Long COVID Could Cost the Economy Trillions, Experts Predict

Editor's note: Find the latest long COVID news and guidance in Medscape's Long COVID Resource Center.

Long COVID is likely to cost the U.S. economy trillions of dollars and will almost certainly affect multiple industries, from restaurants struggling to replace low-wage workers, to airlines scrambling to replace crew, to overwhelmed hospitals, experts are predicting.

"There's a lot we need to do to understand what it takes to enable disabled people to participate more in the economy," says Katie Bach, a senior fellow with Brookings Institution and the author of a study looking into long COVID's impact on the labor market.

Data from June 2022 from the CDC shows that of the 40% of American adults who contracted COVID-19, nearly 1 in 5 still have long COVID symptoms. That works out to 1 in 13, or 7.5%, of the overall U.S. adult population.

Drawing from the CDC data, Bach estimates in her August 2022 report that as many 4 million working-age Americans are too sick with long COVID to perform their jobs. That works out to as much as $230 billion in lost wages, or almost 1 percent of the U.S. GDP.

"This is a big deal," she says. "We're talking potentially hundreds of billions of dollars a year and that this is big enough to have a measurable impact on the labor market."

Other sources have suggested lower figures, but the conclusions are the same: Long COVID is an urgent issue that will cost tens of billions of dollars a year in lost wages alone, Bach says. But it's not just lost income for workers. There is a cost for businesses and the public.

Throughout the pandemic, COVID-19's crippling force could be felt across multiple industries. While business has picked up again, staffing shortages remain a challenge. At some airports this summer, air passengers spent hours in security lines; were stranded for days as flights were canceled, rebooked, and canceled again on short notice; and waited weeks for lost luggage. Restaurants have had to cut back their hours. Those seeking medical care had longer than usual wait times in emergency departments and urgent care clinics. Some ERs temporarily closed.

These challenges have been attributed in part to the "great resignation" and in part because so many infected workers were out, especially during the Omicron waves. But increasingly, economists and health care professionals alike worry about long COVID's impact on employers and the broader economy.

David Cutler, PhD, a professor of economics at Harvard University, believes the total economic loss could be as high as $3.7 trillion, when factoring in the lost quality of life, the cost in lost earnings, and the cost of higher spending on medical care. His estimate is more than a trillion dollars higher than a previous projection he and fellow economist Lawrence Summers, PhD, made in 2020. The reason? Long COVID.

"The higher estimate is largely a result of the greater prevalence of long COVID than we had guessed at the time," Cutler wrote in a paper released in July.

"There are about 10 times the number of people with long COVID as have died of COVID. Because long COVID is so new, there is uncertainty about all of the numbers involved in the calculations. Still, the costs here are conservative, based on only cases to date."

In Bach's Brookings report, she projected that if recovery from long COVID does not pick up and the population of Americans with long COVID were to grow by 10% a year, the annual cost of lost wages alone could reach half a trillion dollars in a decade.

Meanwhile, a working paper by the National Bureau of Economic Research found that workers who missed an entire week of work due to probable COVID-19 illnesses were roughly 7 percentage points less likely to be working a year later, compared to those who did not miss work for health reasons.

"It's not just individuals with long COVID who are suffering from this. It impacts their families, their livelihoods, and the economy on a global scale. So, we have to raise awareness about those ripple effects," says Linda Geng, MD, a clinical assistant professor of medicine with Stanford University's Primary Care and Population Health.

"I think it's hard for the public to grasp… and understand the scale of this public health crisis."

Debilitating Fatigue

Long COVID is roughly defined; the CDC defines it as symptoms that linger 3 or more months after a patient first catches the virus.

The symptoms vary and include profound fatigue and brain issues.

"It's a new degree of extreme and debilitating fatigue and exhaustion, to the point where you can't do your daily tasks," says Geng, who is also the co-director of Stanford's Post-Acute COVID-19 Syndrome Clinic.

"People can be so debilitated, they can't even do basic things, like the activities of daily living, let alone do their job, particularly if it's physically or mentally demanding."

Patients can also have post-exertional malaise, where they feel especially bad and symptoms worsen when they exert themselves physically or mentally, Geng says. Compounding the issue for many long COVID patients is their trouble getting restful sleep. Those with brain fog have issues with memory, processing information, focused concentration, confusion, making mistakes, and multitasking. Pain is another debilitating symptom that can disrupt daily life and ability to work.

Even people with relatively mild infections can end up with long COVID, Geng says, noting that many of the patients at the Stanford clinic were never hospitalized with their initial infections. While existing research and Geng's clinical experience show that long COVID can hit any age, she most commonly sees patients from ages 20 to their 60s, with an average age in the 40s – people in their prime working ages.

Jason Furman, PhD, a former White House economic adviser who is now a professor at Harvard University, noted in August that the labor force participation rate was far below what could be explained by standard demographic changes like an aging population, with the decline evident across all age groups. Furman does not speculate about why, but others have.

