Smolenskaya). Provider: EWi-Fi.Net Price: from $10 / hour

Junka - (Chinese restaurant): Tversckoy Bulvar 22, Theatre "MHAT Gorkogo" (metro Pushkinskaya, Tverskaya). Provider: EWi-Fi.Net Price: from $10 / hour

La Cantina: Tverskaya Street 5/6 (metro Okhotny Ryad). Provider: EWi-Fi.Net Price: from $10 / hour

Silvers (Irish Bar): Bolshoy Nikitisky Per. Provider: EWi-Fi.Net

Trivia Taverna: Spiridonovka Per . Provider: EWi-Fi.Net Smolensky Passage Trading Center (metro Smolenskaya) locations at Pizza Express restaurant, opened mon-fri 8.30-23.00, sat-sun 11.00-23.00. Provider: Tascom , Price: $10 / hour Restaurant Maner at Berlin House: metro Teatralnaya, Kuznetsky Most, Petrovka st., #5, first floor. Provider: Tascom , Price: $10 / hour

Cable TV Providers in Moscow

Below is a list of Moscow cable TV operators and their offers.

Comcor-TV (antenna, not all areas are covered yet) Internet: http://www.comcor-tv.ru Telephone: (495) 231-3333 Offers: 17 foreign channels for $13,4 / month, 10 channels for $9.1 / month, additionally internet packages for $33 / month (unlimited 256/128) or $15 / month (200Mb, 64/64) can be purchased. Installation fees vary from $20 to $50. They speak English.

Kosmos-TV (through antenna pointed towards Ostankino TV tower, good coverage) Internet: http://www.kosmos-tv.ru/ Telephone: (495) 730-0000 Offers: 23 foreign channels for $20 / month , installation fees start at $100. They speak English. Divo TV (through a standard TV cable, simple installation, cheap equipemtn, but not all areas in Moscow are covered yet) Internet: http://www.divotv.ru Telephone: (495) 787-0000 Offers: Installation fees are from $79 to $129, 21 channel package costs $10 / month, 32 channel package costs $18 / month. Film-on-demand feature is $2 one-time fee.

NTV Plus (satellite dish, available in the whole Russia) Internet: http://www.ntvplus.ru/calculator Telephone: (495) 755-5545 Offers: 40 channels (including Russian ones) for 19$ / month

• Park Live Festival (July 12-14)
• Picnic Afisha Festival (August 3)
• Sokolniki Camping for Tents and Motorhomes in Moscow

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It’s hard to count the exact number of great Russian writers who showed their love for Moscow. The city has attracted and prompted stories for a long time now, inspiring many to express their writing talent. Thus, Moscow’s literary sights are fully deserving of our attention, and this guide gladly presents you six of them, from museums to apartments.

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Pre-order Lord of Shadows and Receive an Exclusive Shadowhunter Rune Pin!

Join the shadowhunter army, cassandra clare's author alert, see who's reading tales from the shadowhunter academy on audio, cassie clare on twitter, the last hours, the sequel trilogy to the #1 new york times bestselling infernal devices trilogy.

[Warning: Spoiler alert ahead for those that haven’t read The Infernal Devices trilogy] The Shadowhunters enter the Downton Abbey era in The Last Hours. Will Herondale is head of the London Institute, where he lives with his wife Tessa. But now it’s their children, James and Lucie, who take center stage, alongside their parabatai, Matthew Fairchild and Cordelia Carstairs.

Texas power outage map: Over a million without power days after Beryl

Over a million Texas homes and businesses are without electricity days after Beryl made landfall, but there is no word on when power will be stored to Texas homes and thousands could be left without power a week after the storm made landfall.

Beryl passed through Texas on Monday and as of 6:50 a.m. CT Thursday, 1.3 million Texas homes and businesses remain without power , according to poweroutage.us.

Beryl made landfall as a Category 1 hurricane early Monday morning. It then traveled across the eastern part of the state before dissipating to a tropical storm and continuing its path towards Arkansas.

The number of people without power is lower than on Monday when 2.7 million people were reported to be without power.

Beryl updates: Recovery begins amid heat advisory, millions without power in Texas

Texas power outage map

When will power be restored.

Thousands of CenterPoint customers could be without power a week after the storm passed through, reports ABC 13.

1.1 million people could have their power restored by Sunday, CenterPoint said in a statement. It estimates that 400,000 customers will have power restored by Friday and 350,000 by Sunday, but 400,000 will remain without electricity a week after the storm made landfall.

We reached our goal of restoring 1 million customers by end of the day today. We expect to have an additional 400,000 customers restored by the end of the day on Friday, July 12 and an additional 350,000 customers restored by the end of the day on Sunday, July 14. Read our latest… pic.twitter.com/MFTdIFx0pU — CenterPoint Energy (@CenterPoint) July 11, 2024

"CenterPoint's electric customers are encouraged to enroll in Power Alert Service to receive outage details and community-specific restoration updates as they become available," it stated. "For information and updates, follow @CenterPoint for updates during inclement weather events."

CenterPoint restoration map

CenterPoint released a map detailing where and when power will be restored.

Harris, Fort Bend and Brazoria have the highest numbers of outages, with Harris having nearly a million, according to the website.

Biden declares disaster declaration

On Tuesday, President Joe Biden approved a major disaster declaration for Texas .

"The greatest concern right now is the power outages and extreme heat that is impacting Texans," said Biden in a statement. "As you all know, extreme heat kills more Americans than all the other natural disasters combined."

The Red Cross has set up shelters across the affected area and is inviting people to come in, even if it's to escape the heat for the day.

"We want folks to understand that, with there being more than 2 million or so without power in this area that they can come to these shelters even if they're not going to stay overnight, even if they haven't sustained damage to their homes," Stephanie Fox, the national spokesperson for the American Red Cross in Fort Bend County, Texas, previously told USA TODAY.

Julia is a trending reporter for USA TODAY. She has covered various topics, from local businesses and government in her hometown, Miami, to tech and pop culture. You can connect with her on  LinkedIn  or follow her on  X, formerly Twitter ,  Instagram  and  TikTok : @juliamariegz

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Where Will Nvidia Stock Be in 5 Years?

• Nvidia is a great company with everything it needs for success, but its valuation is cause for concern.
• Profits on the software side of the artificial intelligence industry will need to grow to justify the current level of spending on Nvidia's hardware.
• Motley Fool Issues Rare “All In” Buy Alert

NASDAQ: NVDA

How much longer can this rally last?

Long-term investing is the key to generating sustainable returns in the stock market. Perhaps few will understand this better than Nvidia ( NVDA 1.83% ) shareholders, who have enjoyed total returns of more than 3,000% during the past five years despite challenges like the COVID-19 pandemic and rising interest rates, which crushed many stocks in the short term.

But what could the next half-decade have in store for this powerful technology leader?

The king of the AI opportunity

Since the release of OpenAI's ChatGPT in late 2022, the tech industry has scrambled to accumulate generative artificial intelligence (AI) hardware, such as Nvidia graphics processing units (GPUs), which provide the processing power necessary to run and train AI's complex algorithms. Nvidia's second-quarter earnings demonstrate how this new demand has transformed its operations.

Revenue doubled year over year to $13.51 billion, driven by sales of high-end data center GPUs such as the H100. Profits jumped eightfold to $6.18 billion. And management aims to extend the company's dominance by accelerating the pace at which it releases new AI chips from biennially to annually, which will put even more pressure on its competition.

Nvidia is also expanding into new opportunities like custom chips, a $30 billion opportunity to serve clients with needs for their AI workloads that aren't as well-served by one-size-fits-all solutions.

All in all , the company looks capable of maintaining its 80% market share in the AI chip sector for the next five years and possibly beyond.

