PARIS - Even as countries have long emerged from the dramatic restrictions imposed on populations during the height of the COVID-19 pandemic, an important subset of people infected with COVID-19 continue to struggle with symptoms, in some cases debilitating, that persist for weeks or even months after their initial infection.

The analysis in this paper looks at the burden of long COVID across OECD countries.

It examines its implications for the health of individuals and how long COVID may impact productivity and the labour force, as well as what countries are doing to address the condition.

It further identifies priorities for improving care for people living with long COVID.

Key findings

1. While a precise estimate of long COVID prevalence is still emerging, current research suggests that up to 10-30% of people who contracted COVID-19 exhibit symptoms corresponding to long COVID in the weeks and months following acute infection. Across OECD countries at a minimum, this would represent upwards of 39 million people who had or are currently living with long COVID. Sustainable investment in long COVID research is crucial to inform health and social care resource allocation. As the evidence base grows, developing standardised measures of symptoms and functional impact to support a more precise definition that enables the disaggregation of levels of long COVID severity could be useful to better understand the condition, assess its impact, and to tailor care and support.

2. Standardised definition and surveillance systems remain critical challenges in better understanding long COVID: Four countries responding to the 2022 OECD Long COVID Health Systems Survey reported that they had national estimates of long COVID prevalence in their country. While most countries had adopted definitions of long COVID that were broadly in line with WHO and NICE guidelines, important differences still emerged in how countries interpreted the condition. A more systematic and consistent definition and uptake of long COVID coding, aligned to evidence-based
standardised measures reflecting symptom severity and duration, is needed to support the development of standardised surveillance infrastructure and facilitate the comparative epidemiological assessment of long COVID across OECD countries.

3. Long COVID can severely limit people’s ability to undertake basic activities of daily life and can dramatically hamper quality of life. More than 7 million quality-adjusted life years may be lost annually across OECD countries due to the condition. Studies from across a range of OECD countries suggest that one sixth to more than one-third of people may have persistent cognitive symptoms, often lasting more than 12 weeks, after a COVID-19 infection.

4. Even conservative estimates of long COVID prevalence would indicate that long COVID may be reducing the workforce by nearly 3 million workers across OECD countries, amounting to an economic cost of at least $141 billion USD from lost wages alone. Moreover, even among those who were able to return to the labour force, a significant proportion reported needing to reduce the number of hours they worked, compared to before their infection.

5. The economic and social welfare costs of long COVID are dramatic: Even excluding the direct costs of health care, long COVID is likely costing OECD countries as much as $864 billion - $1.04 trillion USD per year due to reductions in quality of life and labour force participation. The limitations in activities experienced by long COVID patients, including dropping out or reducing their participation in the labour force, as well as direct medical care costs, can have dramatic implications on
their financial well-being. Costs to health and social protection systems may also be high over time.

6. Long COVID could further exacerbate inequalities: The COVID-19 pandemic brought
attention to longstanding socioeconomic and demographic inequalities in health. Evidence from some countries suggests that certain groups – including populations with lower education attainment, and those living in more deprived areas – may be at risk of developing long COVID, and of experiencing more severe symptoms.

7. Patients have played a critical role in bringing attention and action to long COVID: Throughout the pandemic, countries deprioritized many key aspects of person-centred care in exchange for rapidly implementing policies intended to contain the virus. While the need for rapid action was clear, the lack of patient voice in the process was notable. In contrast, patients and patient groups have been at the forefront of advocating for both a recognition of long COVID as a legitimate condition, in articulating their care and support needs, and in spearheading research into the condition. In many cases, countries have responded by actively working together with patient groups to disseminate information and develop patient-centred support services.

8. In many countries primary care has played a key role in the care pathway for people living with long COVID. Many people with long COVID can be supported in primary care, though specialist services and dedicated long COVID clinics have been necessary to care for people living with more debilitating symptoms or complex needs. At least 22 OECD countries have set up dedicated long COVID clinics. Nevertheless, demand for long COVID services such as multidisciplinary clinics appears to exceed available supply, with long waiting times reported in some countries.

9. Long COVID is not the first chronic condition faced by countries, and the care and support for people living with long COVID should draw on lessons learned in developing approaches to care for other chronic conditions and post-viral syndromes, such as myalgic encephalomyelitis (also known as chronic fatigue syndrome (ME/CFS)). Similarly, policymakers should actively consider how and what lessons might be drawn from their experience scaling up the response to long COVID to allocate resources and implement sustainable care pathways for such conditions.

10. Countries must adopt a multi-sectoral response to long COVID, taking into account its implications not only for health but also for broader well-being and labour force participation. Policies that help to cushion the financial impact of long COVID are critical, including to prevent the condition from further exacerbating inequalities.

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