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Home > Topics > Long COVID: New Research and the Economic Toll

Long COVID: New Research and the Economic Toll

Health Equity / Coronavirus

Time & Location

Event materials.

As we enter the third COVID winter, nearly 1 in 3 adults in the US that had COVID-19 also reported experiencing symptoms of long COVID at some point. Emerging research illustrates that long COVID is not just a health problem — it’s an economic one too, disrupting patients’ lives for years to come. Research has found that the economic losses of long COVID 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. Pinpointing the underlying causes of this new and emerging illness has continued to be difficult, and could make treatment costly. Many people fear that the same factors that caused racial and ethnic disparities during COVID-19 may be responsible for driving disparities in the treatment of long COVID. This webinar explored:

Good afternoon. I'm Katherine Santoro, senior director of programming at the National Institute for Health Care Management Foundation. On behalf of ..., thank you for joining us today for this important discussion on long Covid.

Recent national data from the Centers for Disease Control and Prevention found that nearly one in three adults in the US that had kind of a 19, also reported experiencing symptoms of ... at some point.

We also continue to see the impact of health disparities as some people are at increased risk of getting sick from covert 19 and developing Long coven because of where they work, where they live, and their access to health care.

The urgency of this ongoing threat was highlighted this week when the CDC reported that more than 3500 Americans have died at least in part due to long COVID.

Today, we will hear from a prestigious panel of experts to learn more about the impacts that long COVID as having on Individuals, Families, and Communities, as well as the economic burden.

Before we hear from them, I want to thank Nick Adams, president, and CEO, Nancy Chockley, and the ... team, who helped to convene today's event.

You can find biographical information for our speakers, along with today's agenda and copies of slides on our website.

We also invite you to join the conversation on Twitter, using the hashtag Long coven.

Am now pleased to introduce our first speaker. Doctor Walks, her course shots. Doctor ... serves as Director of the National Institute of Neurological Disorders and Stroke.

He joined NINDS and 22,007 as Deputy Director and has held leadership roles and a number of NIH and NINDS programs, including co leading the NIH's Brain Initiative and Recover Initiative.

The Study of post acute skylight of Combat 19.

We're so honored to have him with us today to help us better understand long koven after coercion.

They are very much, Katherine. It's a pleasure to be here and I'm going to talk to you a little bit about what we know and probably more about what we don't know about this condition.

And we use the term post acute ...

as an umbrella term, to cover all the things that are happened to people, because they had covert in the past.

So, this would include things such as long code, which is what you hear about in the newspapers, condition, Oppose viral condition of people do not get better from their acute infection. But it also would include things like any change to one risk of developing, say diabetes, heart disease, dementia, stroke going on in the future. So, that's the term we use, post acute ... as an umbrella term. As the next slide, please.

I'm going to talk talking about the issue of long covert, which of these persistent symptoms that occur, usually during the infection and then don't get better.

Sometimes, they get a little better, and then they and then they plateau, but they can last, for a long periods of time, without exactly sure how long they can actual, alas, going out, but certainly there are people, but when effective now, for over a year, sometimes up to two years now.

So these symptoms of ... are really cacophony of a whole bunch of different things. They usually occur in clusters. Most people have multiple symptoms, average, 7 to 13 symptoms and they fall into these major areas. So there are some that we call neurologic.

These are most most troubling our difficulties with the rapidity of your thinking processes.

Moving from one mental activity to another, very quickly, Goes under the name brain fog.

There is no such thing as fog in the brain, but as it's this kind of sense that everything is slowed down and everything is harder to do, but there's no loss of function. Like, you don't lose your speech, you don't lose your memory.

Everything is slower and more difficult, attention is a problem.

Uh, then, headache is another big problem. Sleep disorder is a big problem. There are also probably this mobility, So most of the people with long ... have this sense of fatigue, which we all understand.

We've always fatigue, either sleeplessness or say, during, you know, a common cold with a fever.

Fatigue is very prominent in this cluster, and that limits people's activities. They're also somebody will have difficulty with their pulmonary system.

Most of these people are people who had infection in the lungs so they have persistent core, persistent shortness of breath.

Some of them have abnormalities on their scans, but many their pulmonary function seem to have been normalized, but they're still having these symptoms of shortness of breath.

When it's because when they exercise, there are some people who develop what we call partial or static tachycardia with palpitations and discomfort in their chest. Next slide.

That's not all. Unfortunately, there's a whole bunch of other symptoms that can occur. Some of them are related to the GI system of Domino paned, decreased appetite a whole bunch of different than a GI disorders.

Then gentle symptoms like feeling, muscle pain, Different types of pain syndromes. I mentioned that in the chat, some people will develop a painful neuropathy, flu like symptoms, fever, less common.

Fatigue we talked about then, you know, if you have, if you had coven, we know what the consequences of coal are.

Certainly, that creates a lot of anxiety.

And if you're not getting better at the code, that's going to create even more anxiety, it's not an anxiety disorder, primarily, but, secondarily, covered can create an anxiety disorder, particularly, if you have all these other symptoms thrown in and you really worried about, when am I going to be better? When am I going to be back normal again and weeks, and months go by, so anxiety depression.

Also, are going to be pretty common in this population.

Next slide.

So, how many people are developing this?

Well, this is a hard question, because it depends a little bit of how you ask the question, and what kind of data you acquire to get your answer, uh, but this is a global look around the world, add the, getting a best estimate of the prevalence of post acute sequelae of covert.

And you can see here that in younger folks, it's pretty uncommon.

You know, a couple of percent here and there, Uh, And men age greater than 20, The percentages go up, and these are the different symptoms that people are feeling greater than one symptom clusters in the orange.

Fatigue is that dark blue, which is, which is pretty common, Respiratory, is that brown?

And you can see that women in general and most of the studies show a slight predominance, just one more.

so, as I've seen in other studies, of these persistent symptoms.

Now of interest in this, in this study, and I don't exact cannot.

I thought I could figure out how they, where they got the data to get at this. But they tried to estimate duration.

And they estimated as nine months for those who are hospitalized and four months, for those who are not hospitalized.

And certainly if you talk to physicians who are taking care of folks who are suffering from these conditions most see that they're on most of the pages are getting better over time. Although some have plateaued and seem to have kind of stagnated.

Nobody really keeps getting worse, though, so it's not a it's not, like, creating a new disease, It gets worse and worse over time.

It's either plateauing or getting better as what we've seen so far. But the knowledge is incomplete. Next slide.

Now, the best evidence that getting at the prevalence and incidence is really comes out of the UK Data and the National Healthcare System, so they can get data, and they've done these surveys, which, And, just to give you an example, of what the issues are and getting at the numbers.

If you just look at the number of people who have persistent symptoms of, in that class, we talked about 12 weeks, so this is, you know, three months after the acute infection.

It's 11.7% based on self classification. So just ask people.

About 11.7% will say yes.

If you take out, if you take the symptoms, and you ask people, do you have any of these specific symptoms? You get about 5% of people reporting any of the 12 common symptoms that we saw in the previous slides.

However, if you ask people who didn't get cov it, if they have those symptoms, the prevalence is 3.4% and that Is the key thing to know, is that the symptoms of post covered are not specific to postcode where they occur.

Very commonly in the population.

The best estimate is, you ask people, if they have had these symptoms continuously over a period of at least 12 weeks.

So in the common population, people have these symptoms at any point in time, but they're less frequently going to cover a period of three months, particularly those three months after you got code. That gets you more specificity. It gets to about 3% of the people who've had coven, Arizona 0.5%, in the Control group.

So, that's why the difficulty there is, in that. And then, you'll see these big differences in estimates.

But I think this is probably the best data from the UK, which says about 3% of people really have this post viral syndrome. We call log code. Next slide.

Couple of things about how the infection has changed those change, because the areas have changed, and it's changed, because people are now being vaccinated.

And, certainly, vaccinations seems to, many studies shows about a 50% lowering risk of developing post acute circlet code.

So it's all another good reason to get vaccinated.

Uh, in terms of the variance.

The thing to know is that the delta variant was the one that got people at the hospitals on ventilators all of those people are going to have long recovery periods with all the symptoms, and they're gonna go on for a year, probably more than a year.