The valuation isn't as good as it looks

Though its market cap has more than doubled in 2024 alone, Nvidia stock may seem reasonably priced when measured against its bottom line. With a forward price-to-earnings (P/E) of about 49, the company's expected future earnings are valued at a premium to the NASDAQ 100 's average of 29 -- no surprise considering the company's growth rate (first quarter earnings soared 628% year over year to $14.9 billion). But this situation is much more complicated than it looks on the surface.

Most of today's large tech companies built up their earnings over decades with businesses well integrated into the productive economy. But this is not necessarily the case for most of Nvidia's explosive growth since 2022. The chipmaker has become overreliant on the speculative AI industry, which currently isn't generating much in the way of either earnings or cash flow.

Image source: Getty Images.

According to Sequoia Capital, the AI industry has already spent $50 billion on Nvidia's AI chips, while generative AI start-ups have only earned $3 billion in revenue. In other words, so far, the AI boom has been based on the proverbial selling picks and shovels to miners instead of actually getting gold out of the ground. This is an unsustainable situation -- unless things change, eventually, those "miners" won't be able to afford their hardware expenses.

Bearing this uncomfortable fact in mind, Nvidia's stock isn't cheap, because its current valuation assumes demand for AI GPUs will remain elevated. And this is far from guaranteed.

Is Nvidia stock a buy?

Over the long term, Nvidia could sail through some of its biggest near-term challenges. While many consumer-facing AI businesses are losing money right now, they could eventually mature into profitable enterprises capable of sustaining enormous spending on Nvidia chips.

The industry could also diversify with contributions from AI use cases like self-driving cars and robotics, which would be great news for Nvidia shareholders.

But these are all what-if scenarios. And with Nvidia's stock currently priced for perfection, betting on this long-term thesis looks risky. It may make more sense to hold off until more information becomes available.

Will Ebiefung has no position in any of the stocks mentioned. The Motley Fool has positions in and recommends Advanced Micro Devices and Nvidia. The Motley Fool has a disclosure policy .

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• Systematic Review
• Open access
• Published: 07 July 2024

Work ability and return-to-work of patients with post-COVID-19: a systematic review and meta-analysis

• Marcel Ottiger 1 ,
• Iris Poppele 1 ,
• Naveen Sperling 1 ,
• Torsten Schlesinger 1 &
• Katrin Müller 1  

BMC Public Health volume  24 , Article number:  1811 ( 2024 ) Cite this article

1450 Accesses

390 Altmetric

Metrics details

In addition to several sequelae of post-COVID-19, individuals also experience significant limitations in work ability, resulting in negative consequences for the return-to-work (RTW) process. This systematic review and meta-analysis were conducted to assess the impact of post-COVID-19 on work ability and RTW of individuals previously infected with SARS-CoV-2.

Studies on the work ability and RTW of patients with post-COVID-19 (more than 12 weeks after an acute SARS-CoV-2 infection) were regarded eligible for inclusion. Systematic search of literature was performed up to March 2023 using five databases (MEDLINE, EMBASE, CINAHL, CENTRAL and WHO COVID 19). Study selection followed the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) Statement. A meta-analysis estimated the overall success rate of RTW. The risk of bias of the included studies was evaluated with the Newcastle Ottawa Scale (NOS).

19 relevant studies, published between 2021 and 2023, were included in the systematic review, involving 21.155 patients from 14 different countries. The findings indicate that a significant proportion of individuals with post-COVID-19 experience persistent symptoms and functional impairments, with fatigue being the most prominent symptom. These persistent symptoms can have a considerable (negative) impact on individuals’ physical and psychological capacity to participate in work-related activities, leading to lower work ability and increased absenteeism. The RTW for post-COVID-19 patients is complex, with approximately 60.9% of patients successfully returning to work after 12 or more weeks following SARS-CoV-2 infection. Among those who successfully returning to work, a considerable number need modifications in their work duties or hours to cope with residual impairments. Factors such as workplace accommodations, supportive policies, and occupational rehabilitation programs play a crucial role in facilitating successful RTW.

Conclusions

The systematic review underscores the substantial impact of post-COVID-19 on work-related outcomes. The implications of this research highlight the need for healthcare providers, employers, and policymakers to collaborate in creating inclusive work environments and implementing tailored rehabilitation programs to support individuals recovering from post-COVID-19. Further research should focus on long-term follow-up studies with mixed methods to gain a more comprehensive understanding of the long-term consequences of post-COVID-19 on work ability and RTW outcomes.

PROSPERO registration number

CRD42023385436.

Peer Review reports

Workplaces were generally a high-risk setting for virus transmission of SARS-CoV-2 due to interpersonal contacts with colleagues, clients or patients [ 1 , 2 ]. Reuter et al. [ 3 ] conducted a study involving more than 100.000 workers across diverse occupational segments such as medical healthcare, as well as business management, and observed an incidence rate of 3.7 infections per 1.000 workers. SARS-CoV-2 infections were higher in essential (180 infections among 33.458 workers) workers compared with workers in non-essential (224 infections among 75.502 workers) occupations (incidence rate ratio 1.95) [ 3 ]. Particularly, healthcare workers were more likely to be affected by COVID-19 (coronavirus disease 2019), compared with other professions [ 4 , 5 , 6 ]. In Germany until October 2023, 350.045 cases of COVID-19 were recognized as occupational diseases (BK) with BK-No. 3101. Furthermore, 26.698 recognized cases of COVID-19 were recorded as work-related accidents (according to the German Social Accident Insurance) [ 7 ]. Acute infection with SARS-CoV-2 can lead to several persistent symptoms [ 8 , 9 , 10 ]. According to the NICE (National Institute for Health and Care Excellence) guideline, persistent signs and symptoms after an acute SARS-CoV-2 infection, which continue for more than 12 weeks and cannot be explained by an alternative diagnosis, are classified as post-COVID-19 [ 11 ].

In population-based cohort studies, the prevalence of ongoing post-COVID-19 symptoms was estimated to be around 6% depending on, for example, virus variants, study design and study population [ 12 , 13 , 14 ]. A pooled analysis of data from 22 countries defined three main post-COVID-19 symptom clusters: persistent fatigue, cognitive problems and ongoing respiratory problems [ 12 ]. This study showed, that 6.2% of over one million individuals, who had symptomatic SARS-CoV-2 infection, experienced at least 1 of the 3 symptom clusters [ 12 ]. In a systematic review, including 70 studies of working age adults, the most frequently reported long-/post-COVID-19 symptoms were fatigue (92%), shortness of breath (82%), muscle pain (44%), and joint pain (35%) [ 15 ]. Moreover, findings from systematic reviews and meta-analyses indicated, that the prevalence of post-COVID-19 symptoms in adults, who were hospitalized due to COVID-19, was substantially higher, than in cases with mild or asymptomatic courses of the disease [ 16 , 17 ]. Studies revealed that both physical as well as neuropsychological limitations can persist for several months (4–24 months) after acute SARS-CoV-2 infection [ 18 , 19 , 20 , 21 , 22 ]. Especially in the case of post-infectious fatigue, a symptom that affected a large number of post-COVID-19 patients, results on long-term courses of other viral and non-viral infectious diseases (e.g., SARS virus, Q-fever, Lyme disease) indicated the risk of chronification [ 23 ].

