Assessing the economic costs of long COVID

A new Yale study finds that the effects of long COVID have led many Americans to miss work for extended periods of time, with 14% of study participants reporting they did not return to work in the months following their infection.

The results, recently published in PLOS ONEsuggest that long COVID may have affected millions of Americans and generated high economic costs, underscoring the need for policies to support people with the disease, the researchers said.

The study built on a long-term survey of people with COVID-19, called the Innovative Support for Patients with SARS-CoV-2 Infections Registry, or INSPIRE, which began enrolling participants in fall 2020 and continued through summer 2022. More than 6,000 participants, across eight study sites in Illinois, Connecticut, Washington, Pennsylvania, Texas and California, received surveys at enrollment and then every three months for 18 months.

The Yale researchers focused specifically on participants’ responses to work-related questions, including whether they had returned to work after contracting COVID-19 and how many days of work they had missed due to COVID-19-related symptoms. They also assessed the number of symptoms participants experienced after having COVID-19.

Among the nearly 3,000 participants who were employed before the pandemic, nearly 10% reported having five or more symptoms three months after contracting COVID-19.

“And that number was important because we’ve shown in previous studies that the number of symptoms a person has after being infected with SARS-CoV-2 may be more indicative of the severity of their long COVID,” said Arjun Venkatesh, lead author of the study and chairman of the department of emergency medicine at Yale School of Medicine.

The researchers also found that more than 7% of participants missed more than 10 days of work in the three months after SARS-CoV-2 infection due to COVID-19 symptoms. (Most of the study data were collected after the U.S. Centers for Disease Control and Prevention reduced its recommended isolation period to five days for people with COVID-19.) Additionally, nearly 14% of participants did not return to work within three months of their infection; people with five or more symptoms were more than twice as likely not to return to work as asymptomatic people.

“We found that having five or more symptoms three months after infection was strongly associated with not returning to work,” Venkatesh said. “And when we compare the rates seen in this study to the national population, that could mean that up to 2 million people could be out of work due to post-COVID health issues.”

This is particularly surprising, Venkatesh said, because the participants in this study were quite young; the average age was about 40.

“This has significant economic consequences,” he added. “It also has consequences for these people individually, in terms of their income security and their ability to care for themselves and their families.”

Early in the pandemic, Venkatesh said, policymakers enacted key measures to provide economic relief and support to Americans, including federal legislation that helped workers keep their jobs even if they were unable to work and weather the economic storm of the early part of the pandemic. But the economic and personal costs of long COVID have yet to receive the same level of attention, he said.

As public health officials and lawmakers consider the long-term health and economic impacts of COVID-19 and long COVID, Venkatesh said, they may want to evaluate how disability policy should address long COVID and whether to support job transitions for people whose long COVID symptoms prevent them from returning to their previous jobs.

“Given the millions of people who have had COVID-19 in the United States and the millions of people who are reporting prolonged symptoms, this is not a minor problem,” Venkatesh said. “So it requires large-scale interventions.”