That's less common now with the, with the, with the auma crime variant.

But, unfortunately, with our crime, there is still a significant percentage of people who are not vaccinated.

And even if they are vaccinated, some will develop the symptoms.

And, again, this is not the most conservative way of approximating but you can kind of see the differences whether your vaccines are not mobile crime versus delta.

Uh, maybe go skip that one, go to the next one.

And so, so the big question is, what's causing this, the problem? The problem is we don't know the answer to that.

I would say that this is not, the first time we've seen this.

There are many other infectious conditions where there are some people who develop persistent symptoms and don't get better.

You may know this is not uncommon when people get Lyme Disease Epstein, Barr Virus infection, mind, and nucleolus and number of other viral diseases, samba less common.

And there is this condition called ...

Chronic Fatigue Syndrome, revered As ME CFS.

Those people generally say that their problem was started after what sounds like some kind of infectious illness, not everyone.

But the larger proportion of people with ME CFS do give that history, and then they have symptoms that go on, unfortunately, for years or decades. And that can be a very severe disease. So that's the big worry.

is that post coven May some proportion of people, maybe a small proportion.

Hopefully, maybe we can stop at this stop at any cost.

But going on to Develop ME CFS would be a real problem for the country, given the millions of people who have been infected with coven.

And the people develop post code.

Now, what's causing it, there's a couple of theories, but we don't really have good evidence.

one is that there's actually persistent virus in the body, so certain viruses, Epstein Barr Virus is a good example.

Once you get it, it's a you always have.

It's hiding and different cells in your body.

It usually doesn't cause trouble but it is persistent herpes viruses, you know, cold sores, herpes zoster That's that's asked to re-activate a, you know, years and years after the Chickenpox.

So viruses can stay later than they may, in some instances be active enough to cause the immune system still go after them which were potentially causing symptoms.

The other thing is there could be viral particles or pieces of viruses that are still in the membranes and they're slowly leaking out.

There's still an immune response, even though there's no active buyers.

The other possibility is that you developed auto antibodies due to the co infection as an antibody response, when you have a big antibody response, sometimes it over spills and the antibodies start to recognize normal proteins as viral proteins.

And then they'll continuously be reacting against these normal proteins and a lot of autoimmune diseases. due to these auto antibodies, so rheumatoid arthritis are good examples, stomach lupus.

Another example of an autoimmune disorder, where antibodies are reacting against your body.

And people with those disorders have a lot of the symptoms that people with lung colon have, because your immune system is hyper activated.

There could be damage to the tissues, particularly in people who have lung problems, infection caused damage, but there could be damaging other tissues as well and taking time to get over and there could be reactivation of other viruses besides a covert like Epstein Barr Virus. So those are the main theories.

We really haven't been our nail down which of these is the real culprit and it potentially could be different to different people.

Just gonna skim through these, so there have been studies, and there are inklings, for each of these theories.

So here, you can see in blue, these are the controls, and red are the people who have Long coven.

And these are the different inflammatory markers. And you can see there's maybe some differences, but a lot of overlap. So it's not nothing definitive yet.

So this was looking at continued immune dysregulation.

Some evidence but not definitive. Next slide.

Uh, this is just studies that looked at auto antibodies. So when you have covert, you do develop a lot of auto antibodies. We don't, we don't know, is whether they are now related postcodes syndrome. But we do know that you do develop auto antibodies when you affected with coven.

Uh, and this is just an example of the vascular changes that occur encoded.

And that sum studies show some evidence that some of these vascular abnormalities are persisting of people with post cove it.

As you know, the virus effects cells that have this particular receptor called the H two receptor and that is on the lining cells of blood vessels.

That causes a lot of trouble with plotting in the acute code.

And so, some suggestions and maybe continued trouble with the vascular system. Even in the postcode state.

But, again, not, clearly, it's connected to the symptom.

Then, there's some papers, mostly from animal experiments, maybe some acute coville brain tissue that coven It can affect the inflammatory processes in the brain.

This is still on the experimental side.

You don't have good evidence that this occurs in the old code, but it's another potential trouble that might affect brain function.

Well, I must say that there are many ways where your flame system can get can get geared up and cause all these symptoms without actually causing something happening in the brain as the circulating factors that go to the brain and cause trouble with concentration, memory and sleep and things like that. Next slide.

There is a one paper which is in press those claiming to see our active virus and people will die months after the covert.

So, that's, it's not published yet, so it's still not peer reviewed finish.

But that's a big question of whether there's some continue viral activity and people with post covert.

Again, not clear that this is occurring in people, no completely recovered, as well as people have post code, but there may be some evidence of continued virus activation months after the covert. Next slide.

Now, this study is still not published, far, as I know, looking at signs of the viral proteins circulating in these little particle called exosomes that People post coven.

Uh, now, some of them are also been seen if you don't have the postcode so, but, more commonly in this study that people had long code.

So, these are the kind of things we're tracking. Next slide.

And the way we're doing this is through this study called Recover, which is a large NIH study. It's recruited over 10000 people.

And we are trying to try and get at these potential different causes.

We're looking at different conglomeration of symptoms and we're trying to develop clinical trials to try and treat the symptoms, but also clinical trials of things like antivirals on the chance that there is still viral activation.

So I'm getting short on time, so I'm just going to run through the next couple of slides very quickly, but I think I hit the high points here. Next slide.

This is just progress in the study over time.

Lots of work going on all across the country not just in the patients that I talked about, but also an autopsy studies, electronic health record studies.

And people, trying to look at the biology on this line, will encode the next slide.

And fluoride findings from the electronic health record is looking at the incidence of people in recent times with people who have a symptom eight to 20%, in the non hospital, and hospitalized in four to 8%.

And the non hospitalized is what this report came out. The next slide.

And why don't we go? These are the main things I think I talked about that the higher peaks or in the early part of the pandemic vaccination decreases your risk.

These are the trials that were focusing on different symptoms.

Whether they be the autonomic, the cardiopulmonary asleep or the neurologic going after, but antivirals for viral assistance and then things that would alter immune dysregulation. Next slide.

No, I think that's it.

I hope that was kind of a quick overview, where we stand now, in terms of the numbers and the work that's being done to try and understand this, but still so much to learn.

So, thanks very much for your attention.

Thank you, doctor ..., for track sharing this update on the current state of their research, and also an update on the recovery initiative.

Next, we will hear from doctor Kelly Tice, who is a family physician with a background in public health who serves as guide well and Florida Blues, Vice President of Medical Affairs, and Chief Health Equity Officer.

And this role, doctor Tice, is responsible for creating solutions that improve health outcomes and address health inequities for guideways customers and communities.

In addition to leading the company's health equity strategy, she has responsibilities and the areas of corporate social responsibility, and public health surveillance. We're so grateful. doctor ... is with us today, to share more about Florida Blues Efforts on Long copan.

Thank you, I am very glad to be here and have the opportunity to participate in today's conversation. I think doctor ... has really illustrated that there is much yet to be learned about this condition and certainly I'm pleased to have the chance to share from a payer perspective.

The truth is where long covert is concerned, there are still a great, many unknowns and from a payer perspective, we are uniquely positioned to see impacts across the health care continuum.

But we're also uniquely disadvantaged because of the, you know, sometimes the lag and data. And the lack of insight. We might have into how things are being managed, decided considered for instance, at the provider level, but. These are good problems to have, because it has forced us to have to be innovative, in terms of our solution ing. Next slide.

You may be familiar with Florida Blue as the health insurance arm of guide, one mutual holdings corporation, and that in fact, is somewhat of a parent company, and we consider ourselves a health solutions company. We are a non-profit, and while the insurance arm covers almost six million lives across every county in the state of Florida, our footprint as a company is actually much larger than that. Now, serving 46 million people in, in 45 states, including Puerto Rico and the US.

Virgin Islands point out, our recent acquisition of triple S is giving us an opportunity to be involved in indirect the care of a number of people on the Island of Puerto Rico, which further expand in particular our efforts to ensure and promote health equity.