Patients also reported severe limitations in their ability to work with negative consequences on the RTW process. A systematic review concluded that long- and post-COVID-19 symptoms are increasing problems in occupational medicine, because they influence the RTW-process and quality of life of workers previously hospitalized with SARS-CoV-2 [ 24 ]. Even a mild SARS-CoV-2 infection can result in a significant reduction in work capacity [ 25 ]. Work ability is a multidimensional concept of various factors that enable employees to successfully complete the work tasks [ 26 ]. The interaction of both personal resources (health, psychophysical performance, professional competence, values and attitudes) as well as work requirements (e.g., work conditions) for maintaining individual work ability takes place in the concept of the “House of Workability” [ 27 ]. Previous research showed that a variety of factors influence the work ability of people with long-term diseases, such as work demands, age, gender, comorbidities and somatic complaints [ 28 ]. In addition, poor work ability was also associated with early retirement [ 29 ], a factor that had significant consequences for both the labor market (fewer skilled workers) and the economy (low productivity) [ 30 ]. As we delved into the concept of RTW, this comprehensive understanding became crucial. Importantly, the RTW process hinged on the restoration of work ability, emphasizing the need for employees to recover their physical and mental capacity to work before entering the occupational reintegration phase. Previous studies showed that improved work ability influenced the RTW positively [ 31 , 32 ]. This relation emphasized the interdependence of work ability and the subsequent RTW, which refers to the process of reintegration into the workforce after an extended period of absence, whether due to illness, injury, or other reasons. Accordingly, various factors both at individual (e.g., socioeconomic status, expectations, psychological recourses) as well organizational level (e.g., workplace factors, RTW coordination) can determine successful RTW after an injury or illness [ 33 ]. In the case of post-COVID-19 patients, the RTW process might be complicated by a range of factors, such as ongoing symptoms, and long-term effects of the disease [ 34 ]. Aben et al. [ 35 ] observed variations in the RTW duration influenced by different virus variants. The duration was found to be longest when the alpha variant was predominant and became progressively shorter with the emergence of the delta and omicron variants [ 35 ]. As highlighted by the meta-analysis of Kamdar et al. [ 36 ], conducted before the COVID-19 pandemic, RTW after critical illness is often delayed (36% at 1–3 months, 60% at 12 months) and accompanied by worsening employment status and performance (e.g., fewer work hours).

While the long-term physical and psychological effects of COVID-19 are meanwhile well documented, the potential occupational impact remains to be explored. Understanding the work ability and RTW of patients with post-COVID-19 is crucial for healthcare professionals, occupational health professionals, employers, and policymakers in adapting or developing strategies and interventions to support the recovery and reintegration of these patients into the workforce and to ensure their social participation. It is particularly pivotal for mitigating potential increases in occupational disability and early retirements, thereby playing an essential role in minimizing broader impacts on the labor market and the economy. However, there is currently limited research available on this topic. A systematic review of the available evidence on work ability and RTW of patients with post-COVID-19 is therefore needed to provide a comprehensive analysis of the existing literature and to identify gaps in knowledge and research needs that guide future research. The aim of this systematic review and meta-analysis is to synthesize the evidence on work ability and RTW of patients with post-COVID-19. Specifically, the review will address the following research question:

What is the impact of post-COVID-19 on work ability and the RTW process of patients previously infected with SARS-CoV-2?

By addressing and bridging the gaps in knowledge and synthesizing the available evidence, this systematic review will contribute to systematize the growing body of literature on the post-COVID-19 population and support efforts to mitigate the long-term effects of the pandemic on the global workforce.

This systematic review of the literature was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement [ 37 ]. To ensure transparency and reproducibility, the review adheres to the PRISMA checklist, which can be found in Appendix 1 in the supplementary materials. The protocol was registered in the International Prospective Register for Systematic Reviews (PROSPERO) database (Registration number: CRD42023385436).

Search strategy

The PRISMA Statement suggest performing the search across multiple databases; therefore, we have chosen five databases due to their relevance in the medical field. A comprehensive search in MEDLINE (via EBSCO), EMBASE (via Ovid), CINAHL (via EBSCO), Cochrane Central Register of Controlled Trials (CENTRAL) and WHO COVID 19 was conducted from January 2020 until December 2022 to encompass the period since the onset of the COVID-19 pandemic. The search in the five databases was repeated in March 2023 to identify further studies with longer analysis periods. The literature search strategy used MeSH terms (Medical Subject Headings) and text words associated with post-COVID-19 and work ability or RTW. MeSH terms used to perform the search in MEDLINE, were the following:

(“coronavirus” OR “covid-19” OR “sars-cov-2” OR “coronavirus infections” OR “betacoronavirus”) AND (“workplace” OR “return to work” OR “absenteeism” OR “occupational health” OR “work performance” OR “work capacity evaluation” OR “sick leave”).

SIGN search filters were used to identify randomized trials and observational studies in the MEDLINE, CINAHL and EMBASE databases [ 38 ]. In addition, secondary searches in other sources, such as Google Scholar and medRxiv were also carried out, to retrieve relevant publications that were not found with the database search. To ensure that the literature was comprehensive, the reference lists of the included studies or relevant reviews identified through the search, were scanned. Furthermore, a search was carried out in the German Register for Clinical Studies (DRKS) and the International Clinical Trials Registry Platform (ICTRP) search portal of the WHO to identify ongoing, discontinued and completed studies. The full search strategy is presented in Appendix 2 . The literature search was conducted independently by two reviewers.

Eligibility criteria

Studies on the work ability and RTW of patients with post-COVID-19 were regarded eligible for inclusion if the following criteria were fulfilled: (1) population: patients with persistent signs and symptoms more than 12 weeks after an acute SARS-CoV-2 infection; (2) intervention: SARS-CoV-2 infection (diagnosed by RT-PCR, suspected, self-report). Comparison was not applicable due to the aim of the performed review; (3) outcomes: the primary outcome measures of the systematic review were work ability and RTW of patients with post-COVID-19. Since work ability and RTW can be measured in different ways, several methods for outcome collection were accepted for this review, including for example interviews; and (4) following types of studies: interventional studies (e.g., randomised clinical trials) and observational studies (e.g., prospective cohort studies).

The exclusion criteria were as follows: (1) studies involving subjects without SARS-CoV-2 infection; (2) case series, case reports, pilot studies, unpublished data, editorials, news articles, commentaries, studies not involving humans and systematic reviews; and (3) studies published before 2020. This review was restricted to articles written in English or German language.

Study selection

The screening of articles was carried out in two stages [ 39 ]. After duplicates were removed, two persons independently screened the titles and abstracts of references retrieved from the searches and categorized them as relevant, not relevant, or possibly relevant. Studies that clearly did not align with the research objectives, such as those unrelated to COVID-19 work outcomes, were excluded. Studies that were categorized as relevant or potentially relevant by at least one reviewer underwent a full-text-screening. In this second stage the full-text versions of eligible articles were evaluated by both reviewers regarding the inclusion criteria independently. Articles were included if they met the predefined criteria. Any disagreement for inclusion was resolved through discussion between the reviewers and, if necessary, via consultation of the supervising researcher. The screening process was facilitated using Rayyan [ 40 ], which allowed blinding in each step of the process. The selection process is documented in the PRISMA flowchart (Fig.  1 ).

PRISMA flowchart of the article selection process

Data extraction

At the end of the filtering, the extracted features were recorded using a pre-designed data table in Excel. The review authors extracted data from each eligible study. The study team extracted bibliographic data (author, title, year, location and study design), population (age, gender distribution, occupation, comorbidities/risk factors, acute COVID-19 severity), sample size, duration of follow-up, outcome measurements, main results, post-COVID-19 symptoms and results on RTW/ work ability.