"We are pessimistic: Both the aging of the population and the impact of long COVID imply that the participation rate will be slow to return to its pre-pandemic level," Anna Wong, Yelena Shulyatyeva, Andrew Husby, and Eliza Winger, economists with Bloomberg Economics, wrote in a research note.

Supportive Policies

There is some evidence that vaccination reduces the risk of long COVID, but not completely, and it is too early to know if repeat infections increase long COVID risks. There is also no definitive data on how fast or how many people are recovering. Economists often assume that those with long COVID will recover at some point, Bach noted, but she is careful not to make assumptions.

"If people aren't recovering, then this group keeps getting bigger," she says. "We're still adding, and if people aren't coming out of that group, this becomes a bigger and bigger problem."

For now, the number of new people being diagnosed with long COVID appears to have slowed, Bach says, but it remains to be seen whether the trend can be sustained.

"If people are impaired longer than we think and if the impairment turns out to be severe, then we can have a lot of people who need services like disability insurance," Cutler says.

"That could put a really big strain on public sector programs and our ability to meet those needs."

Policies that support the research and clinical work necessary to prevent and treat long COVID are essential, experts say.

"To me, that is the biggest economic imperative, to say nothing of human suffering," says Bach.

Employers also have a role, and experts say there are a number of accommodations businesses should consider. What happens when an employee has long COVID? Can accommodations be made that allow them to continue working productively? If they spend a great deal of time commuting, can they work from home? What can employers do so that family members do not have to drop out of the workforce to take care of loved ones with long COVID?

Disability Insurance

To be sure, there is one piece of the puzzle that does not quite fit, according to Cutler and Bach. There is no sign yet of a large increase in federal disability insurance applications, and no one quite knows why. Publicly available government data shows that online applications actually dipped by about 4% each year between 2019 and 2021. Applications in 2022 appear on track to remain slightly below pre-pandemic levels.

To qualify for Social Security Disability Insurance (SSDI), people need to have a disability that lasts at least a year.

"If you're disabled with long COVID, who knows, right? You don't know," says Bach. "Two of the most dominant symptoms of long COVID are fatigue and brain fog. So, I've heard from people that the process of going through an SSDI application is really hard."

Some long COVID patients told Bach they simply assumed they would not get SSDI and did not even bother applying. She stressed that working Americans with debilitating long COVID should be aware that their condition is protected by the Americans with Disabilities Act. But the challenge, based on guidance issued by the government, is that not all cases of long COVID qualify as a disability and that individual assessments are necessary.

While more long COVID data is needed, Bach believes there is enough information for decisionmakers to go after the issue more aggressively. She pointed to the $1.15 billion in funding that Congress earmarked for the National Institutes of Health over the course of 4 years in support of research into the long-term health effects of COVID-19.

"Now, $250 million a year sounds like a lot of money until you start talking about the cost of lost wages – just lost wages," Bach says.

"That's not lost productivity. That's not the cost of people whose family members are sick. Who have to reduce their own labor force participation. That's not medical costs. Suddenly, $250 million doesn't really sound like that much."

Sources

Katie Bach, nonresident senior fellow, Brookings Institution.

David Cutler, professor of economics, Harvard University.

Linda Geng, MD, clinical assistant professor in medicine, Primary Care and Population Health, Stanford University; co-director, Stanford Post-Acute COVID-19 Syndrome Clinic.

Brookings Institution: "New data shows long Covid is keeping as many as 4 million people out of work."

CDC: "Nearly one in five American adults who have had COVID-19 still have 'long COVID."

Bureau of Economic Analysis: "Gross Domestic Product (Second Estimate) and Corporate Profits (Preliminary), Second Quarter 2022."

National Bureau of Economic Research: "The Impacts of COVID-19 illnesses on workers."

Harvard University: "The economic cost of long COVID: an update."

Twitter: @jasonfurman, Aug. 5, 2022.

Nature Medicine: "Long COVID after breakthrough SARS-CoV-2 infection."

Social Security Administration: "Social Security Administration (SSA) Monthly Data for Initial Disability Insurance Applications (2012 Onward) Filed via the Internet."

Social Security Administration: "Disability Determination Process."

U.S. Department of Health & Human Services: "Guidance on 'Long COVID' as a Disability Under the ADA, Section 504, and Section 1557."

National Restaurant Association: "Restaurants added 18,200 jobs in August."

Reuters: "Hit by staff shortages, airlines and airports struggle with travel recovery."

World of Aviation: "Everything you need to know about chaos at global airports."

BlogTO: "Toronto Sunwing passengers stranded all over as flight delay problems drag on for 3rd day."

CBC News: "30 cancelled Swoop flights leave customers bitter. Will passenger rights coming Monday help?"

The Globe and Mail: "Montfort Hospital latest to temporarily close emergency department because of staff shortages."

U.S. News World Report: "Staff Shortages Choking U.S. Health Care System."

CNN: "Overwhelmed hospitals. Staffing shortages. Businesses closing. Here's how the Omicron wave is ravaging local communities."

Bloomberg: "US Employers Add 315,000 Jobs as More Workers Join Labor Force."

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