So, I wanted to start with a review of how we framed and shaped our response to cope at 19 in general.

In fact, it was very early in the pandemic that once we had moved our than some 10000 or so employees into remote status that we began to focused intently on what our role as a payer needed to be in terms of supporting our members as well as being having positive influence in our communities.

On the left side, we see our areas of focus and, and, we met challenges and, you know, significant challenges on that side of things, and one, we were, we were working very hard to keep up with data that was sparse initially, that was difficult to validate.

Certainly, There was a significant delay until we were able to leverage kinked claims data in any sort of meaningful way.

We, in the interim, really relied on partners, providers, hospitals, and even public health officials to ensure a good flow of that validated data into our system.

So that we could determine what needed to be done where and how.

We worked very, very diligently on not just creating messaging, but evolving that messaging as information changed.

And being really particular about how, that messaging was being targeted to the audiences that that were at risk.

We used our partnerships with community organizations, both on the non-profit side, public side, as well as in the private sector, at the local level, at the state level, and at the national level, to ensure that we could, we had contact with in connection to thought leaders who were trusted by various areas of community.

And then, of course, we know we tapped out on every bit of clinical expertise we have within our organization in order to track what was a rapidly changing pandemic.

We moved through several phases, you know, talked about information.

And then as soon as testing was available, vetting and validating the accuracy of testing, ensuring that it was available in an equitable fashion. We actually were members of a White House Task Force that was developed to ensure equitable vaccine distribution and, well, ahead of vaccine distribution, We recognized that.

There was an opportunity for us to use our relationships with minority serving organizations and institutions to build ahead in advance of a vaccine distribution, the messaging and the relationships necessary to deliver both information and vaccines to those at risk communities.

We also very quickly identified in our own member population, who was at risk, and how they needed to be managed to reduce that risk, And that focus is going to continue throughout the response.

Each time there was an uptick, in cases, we brought back to the drawing board in terms of how we needed to the final approach to ensuring so having the appropriate impact. Next slide.

This is the best example best visual I could provide in terms of outfront.

This happens to be, but we used as we look to distribute vaccine equitably, we have applied this model through throughout the pandemic.

And Eric, in fact, continue to leverage it for our overall vaccine strategy, as well as public health and health equity efforts.

So, what you see is a map that was generated out of a social determinants of health dashboard that we created, really, very early in the demo.

That allows us to identify, by snooty social vulnerability levels, You're able to map, where I remember population is, within, that the geographic areas, can also place on the map T, For instance. So you see here a sort of a retail centers, which become our clinical stops in our communities, and allow us to deliver services to, to the community, out of sort of a storefront. In this particular map. We also mapped Faith faith based Partnerships, which became key relationships that we leverage torsional, if I'm not saying. This was the tool that we use to determine where we were going to allocate resources, with whom we were going to park.

Frankly, what we said yes to any little to ensure that we were being good stewards of the resources that that we've had in order to contribute to some of the solutions that were necessary, and we can leverage this over and over again through the pandemic with each iteration, in order to be sure that we are meeting our members have a great essay.

Doctor Cornstarch talked about the, the vast array of symptoms that explain long term symptoms 10 development and we certainly wrestled with this very early on. We will get there wasn't a code for long hoping for some time after we knew that Post acute Somalia was even a thing. And we began to report screen is what we're seeing in our claims data to try to understand what the experience was of our members related to this.

Initially, we had only anecdotal reports, because we were very intentional about gathering information from our members, through all of the available touchpoints by the first sources of information for us, was survey responses that we got at the end of the morgans 30.

So, the webinars that we did, starting in mid 20th, at the end of each of this webinar, as soon as we knew that, that post acute supply was, was a condition for which we needed to be concerned.

We actually deploy your questions out to all of our webinar participants, and Registrant's asking if they themselves were experiencing such symptoms. And we actually got quite a bit of rich data.

We couldn't necessarily string all of those systems together right away, But we certainly need that. What we did hearing and seeing recorded across the country was an issue for a number.

You see there's the definitions that that we use, and we actually, the data I'll show, which is really directional.

Here's a number of reasons that our data is still somewhat inaccurate, That we use both suspected or confirmed, because we know that there are, there's a learning curve in the provider community in particular, And what we're finding is that very often, numbers are being seen multiple times for a diagnosis of long term, but it's actually being blind.

And, in order for us to understand, then we have to be able to look back and, and identifying, you know, planes often, even before they've never begins to carry a diagnosis.

It's critical that also, that we understand that there are large impacts, cardiovascular pulmonary, behavioral health, impacts of being able to characterize this in detail becomes incredibly challenging.

I think in correlation with, with what has been seen, what's been presented already. We're seeing high prevalence in females.

In claims, as well as those with chronic conditions. In fact, the prevalence for those with chronic conditions is actually more than double those without. We also see a higher prevalence in our members who are over the age of 40.

And, and definitely, we see correlation with those that are living in areas of high social deprivation.

Password Enter Introductory remarks actually spoke about the disparities that, that are of concern when we talk about ... infection in general and the same risk factors for disparate impacts exist for long as well.

I'll take you through some of this data again, you know, with a grain of salt, we have to take some of these. But I want to point out a couple of things. You see the increasing frequency of suspected or long, perfect confirmed as age increases. But, if you look there at the younger population, this correlates with some of the impacts that, Sarah, from parents of some of our youngest mammals early in the pandemic as well.

I mentioned that chronic conditions were an issue and an invitation.

here, you see this vast increase in them, the Prevalence of Law coven, and our members, with more than one chronic condition. It is incredibly significant, and this actually aligns with what we saw with perfect hospitalizations.

And, perhaps, it is, Then, it's good to know that using our approach, in terms of identifying a restaurant, finer members, we were already doing proactive outreach to many of these members. Because we recognize that, if conditions placed an at risk for health, and then we determined that, it also is there risk as long?

Just wanted to talk a little bit further, valid, or, or data challenges?

It is, they have been insignificant, and, as most payers, have, we have found, and need to reside somewhere between, you know, what is validated and publicly available, steady proven, but not specific to our members, and what we can gather from our own never population. We've got to do a number of things. First. And foremost, we have to protect our members, which, in many cases, is, our own employees, or team members, as well. So any learnings that, we can gain from any source, certainly is's response. But we also need to be able to predict the impact of long Soviet on on costs.

And while these, these current data on this is somewhat directionally accurate only, we are seeing a significant increase in member costs for those who have a history of, of having been infected and dealt with, in fact, thousands of dollars in those cases of additional costs in the months that followed that diagnosis.

And so that's certainly something, too, to pay attention to, that we'll talk further about the other economic impacts of long serving.

But one of the reasons that, that's a great concern is because in a system where we know access is an issue, those costs can be more significant.

If we are worried about access, if we're dealing with providers, for instance, who aren't sure of the appropriate way to evaluate these, these conditions.

And, what we're finding, in fact, is that many of them are ordering everything in order to be certain that they don't miss anything, which can be, in a rather inefficient for you to utilize our resources. And one of the other things that, that we attempted to do early on, and we are making, continue to make a part of our, supported our members, is to stay abreast of the Centers of Excellence that has, that have been developed in our state, so that we can direct members to those services. Understanding.

As soon as I say, that the difficulty and challenges that exist when you have no, 4 or five kind of four areas in the state, where you've got expertise, and other areas of the state that may be uncovered from a clinical professional staff checks.

When we think about our, our members, and understanding their impact, I mentioned that as soon as we thought long code that might have been a thing, we began gathering information. The other thing that we did fairly quickly, was to pull our team together, and mapped the journey.

A member who had coven subsequently developed long term symptoms.

That allowed us to see all along the care continuum where the opportunities were and where the needs for support existed.

We were able to leverage information that we gathered from our own contact tracing efforts for our employee population, in order to understand the implications of the condition, as well as the limitations of the system, in terms of having access to information about one covert much, less treatment and evaluation.

While we gathered the information clinically, we understood a few things that there were support, that misleading that the impact and long term debilitation required more mental health support. We leveraged the use of our hotlines are multi-disciplinary care teams to do proactive outreach and provide that support, help them feel heard, connected, cared about while we learned what was happening in the clinical landscape, and work to help, sort of, facilitate linkage into care.