Statistical analysis

A random effects proportional meta-analysis [ 41 ] was used to compute a pooled estimate of the RTW rate and respective 95% confidence intervals (CIs). When conducting a meta-analysis on prevalence and encountering heterogeneity in prevalence estimates across studies, it is recommended to employ a random effects model [ 42 ]. This is because a fixed effects model may yield misleading outcomes when significant heterogeneity is present, which is the case in current study. The analysis was performed using the DerSimonian and Laird random-effect [ 43 ]. The statistical heterogeneity between the studies was determined by the τ 2 and I 2 . I 2 indexes of 25%, 50%, and 75% indicated low, moderate, and high heterogeneity, respectively [ 44 ]. Also, the corresponding sample sizes were considered. Events classified the number of individuals who successfully achieved RTW, while Total represented the overall number of individuals, from which RTW rates could be derived. Publication bias was evaluated through a visual inspection of funnel plots. Statistical analysis was conducted using R [ 45 ] and RStudio (version 4.3.0) [ 46 ] and statistical significance was set at p  < 0.05. The forest plot was generated using the “tidyverse” [ 47 ], “meta” [ 48 ], and “metafor” [ 49 ] packages in R. When conducting the meta-analysis, studies that did not provide data for analysing RTW rates were excluded from the analysis. This ensured that only studies with comprehensive RTW rates were included in the meta-analysis. No subgroup meta-analysis could be performed due to the to the limited number of studies providing data on RTW. A narrative, qualitative summary of the work ability of patients with post-COVID-19 was carried out and is presented in text and table form to summarise and explain the characteristics and findings of the included studies.

Meta-analysis of RTW of post-COVID-19 patients

Risk of bias in individual studies

The risk of bias of the included cohort studies was evaluated with the Newcastle Ottawa Scale (NOS) [ 63 ], modified for cohort and cross-sectional studies [ 22 ]. The NOS’s utilizes a star system. The cohort tool assigns a maximum of 9 stars in 3 domains: (1) selection of study groups (max. 4 stars), (2) comparability (max. 2 stars), and (3) ascertainment of outcome (max. 3 stars). In the cross-sectional tool a maximum of 9 stars for quality assessment across the same 3 domains can be attained: (1) selection of study groups (max. 5 stars), (2) comparability (max. 2 stars), and (3) ascertainment of outcome (max. 2 stars). A higher score indicates a higher quality of the study. The total score could be categorized into three groups: low quality (0–4 stars), moderate quality (5–6 stars), high quality (7–9 stars). The risk of bias was assessed independently by two review authors and results were corroborated, with discrepancies resolved through discussion. Modified NOS’s (see Appendix 4 ) and methodological quality rankings for each study type are provided.

Search results and study selection

The comprehensive search identified a total of 5.967 articles across the five databases (MEDLINE, EMBASE, CINAHL, CENTRAL and WHO COVID 19) and 8 additional records through other sources (see Fig. 1 ). After duplicates were removed, 4.625 references remained for the initial screening by title and abstract. This screening resulted in a total of 4.571 excluded articles. The remaining 54 articles were screened by full text, of which 35 did not meet the inclusion criteria with following reasons: wrong study population ( n  = 13), wrong outcome ( n  = 10), no full-text available ( n  = 6), wrong follow-up time ( n  = 2), wrong study design ( n  = 2), duplicate ( n  = 1) and wrong language ( n  = 1). 19 studies met the inclusion criteria and were included in the systematic review [ 18 , 25 , 50 - 62 , 64 - 67 ].

Study characteristics

The characteristics of the 19 studies included are reported in Table  2 . The studies were published between 2021 and 2023. Regarding study design, 12 studies corresponded to cohort studies and 7 to cross-sectional studies. The overall population included 21.155 patients (65.3% female; 34.7% male). Study sample sizes ranged from 42 to 11.955 patients with post-COVID-19 (mean: 1.113). Most studies included middle aged participants (on average 49.15 years of age). The mean follow-up time was 11 months (range 3 months – 24 months). In all, 14 studies included patients treated in the hospital (range: 6.5 − 100%), 8 studies patients treated in intensive care units (ICU) (range: 1.2 − 28.5%) during acute SARS-CoV-2 infection, 3 studies included only non-hospitalized patients and 2 studies did not provide information. The studies were conducted in 14 different countries, of which 5 were implemented in Germany, 3 in Sweden, 2 each in Italy and the United Kingdom and 1 each in Brazil, Canada, Spain, Switzerland, Australia, Denmark and France.

Impact of post-COVID-19 on work ability

Out of the 19 studies included in the review, 15 of them providing data on the impact of post-COVID-19 on work ability. The following analysis summarizes the key findings from each study regarding work status, sick leave, work ability, and limitations in work duties/hours and taking into account different follow-up periods (see Table  1 ).

Follow-up less than 12 months

Many post-COVID-19 patients experienced a prolonged recovery period after COVID-19, leading to temporary or long-term work limitations. Five studies had a follow-up time less than 12 months after the acute SARS-CoV-2 infection. The studies revealed that even individuals with mild or moderate acute SARS-CoV-2 infection required an extended period to recover their pre-illness work capacity. In the study by Davis et al. [ 25 ] 957 (27.3%) participants were able to maintain the same working hours as before the onset of infection. 817 (23.3%) patients were not working 3–7 months after the SARS-CoV-2 infection. Additionally, 1.598 (49.3%) participants were working reduced hours, suggesting some limitations in their work capacity. The cross-sectional study conducted by Nielsen et al. [ 54 ] with a follow-up of approximately 8 months reported a higher percentage of participants working the same hours as before the SARS-CoV-2 infection. Specifically, 39.4% of the participants in the study were able to continue working to the same extent as they did prior to the infection, while 215 out of 401 (53.6%) were on sick leave (84/215 full-time sick leave; 131/215 part-time sick leave). The national registry-based study by Westerlind et al. [ 51 ] involved 11.955 patients (follow-up: 4 months) and reported that 1.592 (13.3%) were on full-time sick leave for post-COVID-19. Kedor et al. [ 53 ] consisted a cross-sectional study of 42 post-COVID-19 patients with a follow-up of 6 months and highlighted that participants had a median Bell disability score of 40 (post-COVID/ME/CFS-group) and 50 (post-COVID/non-ME/CFS-group) indicating limited work ability (reduced working hours or inability to work). Kupferschmitt et al. [ 50 ] and Rutsch et al. [ 52 ] are two studies that evaluated work ability following rehabilitation. Kupferschmitt et al. [ 50 ] examined a sub-sample of 51 post-COVID-19 patients. Out of the 51 individuals assessed, 28 (54.9%) were unable to work on admission. At the time of discharge, 18 participants (35.3%) showed an ability to work at least 6 h per day. Additionally, 6 patients (11.8%) underwent gradual reintegration. Prior to admission, a significant proportion of participants (43.1%) were on sick leave for over 6 months, 13.7% for 3–6 months, and 41% for less than 3 months. 2.0% were not employable. In the study conducted by Rutsch et al. [ 52 ], the rehabilitation took place 5 months after SARS-CoV-2 infection. The study reported that 32% of participants experienced restoration of their work ability after rehabilitation. The mean Work Ability Score (WAS) of the Work Ability Index (WAI) was 4 on a scale of 0–10, indicating some limitations in work capacity. 41% perceive their work ability as permanently at risk. Among the participants, 88 out of 178 (49%) were on sick leave, with an average duration of 21 weeks.

Follow-up between 12 months and 18 months

In 15 studies that provided data on the impact of post-COVID-19 on work ability, there were 6 studies with a follow-up period between 12 months and 18 months. In the study of Buonsenso et al. [ 55 ] with a sample size of 154 participants, the majority (85.7%) maintained the same occupational status as before COVID-19. However, 22 patients (14.3%) experienced a change in their work status with following reasons: sick leave ( n  = 7), loss of job due to ill health ( n  = 3), shortening of working hours ( n  = 3), fired ( n  = 1), different reasons ( n  = 7). Kisiel et al. [ 56 ] included 158 post-COVID-19 patients followed up for 12 months. Among the 158 participants, 35% were on sick leave during the follow-up period, with an average duration of 8.1 weeks. Patients with persistent symptoms at the 12-month follow-up reported a decrease in work ability. With a follow-up of 13 months, Diem et al. [ 57 ] highlighted that 168 patients (62.7%) were unable to work, and the average sick leave duration was 26.6 weeks. There was a significant association between inability to work and symptoms such as fatigue, pain, and sleep disturbances. Müller et al. [ 58 ] performed a study on a total of 127 patients, and had a median time between SARS-CoV-2 infection and beginning of rehabilitation of 408.81 days. Among the participants, 90 (72.5%) were unable to work after rehabilitation. The majority of patients reported poor (69.8%), 29.3% moderate, and only 0.9% good work ability measured by the WAI. WAI-scores (scale 7–49) before (Median (Mdn): 24.75) and after (Mdn: 24.75) rehabilitation did not show significant changes. The study by Peters et al. [ 59 ] involved a large sample of 1.406 post-COVID-19 patients. The WAS-scores (scale 0–10) decreased from 9.3 before COVID-19 to 6.8 at the time of the survey, indicating a decline in work ability over time. The authors showed that the work ability was significant different between patients with symptoms > 3 months and patients without symptoms. Sansone et al. [ 60 ] conducted a study with 247 participants who were followed up for 15 months. The findings reveal that participants with symptoms lasting 200 or more days (Mean (M): 4.5 ± 1.44) had significantly lower mean work ability-scores (scale 1–6) compared to those with symptoms lasting less than 200 days (M: 5.18 ± 1.08; p  < 0,001).