We, we also did, you know, a number of follow ups with members who had these experiences to better understand what it's like to navigate a system that was sort of defining itself real-time.

I'm definitely very, very proud of that slide that you saw at the outset that really talks about how we leverage the data that was available to us in order to really direct and target our responses. The other thing I'm really extraordinarily proud of is our care management approach.

And we have long had a multi-disciplinary approach to care management for our members who have highest needs in terms of chronic illness or, or other social barriers to health care.

And we have to continue to leverage those teams in order to meet the needs of our patients are members of or identified, as long proving. Our care management teams actually exist across our state to serve our member population by geographic location.

And those teams include medical directors, clinical pharmacy leader, social workers, and nurses, and, you know, other skill sets, as needed. And in there, that is a very local approach that is, is present for our members. But, we use the same model to actually contribute similar information support, at the community level, Out of our florida blue Retail Centers.

Again, multi-disciplinary teams, but with including social workers with who was in embedded.

But with partnerships with local community organizations and groups, and an understanding of what's happening on the clinical side of things, what our hospital partners doing, what clinics may be opening, that, they may be providing these targeted services, so that we can disseminate that information.

The other thing that is key and that is new is that we've created a team identified pretty early, that there is a need for someone to be tracking this, changing clinical data and interpreting it and then deploying it across our internal stakeholders. And so our Clinical Pandemic Response Team still exists. I think some would say unfortunately, to ensure that as things change and the appropriate updates are made across our organization, we've got a member service center that's taking them because we have a sales team have sales agents, all of whom need to understand and be able to articulate and respond to you to leverage them to ensure that our members and community leaders have lives today.

That concludes my my presentation for today.

I look forward to to the question and answer period, and again, embrace the opportunity to share our perspective as a payer. Thank you.

Thank you, doctor TACE, for highlighting guide. Ron Florida Bill is leadership and supporting long code that I just wanted to take a quick second to ask. If anyone has dialed in and is listening to the webinar, they could make sure to unmute their phones and others a little bit of background noise happening. So thank you. Next we will hear from Katie back and Debug Kotler. Katie is a non resident senior fellow at the Brookings Institution where she writes about long covert job quality and low wage work.

Doctor Cutler is currently the ..., professor of applied economics, and the Department of Economics at Harvard School of Government.

Professor Cotler holds secondary endpoint appointments at the Kennedy School of Government, and the School of Public Health. We're so grateful to have both of them with us today to talk about the economic burden of ....

Catherine, thank you very much for having us, inviting us here, the fire trucks going by outside. So we're gonna do a true tag team here. I'm gonna, we're gonna pass the baton back and forth a couple of times.

Depending on the size of the player, I made to skip the entire thing to Katie, but if we could start off with this.

Thanks. And then to the next one, there are couple of things we want to talk about. We'll talk very briefly about the prevalence, because that was covered in some of the other presentations. And just give you a little bit on that.

Then we'll talk about the Costs of Long coven. And so we'll do it, at two levels, will talk about that.

Cost to Individuals and families, and then we'll talk about the aggregate social costs. And finally, we'll come back to the policy choices. That influence cancer.

If I could jump to the next one, please.

So first off, in terms of overall prevalence, as you heard it to be at the beginning of the webinar, this is not known extremely well, there are different estimates from different surveys.

There are different institutes in different countries even with relatively similar acute coby burdens in the US based on recent data from the Household Pulse Survey, as people are you currently suffering from, from symptoms that are low-income and symptoms.

About 6.5% of the adult population currently experienced as long Kobe, that's about seven.

billion adults.

Roughly 85% of those That's the 5.4% say that they have any limitations associated with lung ....

Then about 25% of the 6.4% or 1.6% in total and have significant limitations. So that's about four million adults that have significant limitations from one code. That's obviously a really large number.

People suffering here.

If I could jump, jump.

The next slide. You look a little bit by age, relative to the total amount of lung coven. It sort of peaks in the late Middle Ages. I don't know.

Maybe I'm getting my my own age is killing my description of this. Roughly 40 to 5050 to 60, then declines from there. I think, in part, Because co-produce more likely to lead to death at older ages. So the Lung covered component is somewhat smaller, thankfully, at younger ages, the tool is not nearly as big.

So you see a sort of shape in death, in age.

And then on the next slide shows you a bit by characteristics of the economy. And the law uncovered is higher among people with fewer years of education, people without a high school degree, those with a high score, some GED or a little bit lower. But then those without a college degree without a BA tend to be higher again. So there's a rough divide in long covert as there is with many things now. And the divide is, sort of between having a college degree, or not having a college degree, And the labor force is working that way.

And, unfortunately, disease is turning that way, as well. So, that's a little bit on just kind of, how many people have it. As they said, what we're gonna do is, we're going to turn to, what is the Net Impact, both on people and families in the economy?

So, the first thing I'm gonna do is, I'm going to toss the microphone proverbially to Katie, who's going to pick up from here?

Thanks. Next slide, please.

So we're starting with the personal costs, so the cost to patients and to their families.

And, you know, I think the first and probably most important thing to say, and this echoes what we've heard before it echoes what David just said, is the burden does seem disproportionately on people with a high school degree or less. They are likely to be lower income and experience higher levels of financial insecurity to start with.

So as we think about the financial impact of long coed, obviously it depends as I sat on underlying financial security and on severity. But there are two elements. The first is that patients with Long coven and their households may see their income decline.

As has been a theme today, we don't have a definitive answer on the impact of long kovac on work.

But we know from the UK's very good Office of National Statistics work that Working Age Long coven patients are about 35 to 45%, more likely, to be out of work post infection. Than they were pre infection.

We also know from a longitudinal study that somewhere around a quarter of long kovac patients have either their employment status or their working hours impacted, and obviously, both can translate into a loss of income.

At the same time, that some patients and households are losing income, as we just heard from doctor ties, their health costs are rising.

Again, we don't have a good number. The best proxy might be what we see in ME CFS. As we heard earlier, there are overlaps between some cases of Lung coven, and ME CFS.

And in ME CFS, we see about $9000 a year in household spending associated with the illness.

Obviously, that is a huge number, given the US. Median Income.

And as we think about where that number comes from, it's a few things.

So one, as doctor Case just mentioned, there are no validated treatments for long ..., or these other infection associated chronic illnesses.

And so, in many cases, patients are bouncing from doctor to doctor from treatment to treatment, trying to find something that works and to rule out Causes that aren't on coven.

two, in many cases, people don't have insurance. As we said, this is disproportionately falling on people who are less well off financially. In addition, of course, many people get their insurance through their job, So if you lose your job, you can lose your insurance. Then, finally, in some cases, insurance just isn't covering the tests and treatment that some of the more expert physicians who treat long coed and other infection associated chronic illnesses are recommending.

Final point, I have heard from a number of people who reached out and said, Yeah, I don't have long Cove Ed. But my partner who was not a breadwinner does.

But because my partner was the primary caregiver for the family, I have had to reduce my working hours and so it's important to remember that household can lose income even if it isn't the breadwinner. Who is impacted by law?

Next slide please.

So if we zoom out from the patients to what does the Net Impact on employment, probably the best analysis was done by Gopi Goda and Evidence Altice from Stanford and MIT.

And they found that after a week long work absence that was due to acute ..., they say they looked at what happens to people's labor market behavior after a week long health absence that was due to acute covered.

And they estimate that somewhere between half 1,000,000.75 of a million people have fully dropped out of the labor force as a result of having an acute co-pay.

And that does not include additional reductions in hours worked, for people who are still in the labor force, after having co bid.

There are two caveats, as we think about this, as a summary of the labor force impact of lancome ed. First, not everyone with long cauvery took a week off from work when they had acute covered. In some cases, the acute covered symptoms weren't more severe, and in other cases, they didn't have sick leave, and they couldn't afford to take any time off.

On the flip side, this doesn't tell us why people drop out of the labor force.

It just tells us that many do, they're having acute ..., it could be due to lack of it. But it could also be, for example, early retirement and a fear of getting over it again.

So, if we can flip to the next slide, I guess the question then is, where does that leave us on the labor market impact? And the answer is that we don't have a definitive answer.

What we do know is that it is a non trivial labor market impact, which isn't a surprise given that, as David said earlier, somewhere around four million Americans are currently significantly limited by Long coven.

I think our best estimate standing here today is that it's probably somewhere between half three million full-time equivalent workers. Or out of the labor force. And when I say full-time equivalent, I don't mean half a million to two million people. I mean, the equivalent of half a million to two million full-time workers. So that would include people who are still working but have had to reduce their hours to decode.

And now I'm going to flip the microphone back.

OK, thank you, and let me go onto the next slide.

So, what we've tried to do is add this up to an aggregate cost long code into the economy.

And so I want to just give you a brief description of how we did that and then present the results to, and then we'll talk about some implications. So at the economy wide level, there are three costs that we consider.

The first, the first, is the health loss. That is, people are in worse health as a result of co-pays.

We can measure that in a usual, sort of cost effectiveness banner, which is we know roughly what the utility associated with having symptoms on cope. It is from other related conditions. We then value that. This is not money lost. I want to come to that.

This is kind of the lost welfare of not living, less healthy lives. And that's one of the reasons why.

the way we train earned income is to live better lives. So that's the first part, is the health loss. The second and third are really money that's not earned.

Because people cannot work, That's the second or money that we have to devote to things other than kind of consumption enjoyment. That's the health spending part.

So, each of those, if you will, is the loss of GDP, either GDP that's not earned because there are fewer people that are working where GDP. That's not available for consumption of things. That we like, assuming we don't particularly like medical care other than the access healthier.

And so that's the third of those other things that Katie had mentioned that are really important would not show up in a GDP calculation.

For example, if you took money from me and gave it to someone else, that doesn't change the GDP of the economy, makes me better or worse off than the other person better off, but that's not it. That's sort of a transfer, more than it, is an aggregate impact. So as an aggregate economic impact, we want to think about these three things here.

So we've gone about pricing them out, and I'll show you the estimate on the next slide.

Without going into enormous detail, the total cost that I get is around three point seven trillion dollars.

To be clear, what that is, is that's the cost based on the number of cases of Long coven to date.

So assuming that case, that people have Long coven today don't do anything different.

No new cases in the future, And these cases resolved themselves kind of slowly over time, in the way that's consistent with literature, so they don't all go on forever, but they don't know today.

And so that, there are three parts to that, the three on the previous slide, the biggest one is the reduced quality of life. But there's a very significant, that is roughly trillion dollar impact on earnings that will occur.

And then, another half trillion dollar impact through medical spending, which we benchmark for people with, with relatively similar chronic, can be chronic fatigue symptoms.

I will just note one other macroeconomic point, which is that part of the reason why inflation is high, is, because firms can't hire workers part of the workers. They can't hire a low wage service workers. Remember, those are the same workers that have Long coven disproportionately .... And so I actually think part of our current macroeconomic situation. Now, not all of it, but part of it is the result of long overdue and other things. And it reduced the labor force labor supply of workers who desperately need. So I think there's actually even a bigger impact than this, but I haven't tried to quantify that.

The final two minutes or so, We'll just talk about implications, so in the next slide, I'll just give one of them, and then I won't pass the microphone back. So first is implications for public policy, one is, we desperately need to know more, And in this was sort of broader.

Earlier on, doctor ..., we just couldn't the amount that we know about it, is just far far below what we ought to know.

There's an interesting part, which is this could not have a big impact on SSDI and other forms of disability insurance. So far, we have not seen an increase in SSDI enrollment or applications, which is really quite anomalous.

Many workers with Long Cove it seemed to be working, whether they will be able to continue doing that and what form that will be able to continue doing. that is going to depend on all sorts of things, including their own personal health as well as what employers are doing. So, there are other sort of, implications here. And to talk about those, let me just pass it to the final time, back to Katie.

And, next slide, please.

So, when people ask, what do we do to reduce the economic burden of long ..., I mean the obvious answer, if you think back to, to what David presented and where the, where the cash costs are coming from, not the loss of welfare.

It's, you have to keep people at work, and that means there are significant implications for how employers behave. This matters tremendously to society. Loss of work, and income is devastating for individuals and families. It also matters to employers. As David said, particularly when it comes to low wage service work, employers are still facing significant challenges hiring, which is impacting their bottom line. So employers are highly incentivized to keep people working, if they can.

Which means we need better information on what accommodations work for Long coven.

A few that we know. Telework. Obviously, commuting is tiring, physically demanding, and people with long covert don't want to risk getting coven again. Flexibility on working hours and deadlines. More frequent breaks, and particularly for low wage service work, think like food preparation or retail.

Finding opportunities to let people set, instead of stand, if they have orthopedic and tolerance. And finally, Brain Fog is one of the prominent lancome symptoms, and some workers are finding that prompts are making their jobs easier. So, thanks for example, of printing out recipes for food service workers instead of having to memorize them or posting checklists.

Unfortunately, not all jobs are easily amenable to accomodation.

The jobs that are easier to accommodate are jobs like mine that can be done remotely, that are primarily asynchronous, I can work sort of when I want, that are not particularly physically demanding.

The very people, though, who are in the jobs that have to be in person are synchronous and are pretty physically demanding, are often lower wage workers. Think retail clerks, nursing aides in nursing homes and food service workers. So it is critical that we also have a safety net for people whose covert is too severe and whose jobs just can't accommodate.

Next slide, please.

Then, finally, the other piece of, you know, allowing people to maintain economic productivity.

And obviously, reducing the welfare loss is treatment for people who get lancome it.

There are a few clinicians, not many but a few who do have experience with infection associated Chronic Illness, ME CFS, which has been mentioned a few times.

And anecdotally, though, we don't have large-scale trials validating treatment approaches, there are treatments that are helping some Long coven patients. Those who have muscle activation issues, those who have parts, as doctor ...

mentioned, and a few more what we need are long fluid Leverette: PCPs. primary care physicians.

Because this is, this is the first point of call for most patients and specialists who not only understand these conditions, and are up to date on the latest treatments, but also critically who take insurance. Today, many of the few, many of the few really expert clinicians in these fields don't take insurance, because the reimbursement model doesn't work for the types of tests, treatments, and appointment times that they are that they are spending.

So that was kind of a whirlwind at the end.

But thank you so much for the time and we look forward to well, it looks like maybe three minutes of questions.

Thank you, Katy and David, for sharing your work on the economic burden. We'd like to just take a quick minute or two to engage and Q&A.

So, I'll ask our panelists to come off mute and back on video. And I wanted to just tee off of your comments, Haiti, about the healthcare workforce, and see if any of our other speakers wanted to weigh on. Especially, you know, the pandemic eliminated our Health Care Workforce Challenges. We're seeing that right now with coven Flu and RSVP.

Do any of the other speakers want to talk about how Long Covert is impacting our frontline workers, whether they have code that are struggling with long covered, or treating those patients? Are you seeing requests from providers for education on treatment? And what sort of public health infrastructure, or other changes do we need, for, The Future, to Accommodate Long coven patients?

Yeah, I would say that now, when the pandemic head clinic started to take care of people coming out of ...

that was expected at the RDS.

They started to fill up with people and never in the hospital.

But those have continued, so there has been a whole new area of science and medicine that's that sprung up in the specialized clinics, but as Katie said, some of these have waiting lists of 3 to 6 months to even get into them.

So it's it started, but it's not scale.

On the other hand, I would also say that the people who had ME CFS pre coded, they always had trouble finding a position to take care of them. Many physicians just ignored the issue, I didn't want, didn't want to deal with it, they didn't understand that.

Now, now it's pretty hard to say that anymore because everybody knows this is a Kobi related issue.

So I think PSAPs are getting more experience and take care of these patients.

But I would say it's, you know, it's really, it's really in its infancy.

So anything that can be done to scale this up is going to be helpful.

And I would just add the importance of remembering that hospitals and clinics are themselves employers.