Follow-up more than 18 months

Some individuals experienced a prolonged recovery period after COVID-19, leading to long-term work limitations. Three studies had a follow-up time of 15 months and longer. Delgado-Alonso et al. [ 61 ] involved 77 participants who were followed up for an average of 20.71 months. Out of the participants, 38 (49.4%) were working, while 39 (50.6%) were not working. Among those who were currently not working, 36 (92.3%) were on sick leave. A portion of the participants (16%) reported reduced working hours, and 23% required job adaptation (e.g., more breaks, telework, cognitive aids, or a position change). Factors contributing to work disability include higher levels of fatigue, and lower cognitive performance. The cohort study by van Wambeke et al. [ 62 ] included 45 participants who were followed up for 22 months. Among these participants, 18 (40%) patients were working full-time, 3 (6%) working 60-70% of the time, 8 (18%) working half-time and the remaining individuals (36%) did not RTW. Among the mentioned studies, Wahlgren et al. [ 18 ] conducted the longest follow-up period with 24 months. At the 4-month follow-up, the majority (69.1%) of the participants were working, while a smaller proportion (23.4%) were on sick leave. At the 24-month follow-up, a similar percentage (66 out of 94 patients) were working, and a smaller proportion (16 out of 94 patients; 16%) were on sick leave.

Impact of post-COVID-19 on return-to-work

The meta-analysis included eight studies that examined the RTW outcomes of patients previously infected with SARS-CoV-2 (Fig.  2 ). The random-effects meta-analysis estimated a pooled proportion of 0.609 (95% CI: 0.458–0.751), indicating that approximately 60.9% of post-COVID-19 patients were able to successfully RTW 12 or more weeks following the SARS-CoV-2 infection. In the Forest Plot, the dashed line represents the aggregated average RTW rate across all studies. Studies to the right of this line tend to indicate higher RTW rates, while those to the left suggest lower rates. Among the individual studies, Hodgson et al. [ 67 ] had the highest weight (13.1%) and reported a proportion of 0.886 (95% CI: 0.813–0.938), suggesting a high likelihood of successful RTW. The remaining studies had weights ranging from 11.5 to 13.0% and reported proportions ranging from 0.414 to 0.833. Heterogeneity analysis yielded an I 2 index of 92% and a τ 2 of 0,042 with p  < 0.01, indicating substantial variability and inconsistency. Visual inspection of funnel plot asymmetry for the RTW meta-analysis did not suggest the presence of publication bias (Appendix 5 ), and the Peters’ regression test (intercept = 1.111; standard error (SE) = 0.147; p  = 0.146) was not statistically significant.

Factors influencing the work ability and return-to-work of post-COVID-19 patients

Based on the information provided from various studies, several influencing factors for work ability and RTW of post-COVID-19 patients could be identified. The duration between symptom onset and the beginning of rehabilitation or treatment influences the likelihood of returning to work [ 65 ]. Early intervention and rehabilitation improve the chances of returning to work. Job adaptations and modified duties, such as reduced working hours, tasks with lower physical or mental strain, telework or flextime can positively affect work ability and facilitate the RTW [ 25 , 65 ]. Economic factors and financial needs can force post-COVID-19 patients to continue working or RTW sooner despite ongoing symptoms [ 25 ]. An individuals’ work ability can be significantly impacted by various psychological factors, among which include high levels of fatigue, depressive symptoms, and reduced cognitive performance. These factors are closely linked with diminished work capacity and overall effectiveness in the workplace [ 61 ]. In addition, Diem et al. [ 57 ] reported, that inability to work is commonly reported alongside symptoms such as fatigue, sleep disturbances, and pain. These symptoms act as significant barriers for post-COVID-19 patients, impeding their ability to engage in work-related activities and having a negative impact on overall performance and productivity. The presence of fatigue is also associated with a lower likelihood of returning to previous work hours [ 66 ]. Additionally, certain demographic and health-related factors have been associated with higher odds of not returning to work after SARS-CoV-2 infection. According to the study conducted by Westerlind et al. [ 51 ], factors such as older age, being male, having a history of sick leave before contracting COVID-19, and having received inpatient care are all associated with an increased probability of not returning to work. Overall, the influencing factors for work ability and RTW of post-COVID-19 patients are diverse and can vary between individuals, interacting in complex ways to determine work outcomes.

Post-COVID-19 symptoms

Studies [ 61 , 62 , 63 , 64 , 65 , 66 ] have underscored the impact of post-COVID-19 symptoms on an individual’s work ability and RTW. Therefore, it is crucial to outline the prevalent post-COVID-19 symptoms reported in the included studies. 13 studies investigated self-reported post-COVID-19 symptoms in COVID-19 patients 12 or more weeks following diagnosis. The studies reported on a wide range of post-COVID-19 symptoms experienced by patients. Appendix 3 presents the five most commonly reported symptoms in the included studies, along with their respective prevalence rates. The prevalence of post-COVID-19 symptoms varied across studies, with estimates ranging from 12.2 to 100% of individuals who had recovered from the acute phase of the illness. Fatigue was the most commonly reported symptom, with prevalence rates exceeding 80% in many studies (mean prevalence: 72.9%). Other frequently reported symptoms included neurocognitive disorders such as concentration impairment, dizziness or memory problems. Estimates of neurocognitive symptoms prevalence ranged from 14 to 92% (mean prevalence: 59.5%). Most of the studies also reported physical ailments such as weakness, muscle pain or exercise intolerance with prevalence rates between 13% and 100% (mean prevalence: 56.2%). Other frequently reported symptoms included shortness of breath, headache, and sleep disturbances. Long-term follow-up studies indicated that patients with post-COVID-19 continued to experience symptoms for up to two years after the initial infection [ 18 , 60 , 61 , 62 ]. For a comprehensive understanding of the full range of post-COVID-19 symptoms, it is recommended to refer to the original studies included in this systematic review.

Risk of bias

Of the 19 studies, more than half were assessed to be of moderate quality ( n  = 10). Five studies were considered to be of high quality, and the remaining studies ( n  = 4) were considered to be of poor quality. Taken together, the NOS rating of the component studies was moderate, evidenced by mean scores of 6.2 for cohort studies and 4.8 for cross-sectional studies. The NOS quality assessment results for cohort studies are summarized in Table  3 , and quality assessment results for cross-sectional studies are summarized in Table  4 .

Within the cohort studies ( n  = 12), nearly all studies scoring a star for being either truly or somewhat representative of the average target population. Common methodological limitations were the failure to include a non-exposed group in cohort studies, and to ascertain whether outcomes were present prior to SARS-CoV-2 infection. The exposure (COVID-19) was usually measured using either objective measurement (e.g., polymerase chain reaction (PCR) test) or clinical judgment. Within cross-sectional studies ( n  = 7), all but two studies had somewhat representative or truly representative samples (with selection bias). However, nonresponse characteristics (with non-response/self-selection bias); and a sample size justification were not provided or poorly described in all of the cross-sectional studies. 5 out of 7 studies used validated measurement tools.