And so, one of the issues that we're hearing is that, for instance, our hospital providers, their costs, the costs of just paying salaries, is going up, in addition to the, the additional health care across, the, the limitations, and the need to use contracting workers. And that sort of thing, in order to fill those gaps, is, is really impacting hospital systems in a specific way, in terms of their, their financials.

Need to pay the Rehab Physician.

The Association of No Desire to Us, has taken this on, and they said they had some really good guidelines to help physicians, but I think that's something else to put on the table.

And now, we are over time, but I'm gonna take one last question from our audience and ask each of you, if you could just leave us with one of your top items on your wishlist or research that you think are needed to continue to advance the discussion of long copan.

Doctor ..., do you want to start?

Matthew, do I need, I needed medicine, fix this problem?

For me, I would say, you know, we noticed that vaccine uptake correlates with sort of surges of illness spray. And so the uptake of vaccine is really morbidly low, It's a dismal. And as the data continues to prove that, it has an impact on reducing the incidence of lung. Totally just, I wish we could get folks be paying attention to that, and really protecting themselves.

OK, so I agree with the, prior to, I'll just add, thinking about how to maximize the productivity of people who are limited, so that we're not wasting valuable time for people really want to work, and we need to work.

OK, I strongly echo that, and I would like a deeper dive and more research on specifically how this is impacting low wage workers. The workers who we know disproportionately bear this burden and who are probably the hardest to accommodate to understand what type of safety net interventions we might need to put into place.

Well, thank you all for being with us today, and sharing your work and perspectives. Thank you to our audience. Your feedback is important. Please take a moment to complete a brief survey that will open on your screen and after the event, you can access the speaker slides and we will make a recording of the event available. Please also check out other resources on our website and stay tuned for our upcoming infographic on Long Co brand that we'll be releasing and January. Thank you all again for joining us today for this discussion.

Speaker Presentations

Walter Koroshetz, MD

National Institutes of Health

Kelli Tice, MD

GuideWell & Florida Blue

Brookings Institution

David Cutler, PhD

Harvard University

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Published on: February 02, 2023.

Long COVID: What We Know

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Biden–Harris Administration Releases Two New Reports on Long COVID to Support Patients and Further Research

The Biden–Harris Administration is committed to helping people across America affected by Long COVID. In April, President Joe Biden issued a Memorandum on Addressing the Long-Term Effects of COVID-19 , which called for the creation of two reports. Within 120 days, the U.S. Department of Health and Human Services (HHS), leading a whole-of-government response, developed two reports that together, pave an actionable path forward to address Long COVID and associated conditions.

The National Research Action Plan on Long COVID details advances in current research and charts a course for future study to better understand prevention and treatment of Long COVID. The Services and Supports for Longer-Term Impacts of COVID-19 report highlights resources for health care workers, and those effected by broader effects of COVID-19, including not only Long COVID but also effects on mental health and substance use, and loss of caregivers and loved ones.

“Long COVID can hinder an individual’s ability to work, attend school, participate in community life, and engage in everyday activities,” said HHS Secretary Xavier Becerra. “As our nation continues to make strides in the fight against COVID-19, these reports are critical to shine a light on Long COVID’s impact and how to match people to resources.”

“The Biden-Harris Administration is committed to combating and responding to the COVID-19 pandemic with the full capacity of the federal government,” said HHS Assistant Secretary for Health ADM Rachel Levine. "These initial reports are an important step as HHS continues to accelerate research and programmatic support to address the consequences of the pandemic and work across sectors to ensure no one is left behind as we continue to build a healthier future.”

People with Long COVID have disease symptoms that persist for weeks or months after acute COVID-19 infection. It remains difficult to measure precisely, but an estimated 7.7 to 23 million Americans have developed Long COVID , and roughly one million people may be out of the workforce at any given time due to the condition—equivalent to about $50 billion in lost earnings annually.

The National Research Action Plan on Long COVID (the Research Plan), created in coordination with 14 government departments and agencies, introduces the first U.S. government–wide national research agenda focused on advancing prevention, diagnosis, treatment, and provision of services and supports for individuals and families experiencing Long COVID.

The Research Plan stresses four guiding principles to govern federal government data analysis work: health equity, accelerating and expanding current research, orienting the research effort to improve patient care, and partner engagement. The plan demonstrates innovation in early achievements and highlights the importance of collaboration between the public and private sectors to advance prevention, diagnosis, treatment, and provision of health care, public health, and human services for individuals experiencing Long COVID.

The Services and Supports for Longer-Term Impacts of COVID-19 Report (Services Report) outlines federal services available to the American public to address longer-term effects of COVID-19, including Long COVID and related conditions, as well as other impacts on individuals and families. It provides valuable information in three key areas:

• Federal supports and services available for people experiencing Long COVID – from how to navigate your rights to how to navigate health care coverage, community services, financial assistance, nutrition and educational questions and more.
• Resources for health care personnel treating patients with Long COVID, as well as support for health care personnel experiencing stress and trauma related to COVID-19.
• Services for individuals confronting challenges related to mental health, substance use, and bereavement.

Federal departments will continue to engage with partners, including state and local governments, on the scope and accessibility of these services to meet the needs of individuals. Engagement of nongovernmental experts, organizations, and stakeholders, including individuals affected directly by the longer-term effects of COVID-19, has played an essential role in shaping the government’s response to COVID-19 and Long COVID, including the development of these reports.

As we learn more about Long COVID, the best protection remains to prevent COVID-19 in the first place by following basic public health interventions, including getting vaccinated, boosted, and wearing a mask indoors in public where the COVID-19 community level is high.

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Experts detail the toll of long COVID in congressional testimony: ‘The patients keep coming’

Long COVID is disabling millions of Americans and putting stress on both the health care system and the economy, experts said Tuesday in a House Subcommittee hearing on the poorly understood illness.

Their testimony underscored the enormity of this mostly unrecognized epidemic.

Explaining the patient toll, Dr. Monica Verduzco-Gutierrez, a specialist in brain injury and rehabilitation medicine at UT Health San Antonio, talked about the nearly 500 patients she’s seen, each fighting their own individual battle against the condition: “patients who have developed autoimmune disease, who can’t stand up for two minutes without their heart rate going through the roof, who have fatigue 100 times worse than when they had cancer, marathoners who can’t run, healthcare providers can’t physically or cognitively return to the bedside.

“And the patients keep coming. Some are waiting upwards of six months to be seen,” she said. “When the day of their appointment arrives, some do not make it. Not because they got better, but because they got worse. They lost their job and healthcare insurance, or they are so disabled they can’t get out of bed. This is a public health crisis.”

Even though the condition is affecting millions of Americans, “there is not a way for me as a physician to diagnose long COVID based on physical exam, blood work, an EKG or a scan,” Verduzco-Gutierrez said.

Among the most disabling symptoms of long COVID is cognitive damage, Verduzco-Gutierrez said. “Many of my patients have overlapping symptoms with those seen after brain disease: dizziness, memory loss, concentration problems, insomnia, headaches, tremors, [dysfunction of the autonomic nervous system], anxiety, PTSD and suicidal thoughts,” she added.

Unfortunately the public has many misunderstandings about long COVID, said Hannah Davis, co-founder of the Patient-Led Research Collaborative. Davis got COVID in March of 2020 and has been disabled by its symptoms ever since. “Before I got sick I worked in artificial intelligence, but I haven’t been able to return to that kind of work,” she said.

What many do not understand is that 76% of those who develop long COVID had a mild initial case of COVID , Davis said. Even those who had COVID and fully recovered are not safe from disabling long term symptoms. Some people develop long COVID when they are reinfected with SARS-CoV-2, she added.

There is not a way for me as a physician to diagnose long COVID based on physical exam, blood work, an EKG or a scan.

Dr. Monica Verduzco-Gutierrez

Women and minorities appear to be hardest hit by long COVID, said the Subcommittee’s chairman, Rep. James E. Clyburn. Recent data from the Centers for Disease Control and Prevention (CDC) suggest “that women are more likely to be diagnosed with long COVID than men and that Black and Hispanic Americans are more likely to experience long COVID than white Americans,” he added.

That coupled with bias among health care workers can exacerbate the situation, said Cynthia Adinig, a business woman and stay-at-home mom who has long COVID. Adinig described her last traumatizing visit to the emergency room in 2020.

“Being wheelchair dependent at the time, I was threatened with arrest by the emergency room hospital staff while seeking medical help during an episode of dangerously low oxygen and high heart rate. I had learned a few weeks prior that this same hospital had tested me for illicit drug use without my knowledge three times prior, in response to the long COVID symptoms I presented with.”

Even worse, “despite my drug tests repeatedly coming back negative for drug use, I was slated to be given Narcan for withdrawal symptoms during one of my admissions for dehydration and starvation brought upon by long COVID,” Adinig said.

Long COVID is having an even broader impact than the effects seen by the healthcare system and individual patients, said Katie Bach, a nonresident senior fellow at the Brookings Institute.

Recent data suggests that around 16 million Americans may currently have long COVID, Bach said. A longitudinal study by the Federal Reserve Bank of Minneapolis “found that 24.1% of people who’ve had COVID experienced symptoms for three months or more, which is how the study defined long COVID,” Bach said.

By Bach’s estimates, four million full-time workers may now have a reduced ability to work. “To put this in perspective, consider the economic cost of just the lost earnings of long haulers,” Bach said. “Four million people out of work translates into $230 billion a year in lost earnings. If the long COVID population increases by just 10 percent each year, by 2030 that will be half a trillion dollars each year.”

The federal government has been responding by, among other actions, specifying that long COVID qualifies as a disability under the Americans with Disabilities Act, Clyburn said. “This is an important step in ensuring that long COVID is appropriately treated by employers as the disabling event it can often be and providing workers the protections workers the protections they need so they do not have to choose between a paycheck and their health.”  

Linda Carroll is a Peabody Award-winning journalist who is a contributing health and medicine writer for NBC News and TODAY. She is co-author of three books: “The Concussion Crisis: Anatomy of a Silent Epidemic”, “Out of the Clouds: The Unlikely Horseman and the Unwanted Colt Who Conquered the Sport of Kings” and “Duel for the Crown: Affirmed, Alydar, and Racing’s Greatest Rivalry”.  

Long Covid explanation in new study possibly paves way for tests and treatments

Scientists have identified a persistent change in a handful of blood proteins in people with long Covid that indicates that an important part of their immune system remains on high alert for months after an acute infection.

The findings , published Thursday in the journal Science, could help explain what causes the persistent fatigue, brain fog and other debilitating symptoms of long Covid , as well as pave the way for diagnostic tests and potentially, a long-awaited treatment, experts say. 

The study followed 113 Covid patients for up to one year after they were first infected, along with 39 healthy controls. At the six-month mark, 40 patients had developed long Covid symptoms . 

Repeated blood samples turned up important differences in their blood: A group of proteins indicated that a part of the body’s immune system called the complement system remained activated long after it should have returned to normal.

“When you have a viral or bacterial infection , the complement system becomes activated and binds to these viruses and bacteria and then eliminates them,” said Dr. Onur Boyman, a professor of immunology at the University of Zurich in Switzerland and one of the study’s investigators. The system then returns to its resting state, where its regular job is to clear the body of dead cells, he said. 

But if the complement system remains in its microbe-fighting state after the viruses and bacteria are eliminated, “it starts damaging healthy cells,” he said.

“These can be endothelial cells that line the inner layers of blood vessels, the cells of the blood itself, and cells in different organs, like the brain or the lungs,” he continued. The result is tissue damage and microclots in the blood.

Previous studies have documented blood clotting and tissue damage in people with long Covid. “But this research gets at the molecular mechanism of how that might be initiated,” said Akiko Iwasaki, a professor of immunobiology and molecular, cellular and developmental biology at the Yale School of Medicine, who was not involved with the new study.

Tissue damage along with blood clots can lead to the disabling symptoms of long Covid, including an intolerance to exercise.

During exercise, the heart pumps more blood and agitates the endothelial cells inside blood vessels, which are everywhere in the body, Boyman said. 

“In healthy people, normal endothelial cells can take these changes, but the inflamed endothelial cells in long Covid patients cannot,” he said.

Iwasaki noted that microclots can reduce the level of oxygen and nutrients delivered to different organs. 

“If your brain, for example, isn’t getting enough oxygen, obviously there will be a lot of issues with memory, brain fog and fatigue,” she said.

A possible path to tests and treatments 

A little more than 14% of adults in the United States report ever having experienced long Covid, according to the most recent data from the U.S. Census Bureau’s Household Pulse Survey . 

Dr. Monica Verduzco-Gutierrez, chair of rehabilitation medicine at the University of Texas Health Science Center at San Antonio and head of its long Covid clinic, praised the new study.

“Understanding the mechanisms of long Covid is how we’re going to figure out treatments,” she said.

Other studies have also identified potential mechanisms. In  one study , published in the October issue of the journal Cell, researchers suggested that remnants of the virus lingering in the gut of long Covid patients triggered reductions in the neurotransmitter serotonin. Lower serotonin levels, they said, could explain some neurological and cognitive symptoms.  Another study , published in the journal Nature in September by Iwasaki and her colleagues, found that long Covid patients had significantly lower levels of the hormone cortisol than other Covid patients and healthy controls. Cortisol helps people feel alert and awake.

Verduzco-Gutierrez, Iwasaki and Boyman agree that the new research points the way toward developing diagnostic tests and treatment by focusing on the proteins of the complement system.

However, Boyman and his colleagues used cutting-edge, complicated methods for detecting the differences in these proteins that could not be used in a routine diagnostic lab. 

“We need companies already active in diagnostics that have sufficient manpower and financial power” to develop a simplified test, he said. 

Once a test is developed, or with rigorous screening for long Covid patients, pharmaceutical companies could begin clinical trials of potential treatments, Boyman said. Drugs already exist to modulate and inhibit the complement system for very rare immune diseases that affect the kidneys, muscles or nervous system, and they could be tested in long Covid patients, he said.

New drugs could also be developed, Iwasaki said. 

“I think there are a lot of things that we can try in the future,” she said. But first, the results of this study need to be replicated, as with any research, she added.

Verduzco-Gutierrez said she would like to see any future studies follow patients for a longer period of time. “What about people who have had long Covid for three years? We don’t know what their blood looks like,” she said.

Barbara Mantel is an NBC News contributor. She is also the topic leader for freelancing at the Association of Health Care Journalists, writing blog posts, tip sheets and market guides, as well as producing and hosting webinars. Barbara’s work has appeared in CQ Researcher, AARP, Undark, Next Avenue, Medical Economics, Healthline, Today.com, NPR and The New York Times.

Long COVID. Shorter Life? New research reveals an arduous road to recovery

With or without a declaration from the U.S. Centers for Disease Control and Prevention, COVID-19 cases continue to rise. Fortunately, the number and severity of those new cases is nowhere near the terrible peaks of the past three years, and deaths are very low. But that’s not the whole story.

Practically since the term “long COVID” was coined, anecdotal evidence and shorter-term studies indicated that the often-debilitating condition would not only affect significant numbers of people (roughly 15% of all U.S. adults have experienced long COVID symptoms) but also that it might do so in the most serious ways.

We’re beginning to see the severity of that issue. According to a paper published today in Nature Medicine , the physical fallout from long COVID may last two years or longer–and it can take a toll on quality of life even for those whose initial cases didn’t require hospital care.

“I think this is a sobering reminder that SARS COV-2 infection can have long-lasting risks on people even among the non-hospitalized, that they really need to consider this data very seriously,” Ziyad Al-Aly, a clinical epidemiologist at Washington University in St. Louis and the senior author of the study, told me in an interview. “I mean, this is data at two years. This is not like six months or a year out.”

A long risk horizon

The study, conducted in coordination with the Veterans Affairs St. Louis Health Care system, found that those who contracted COVID-19 but didn’t require hospitalization were still at elevated risk two years later for several conditions, including diabetes, lung problems, fatigue, blood clots, and disorders affecting the gastrointestinal and musculoskeletal systems. Those whose initial cases required hospitalization within the first 30 days faced more dire outcomes, with elevated risk for both hospitalization and death, along with significant risk across all organ systems.