Comparability

Cohort studies controlled for confounders in 12 of the 13 studies. However, only two studies controlled for age, sex, and an additional factor required to score two stars. One study scored zero stars, as it used unadjusted analyses. In the cross-sectional studies, 5 studies used adjusted analyses.

Within the cohort studies, all studies used a validated objective assessment tool (e.g., WAI) or a structured/systematic interview conducted by a trained healthcare/research professional and were followed up after a sufficient duration (3 months). The follow-up cohort rate was inadequate in 3 studies, as no description of differences in responders and non-responders was provided, or less than 80% responded. Within the cross-sectional studies, 3 studies used a validated objective assessment tool or a structured/systematic interview conducted by a trained healthcare/research professional; therefore, they scored a star. 3 studies scored zero stars, as they used self-reported work ability measurements. All of the cross-sectional studies were considered to have used appropriate and clearly described statistical tests.

The present systematic review aimed to assess the impact of post-COVID-19 on work ability and the RTW of patients previously infected with SARS-CoV-2. Through a comprehensive analysis of the available literature, we have identified several key findings that shed light on the long-term consequences of COVID-19 on individuals’ ability to work and their journey back to the workforce. The comprehensive search and rigorous study selection process resulted in the inclusion of 19 relevant studies published between 2021 and 2023, involving a diverse population of 21.155 patients from 14 different countries.

Work ability and return-to-work

An essential determinant of a sustainable RTW is the perceived work ability, which is more independent of the patient’s specific context compared to the aspects of returning to work [ 68 , 69 ]. The impact of post-COVID-19 on work ability was assessed in 15 of the 19 included studies. The findings varied depending on the follow-up period. In studies with a follow-up period of less than 12 months, it was found that many post-COVID-19 patients experienced a prolonged recovery period, resulting in temporary or long-term work limitations. A significant proportion of patients were not working or were working reduced hours (range between 13.3% and 54.9%). Even those with mild or moderate acute SARS-CoV-2 infection required extended periods to regain their pre-illness work capacity [ 25 ]. This indicates that a significant proportion of patients face challenges in resuming their work responsibilities. However, some participants were able to maintain their pre-illness work capacity. Also, in studies with a follow-up period between 12 months and 18 months, a decline in work ability over time was observed. The percentage of patients unable to work or on sick leave was relatively high in these studies (14.3 − 67.7%). Work ability scores decreased compared to pre-COVID-19 levels, indicating limitations in work capacity. For studies with a follow-up period of more than 18 months, some individuals experienced long-term work limitations. The percentage of patients working varied across studies, with a range of 40.0–70.2%. However, it is important to note that these patients may also experience a decline in work ability, resulting in reduced work productivity. Lemhöfer et al. [ 70 ] demonstrated that more than half of the post-COVID-19 patients who were able to work experienced impairments in the physical sum score of Health-Related Quality of Life (HRQoL), resulting in reduced productivity. In this context, the concept of presenteeism gains relevance.

Presenteeism involves individuals continuing to work despite being unwell, and exerting extra efforts to manage job demands, which can exacerbate health problems [ 71 ]. The estimated costs of having a sick employee could potentially be higher than the costs of their actual absence, due to lower productivity and if illnesses become worse and chronic as a result which is associated with longer periods of absence from work [ 30 , 72 ]. This becomes especially notable as a substantial proportion of participants in this systematic review remained on sick leave or needed job adaptation for 15 months or longer after the SARS-CoV-2 infection.

Fatigue remained a prevalent symptom even in the long term, which could significantly impact an individual’s ability to perform daily work tasks and maintain productivity. Especially in the case of post-infectious fatigue, a symptom that affects a considerable number of post-COVID-19 patients, results concerning the long-term course of other infectious diseases (e.g., SARS virus, Q-fever, Lyme disease ) indicate the risk of chronicity [ 23 ]. Other frequently reported symptoms, such as neurocognitive disorders, physical ailments, and sleep disturbances also contributed to work limitations and challenges in returning to work [ 57 , 61 ]. Delgado-Alonso et al. [ 61 ] confirmed, that there was a wide variability of influencing post-COVID-19 symptoms on work ability among the participants. Similarly, results from Pauwels et al. [ 34 ] and Sanchez-Ramirez et al. [ 20 ] indicated, that the impact on work ability and RTW for patients with long- and post-COVID-19 is complex and varies due to the different symptomatology, disease severity during the acute infection and age. Rehabilitation can play a central role in restoring the ability to work after a SARS-CoV-2 infection [ 73 ]. According to national [ 74 , 75 ] and international guidelines [ 76 ], a specific post-COVID-19 rehabilitation program is recommended to contribute to the preservation and restoration of biopsychosocial health and work ability. Positive rehabilitation effects have been demonstrated for both physical and mental health in patients with post-COVID-19 [ 77 , 78 ]. After regaining work ability through rehabilitation and ongoing aftercare, the process of occupational reintegration is essential.

The RTW of post-COVID-19 patients is complex and multifaceted. The meta-analysis estimated that approximately 60.9% of post-COVID-19 patients were able to successfully RTW 12 or more weeks following the SARS-CoV-2 infection. This finding highlights the importance of understanding the long-term impacts of COVID-19 on individuals’ ability to return to their pre-infection work status. However, there was substantial heterogeneity among the studies. This suggests that differences in methodologies such as study populations, follow-up durations, and other factors might have contributed to the variability in RTW outcomes observed across the studies.

Moreover, it is crucial to recognize that this prevalence figure represents just the endpoint of a much more complex process of RTW. RTW is not a straightforward, linear process. It often involves multiple stages, including gradual reintegration, adaptations, and even job changes [ 34 ]. The coexistence of comorbidities alongside post-COVID-19 can increase the complexity of the RTW process [ 51 ]. Additionally, psychosocial factors like anxiety, depression and stress can have a significant impact, leading to delays, problems, or even making it necessary to change jobs [ 79 ]. Individual differences in resilience, coping strategies and self-efficacy are key factors in how they handle the disease and navigate the RTW process [ 80 , 81 ]. Some may adapt more effectively, while others may face challenges.

The findings in this systematic review reveal that environmental and organisational factors such as the availability of workplace accommodations, supportive policies, and occupational rehabilitation programs play a crucial role in facilitating successful RTW. Workplaces that offer flexible work arrangements, including modified duties, reduced working hours and remote work options were positively related with the reintegration process [ 25 , 65 ]. This is particularly relevant for healthcare workers who face high work demands and workplace stress [ 82 ]. Therefore, the possibilities for adjusting workplace conditions within the company should be given more emphasis, especially to facilitate RTW for post-COVID-19 patients with extended periods of work disability. Moreover, collaboration between healthcare providers, employers, and employees was emphasized as crucial in developing personalized RTW plans tailored to individuals’ specific needs and capabilities [ 83 ]. In order to facilitate the RTW of patients with post-COVID-19, it is necessary to develop a long-term strategy [ 83 ]. Strategies for returning to work after SARS-CoV-2- infection may be similar to programs already developed for chronic diseases [ 84 , 85 , 86 ]. It is important to recognize that the RTW for COVID-19 survivors may be influenced by a multitude of factors, including the severity of the infection, the presence of long-term symptoms, individual resources such as resilience or self-efficacy, the socio-economic context and the nature of their occupation. Therefore, a comprehensive understanding of these factors is necessary to facilitate the successful reintegration of COVID-19 survivors into the workforce. This is in line with results by Pauwels et al. [ 34 ] indicated, that the impact on return to the workplace for patients with long-COVID and post-COVID-19 is complex and varies due to the different symptomatology. Economic aspects such as continued wage payment during illness must also be taken into consideration. The financial losses resulting from extended absences are not sustainable for some patients in the long term and can lead to psychological disorders, e.g., depression disruption of financial wellbeing up to existential fears [ 87 ]. The risk of not achieving a successful RTW increases significantly with the duration of absence. Approximately 50% of individuals are unable to RTW after a sick leave of six months [ 88 ]. In the study by Wahlgren et al. [ 18 ], it was also found that out of the 22 patients who were on sick leave four months after the SARS-CoV-2 infection, only 11 patients managed to achieve a RTW after 24 months. The process of returning to work itself can contribute significantly to the recovery from SARS-CoV-2 infection. When individuals successfully adapt the requirements of their workplace to accommodate their existing limitations, employment can serve as an effective way to improve overall performance and reduce mental stress [ 89 , 90 ]. It’s important to mention that aftercare and support or self-help groups also play an important role in assisting individuals during their RTW process. They take care of the medical, emotional as well as mental and social aspects of the individuals and can create a sense of togetherness and social inclusion.

The systematic review highlights that a significant proportion of individuals who have recovered from COVID-19 experience persistent symptoms and functional impairments that can impact their work ability. Identifying and presenting these symptoms not only provided a clear insight into the challenges individuals face but also contributes to developing interventions and support measures to reduce the long-term effects of COVID-19 on work ability. Neurocognitive disorders (e.g., concentration impairment or dizziness), physical ailments (e.g., weakness or exercise intolerance), shortness of breath, headache, and sleep disturbances were commonly reported symptoms among these individuals. Fatigue emerged as the most prominent symptom, with prevalence rates exceeding 80% in many studies. The occurrence of fatigue is consistent with systematic reviews on post-COVID-19 [ 8 , 22 ], indicating that persistent fatigue is a common and debilitating symptom for many individuals recovering from SARS-CoV-2 infection. According to a previous study, 40% of SARS survivors experienced chronic fatigue for an average duration of 41 months following the infection [ 91 ].

Persistent symptoms can have a significant impact on the physical and psychological capacity of post-COVID-19 patients to participate in work-related activities, resulting in lower work ability and increased sick leave. Residual impairments lasting months after the acute SARS-CoV-2 infection could also explain why some of the people returning to work required modifications in their work duties or hours. This is supported by Böckermann et al. [ 92 ], who demonstrated that poor health status is linked with a higher rate of unemployment. Lemhöfer et al. [ 70 ] already revealed, that 38% of the patients were unable to work and showed impairments in physical and mental health 3–12 months after the SARS-CoV-2 infection. Especially cognitive and physical limitations, as well as existing fatigue symptoms, were associated with reduced work capacity [ 93 , 94 ]. Similar associations were also demonstrated in studies included in this systematic review [ 57 , 61 ].

It’s important to note that these findings are based on the available studies, and individual experiences may vary. Additionally, the long-term effects of COVID-19 on work ability are still being researched, and further studies may provide additional insights.

Implications

The results of this systematic review and meta-analysis generate a lot of implications for healthcare providers, occupational health professionals, employers, and policymakers. It highlights the need for a comprehensive understanding of the post-COVID-19 symptoms and their impact on work ability. Healthcare professionals should be aware of the potential long-term consequences of COVID-19 and consider appropriate rehabilitation as well as aftercare and support services to help individuals RTW. Early identification of post-COVID-19 symptoms and timely interventions may significantly improve the work ability, overall well-being of patients and the successful reintegration into the workplace. Brehon et al. [ 65 ] showed, that patients with a shorter time between the onset of SARS-CoV-2 infection and admission to a rehabilitation program had a higher likelihood of RTW. It is important to note that the long-term effects of COVID-19 on work ability and the RTW process are not limited to physical symptoms alone. The systematic review highlights the significant impact of neurocognitive health challenges, such as concentration impairment, dizziness or memory problems, on individuals’ ability to work and return to the workforce. Therefore, comprehensive support systems encompassing both physical as well as neurocognitive health interventions under consideration of individual load limitations are crucial for optimizing work outcomes in post-COVID-19 patients. Rehabilitation plays a central role in restoring workability and reintegrating into the professional routine after SARS-CoV-2 infection [ 73 ]. In accordance with national [ 74 , 75 ] and international guidelines [ 76 ], a specifically designed post-COVID-19 rehabilitation aims to contribute to the preservation and recovery of biopsychosocial health and work capability within the rehabilitation management of long-/post-COVID-19 patients.

Employers may need to implement flexible work arrangements, offering support services and provide reasonable accommodations for employees recovering from SARS-CoV-2 infection to facilitate their RTW and foster a more supportive and inclusive work environment. The possibilities of adapting working conditions within the company should be given more attention, especially to enable an optimal reintegration into the profession and achieve a RTW for post-COVID-19 patients with prolonged work disability periods [ 65 , 83 ]. Employers should also be educated about the potential challenges faced by post-COVID-19 patients and the importance of providing appropriate resources and support to aid in their recovery and successful RTW. Policy initiatives could focus on ensuring that post-COVID-19 patients have access to necessary healthcare and rehabilitation services, and protections against discrimination in the workplace due to COVID-19 related symptoms. Furthermore, continuous monitoring of the potential increase in the number of people opting for early retirement due to post-COVID-19 is crucial in the upcoming years, as reduced work ability serves as a predictor for such decisions [ 29 ].

Limitations

While the systematic review provides valuable insights into the impact of post-COVID-19 on work ability and the RTW process, there are some limitations to consider. The available literature is still evolving, and the studies included in this review vary in their methodologies, leading to heterogeneity, and thus, difficulties of comparison. Additionally, there is a scarcity of long-term follow-up studies, making it challenging to ascertain the impact of post-COVID-19 on work ability and RTW. Future research should focus on longer follow-up periods to better understand how post-COVID-19 symptoms change over time and affect people’s ability to work. Large and long-term cohort studies incorporating mixed methods, encompassing both qualitative as well as quantitative approaches, are essential for gaining comprehensive insights into the long-term consequences of COVID-19. These studies allow a more differentiated understanding of the multifaceted impacts of the disease on individuals’ work ability and RTW and should aim for diverse representation in terms of age, gender, severity of acute COVID, occupation, and geographical locations. Supplementing quantitative approaches with qualitative research can offer a better understanding of the lived experiences and challenges faced by individuals recovering from post-COVID-19. Previous research has descriptively analysed work ability and RTW as a secondary parameter over mostly short periods of time. No articles were found that analysed the impact of post-COVID-19 on work ability and RTW as their primary objective. Data about work ability and RTW was collected from different questionnaires (Bell Disability Scale, World Health Organization Disability Assessment Schedule, Work ability index), open questions, online surveys or work ability scales. The studies primarily relied on self-reported work ability, which may introduce biases and problems such social desirability. Moreover, there were no articles found describing a validated screening tool for post-COVID-19. Employing standardized assessment tools for work ability and RTW outcomes will enhance the reliability and comparability of findings across studies.

There is heterogeneity across the studies with respect to the selection of participants, the assessment of outcomes, follow-up periods and sample sizes in almost all the studies which may influence the generalizability of the results of this study. Despite these limitations, the authors maintain that this systematic review significantly addresses the knowledge gap regarding the impact of post-COVID-19 on work ability and RTW.

The risk of bias assessment indicated that more than half of the included studies were of moderate quality. Common limitations included the failure to include a non-exposed group in cohort studies and inadequate control for confounders. In cross-sectional studies, nonresponse characteristics and sample size justifications were often poorly described. The Quality Assessment of the included studies using the Newcastle-Ottawa Scale has revealed certain consistency problems and its reliability relies on the expertise of the operator [ 95 , 96 ]. Consequently, if conducted by a different research group, the quality assessment might have yielded varying results.

Another notable constraint of this systematic review is the restriction to articles published only in English or German. This might result in the exclusion of relevant studies published in other languages, limiting the reviews’ overall comprehensiveness.

The majority of studies included hospitalized patients, potentially impacting the generalizability of our findings to the broader population of individuals with post-COVID-19. This focus might introduce bias due to the higher prevalence of comorbidities among hospitalized patients [ 97 ]. However, previous studies demonstrated that individuals, even with mild SARS-CoV-2 infections, developed post-COVID-19 symptoms [ 98 , 99 ], underscoring the importance of considering varying disease severities. To improve our understanding, future studies should include more non-hospitalized individuals, providing a more balanced perspective on the post-COVID-19 landscape.

In addition to the previously mentioned limitations, one crucial aspect that most of the included studies overlooked is the consideration of the specific COVID-19 variants by which the patients were infected. This oversight prevents us from comprehensively understanding the potential differential effects of various variants on individuals’ ability to RTW after recovering from SARS-CoV-2 infection. Notably, most studies with a large sample size were conducted in the early stages of the pandemic when the alpha and delta variants were predominant. However, the study by Aben et al. [ 35 ] provided the insight that later virus variants (e.g., Omicron) demonstrated a shorter duration between infection and RTW. This crucial finding does not receive adequate attention within the context of this systematic review.

Unanswered questions

In addition to detailing a number of methodological considerations, this review has also highlighted gaps in the literature. The following unanswered questions will help focus future research:

How does the individual recovery of employees’ ability to work with post-COVID-19 look like?

How do processes of occupational reintegration post-COVID-19 employees look like, and which (promoting and hindering) factors are relevant?

What problems arise during the recovery process to the ability to work, and how do employees deal with such problems? What coping strategies do they develop and apply?

What influence do physical and psychological resources have on the ability to work of employees with post-COVID-19?

What role does the social as well as the workplace environment (considering the broader context of the International Classification of Functioning, Disability, and Health) play in the recovery of employees’ ability to work?

How do demographic factors impact the ability to work of individuals with post-COVID-19, and what tailored interventions can be developed to address specific needs based on demographic diversity?

What are the different subtypes of post-COVID-19, and how can a deeper understanding of the various clinical manifestations post-COVID-19 enhance the effectiveness of RTW interventions?

To what extent do specific interventions such as rehabilitation programmes, aftercare and support services for employees with post-COVID-19 result in improvements of ability to work and faster RTW?

This systematic review and meta-analysis provide valuable insights into the impact of post-COVID-19 on work ability and the RTW. The findings underscore the need for comprehensive support for individuals recovering from SARS-CoV-2 infection to improve their work capacity and overall quality of life. However, the influence of post-COVID-19 on the working-age population seems to be substantial, and it is expected to result in enduring strains on economic and healthcare systems. Policymakers, healthcare providers, occupational health professionals and employers need to collaborate to create inclusive work environments and implement tailored rehabilitation and aftercare programs that improve the work ability of post-COVID-19 patients in long-term. Future research should focus on long-term follow-up studies with mixed methods (qualitative and quantitative) to gain a more comprehensive understanding of the trajectory of post-COVID-19 symptoms and their impact on work outcomes and to identify effective interventions to facilitate the RTW for affected individuals.

Data availability

All data generated or analysed during this study are included in this published article and its supplementary information files.

Abbreviations

Six-minute walking distance 6MWD

Confidence intervals

Coronavirus disease 2019

German Register for Clinical Studies

Health-Related Quality of Life

International Clinical Trials Registry Platform

Intensive care units

Interquartile range

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

International Prospective Register for Systematic Reviews

• Return-to-work

Polymerase chain reaction

Medical Subject Headings

National Institute for Health and Care Excellence

Newcastle Ottawa Scale

Standard deviation

Standard error

Work ability index

Work ability score

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Editor's note: The press conference has concluded, but you can see the full replay below. Due to a late start time, skip ahead 60 minutes on the video player for the opening of the press conference.

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Michael Cunningham

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The women of Michael Cunningham’s The Hours are all united by the novel Mrs. Dalloway , which Virginia writes, and which Laura and Clarissa later read. For Virginia, writing is both a release and a weight on her. It provides structure to her life, occupying her thoughts even when she can’t actually be writing, but it also haunts her with the feeling that she needs to be doing more. Laura struggles with similar feelings of inadequacy, but her anxieties pertain to reading instead of writing. She relishes the time when she can disappear into a novel like Mrs. Dalloway , but reading the novel in the “right” conditions becomes an obsession for her, to the point where she rents a hotel room for the night, just to read for two solitary, uninterrupted hours. Finally, as a publisher, Clarissa occupies a role somewhere between reading and writing. While a mutual love of Mrs. Dalloway is a key element of Clarissa’s relationship with Richard , a part of Clarissa resents the ways that Richard tries to flatten her into a character, both by calling her “Mrs. Dalloway” and by loosely basing the suicidal main character of his own novel on her.

While literature—particularly Mrs. Dalloway —connects three women from different circumstances and eras, it also ends up meaning something different to each of them. For all three women, fiction represents a necessary form of escapism, but it also has important limits. No amount of reading can fix Laura’s feelings about her marriage, for instance. Meanwhile, Virginia’s successful completion of Mrs. Dalloway doesn’t Virginia’s mental health issues. And helping authors publish “difficult” (meaning literary and unprofitable) novels doesn’t improve Clarissa’s self-esteem. Whereas literature is a way for Virginia to communicate with a future she won’t live to see, for Laura and Clarissa it is a way for them to connect to the past and realize that the challenges they face in their own lives aren’t new. The Hours celebrates the power of reading and writing to connect people across time and to help them escape their ordinary lives, but it also demonstrates the limits of literature, showing how in the end it can’t fully reflect life’s complexities or provide a solution to them.

Reading and Writing ThemeTracker

Reading and Writing Quotes in The Hours

She hurries from the house, wearing a coat too heavy for the weather. It is 1941. Another war has begun. She has left a note for Leonard, and another for Vanessa.

Writing in that state is the most profound satisfaction she knows, but her access to it comes and goes without warning. She may pick up her pen and follow it with her hand as it moves across the paper; she may pick up her pen and find that she’s merely herself, a woman in a housecoat holding a pen, afraid and uncertain, only mildly competent, with no idea about where to begin or what to write.

She decides, with misgivings, that she is finished for today. Always, there are these doubts. Should she try another hour? Is she being judicious, or slothful? Judicious, she tells herself, and almost believes it. She has her two hundred and fifty words, more or less. Let it be enough. Have faith that you will be here, recognizable to yourself, again tomorrow.

Leaving the desk, she can hardly believe she’s done it. She has gotten the key, passed through the portals.

She is better, she is safer, if she rests in Richmond; if she does not speak too much, write too much, feel too much; if she does not travel impetuously to London and walk through its streets; and yet she is dying this way, she is gently dying on a bed of roses.

“But there are still the hours, aren’t there? One and then another, and you get through that one and then, my god, there’s another. I’m so sick.”

Richard smiles. He shakes his head. He says, “I don’t think two people could have been happier than we’ve been.”

He inches forward, slides gently off the sill, and falls.

Yes, Clarissa will have loved a woman. Clarissa will have kissed a woman, only once. Clarissa will be bereaved, deeply lonely, but she will not die. She will be too much in love with life, with London.

They settle into another silence, one that is neither intimate nor particularly uncomfortable. Here she is, then, Clarissa thinks; here is the woman from Richard’s poetry. Here is the lost mother, the thwarted suicide; here is the woman who walked away. It is both shocking and comforting that such a figure could, in fact, prove to be an ordinary-looking old woman seated on a sofa with her hands in her lap.

And here she is, herself, Clarissa, not Mrs. Dalloway anymore; there is no one now to call her that. Here she is with another hour before her.

“Come in, Mrs. Brown,” she says. “Everything’s ready.”