Al-Aly and his team analyzed about 6 million anonymous medical records in a database maintained by the V.A., and created a control set of people who from March through December of 2020 either never tested positive for COVID , tested positive but weren’t hospitalized, or tested positive and required hospitalization.

Two years out, those who’d tested positive for the virus but didn’t need hospitalization were still at elevated risk for 31% of 80 long COVID-related conditions, although their risk of death and hospitalization diminished to levels roughly the same as those who’d never tested positive. For people who had required hospitalization for their cases, the risk of death and another hospitalization remained elevated, along with 65% of the long-COVID related conditions.

Like any study, this one has parameters. For one thing, because Al-Aly wanted to study the longer-term effects of the virus, his team analyzed data of patients from the earlier stages of the pandemic. The researcher says the subsequent development of vaccines and antivirals might produce different results in a study of people who were infected more recently.

In many ways, though, that’s the point. Most of the research pertaining to long COVID has concentrated on shorter-term benchmarks: six months or one year. As the Nature Medicine paper makes it clear, science is just beginning to understand how long the tentacles of the disease may reach.

At two years post-infection, the non-hospitalized group was at 27% higher risk than the non-COVID control group for ischemic stroke, 23% higher risk of a clotting disorder, 37% higher risk for headaches, and 250% higher risk for still having loss of smell, among many other sequelae. Those who were hospitalized had a 29% higher risk for death and a 257% higher risk for hospitalization, even at two years, and dramatically higher chances of diabetes, Alzheimer’s, low oxygen, and memory loss, the study found.

Al-Aly and his team also quantified the risk in terms of disability-adjusted life years, or DALY. One DALY, Al-Aly says, is equal to one less year of healthy life. In the non-hospitalized COVID-19 group, the research found about 80 DALYs per 1,000 people. For the hospitalized group, that number shot up to 642 DALYs per 1,000. By comparison, cancer and heart disease in the U.S. claim 50 and 52 healthy-life years lost per 1,000 people, respectively.

“It’s a difficult and protracted road for recovery in people who were hospitalized to start with,” Al-Aly says. “But most importantly, even for people who are not hospitalized, it is still a long risk horizon for many, many sequelae and multiple organ systems.”

‘An empty white box’ of validated treatments

The research should shine new light on the subject of long COVID, which has generally been understudied in the U.S. despite the large number of adults who’ve already been affected by it. Eric Topol, the scientist and vice president at Scripps Research in San Diego, has written extensively about long COVID and told me he does not believe the CDC and federal government are taking it seriously enough.

Topol, who was not involved in the St. Louis study, says it provides “important new evidence of the durable multi-system sequelae of long COVID.” When I asked whether the public really understands the long-term risks associated with the disease, he replied, “No, only the people affected and their friends and families.”

How the findings of the St. Louis study might translate to a younger population remains unknown. Almost by definition, the V.A. sample skews older and male. Al-Aly says it’s one reason the study pulled from the pool of 6 million, which included more than 600,000 women. “Those could fill like six Taylor Swift stadiums,” he says, “So it’s not a small number.” About 20% of the medical records were from Black patients, and the study included multiple ages and races.

And all of the information is more than the CDC has–or any governing body, for that matter. Very few studies of this longitude have been completed, and none at this scale.

Al-Aly says one of his hopes is that the St. Louis study will prompt a closer look on the governmental level at the ways clinical trials for long COVID treatments can be initiated–now. “We need to have a coherent national strategy to accelerate clinical trials and get a treatment that works as soon as possible,” the researcher says. “That really should be a national priority. The patient community has been waiting so long, and we need to find treatments as soon as possible.”

He’d also like to see studies like this one reproduced in other countries, especially since the limited work that’s been done so far has essentially replicated the results found in the St. Louis research. Those results are serious enough, and long-lasting enough, that they ought to grab the attention of national policymakers the world over–and the U.S. should take the lead.

Where are the long COVID treatment trials?  A recent report by the health news site STAT revealed that the National Institutes for Health has failed to test meaningful treatments for long COVID after two and a half years and a $1.15 billion Congressional grant. Topol, meanwhile, has repeatedly used an empty white box to depict the number of validated treatments we have from well-designed randomized trials.

So great is the urgency that researchers like Topol are advocating for digital clinical trials in which the patients don’t have to leave home–a critical need, considering that some long COVID sufferers can barely get out of bed. Whether the federal government can move to such a system to produce treatments remains to be seen–but about the extended effects of long COVID, we no longer have much doubt.

Carolyn Barber, M.D ., is an internationally published science and medical writer and a 25-year emergency physician. She is the author of the book   Runaway Medicine: What You Don’t Know May Kill You , and the co-founder of the California-based homeless work program  Wheels of Change .

The opinions expressed in Fortune.com commentary pieces are solely the views of their authors and do not necessarily reflect the opinions and beliefs of  Fortune .

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NIH opens long COVID trials to evaluate treatments for autonomic nervous system dysfunction

Part of NIH’s RECOVER Initiative, trials will test at least three treatments for symptoms such as fast heart rate, dizziness and fatigue.

Two phase 2 clinical trials to test the safety and effectiveness of three treatments for adults with autonomic nervous system dysfunction from long COVID have begun. The autonomic nervous system acts largely unconsciously and regulates bodily functions, such as heart rate, digestion and respiratory rate. Symptoms associated with autonomic nervous system dysfunction have been among those that patients with long COVID say are most burdensome. The trials are part of the National Institutes of Health’s Researching COVID to Enhance Recovery (RECOVER) Initiative, a nationwide research program to fully understand, diagnose and treat long COVID. Other RECOVER phase 2 clinical trials testing treatments to address viral persistence and neurological symptoms, including cognitive dysfunction (like brain fog), launched in July 2023.

“As a long COVID patient, I know firsthand how disruptive and frightening symptoms including rapid heart rate, dizziness and fatigue can be. Patient representatives across RECOVER have also shared that these symptoms are some of the most debilitating symptoms of long COVID,” said Heather Marti, co-chair of the RECOVER National Community Engagement Group. “These trials are giving me and others with long COVID hope that it will restore our health and get us back to the lives we so desire.”

The two trials, collectively known as RECOVER-AUTONOMIC, are testing three potential treatments in adults who, following COVID-19, now have postural orthostatic tachycardia syndrome (POTS). An autonomic nervous system disorder, POTS is characterized by unexpected fast heart rate, dizziness, fatigue or a combination of these symptoms when a person stands up from sitting or lying down. 

“The trials were developed with input from people living with long COVID, caregivers, community representatives, clinicians and scientists all with unique expertise in the field,” said Gary H. Gibbons, M.D., director of the National Heart, Lung, and Blood Institute at the NIH and co-chair of RECOVER. “We are grateful for their collective involvement which significantly shaped the trials and the choice of interventions.”

The trials will initially examine three potential treatments:

• Gamunex-C, a form of intravenous immunoglobulin (IVIG), contains antibodies to help the body protect itself against infection from various diseases and is given by intravenous infusion.
• Ivabradine, an oral medication that reduces heart rate.
• Coordinator-guided, non-drug care, which includes a series of activities managed through weekly phone calls with a care coordinator, such as wearing a compression belt and eating a high-salt diet, which are recommended for patients with POTS to counteract excessive loss of fluids.  

“Patients who develop POTS after having COVID-19 are often severely limited by their symptoms, and there are no proven effective treatments,” said Christopher Granger, M.D., Duke University Medical Center, who is co-leading RECOVER-AUTONOMIC. “These interventions were selected because they have shown potential benefit in treating symptoms for POTS. The theory we’re testing is that they might also help individuals with long COVID.”  

Participants will first be randomly assigned to receive either IVIG, ivabradine or a placebo. Participants will then be randomly assigned a second time to receive either coordinator-guided, non-drug care or what is considered the usual non-drug care for POTS following COVID-19, such as diet and lifestyle recommendations. RECOVER-AUTONOMIC is an adaptive clinical trial, meaning if additional potential interventions emerge, they can quickly be added and studied in the trial.

Researchers plan to enroll 380 total participants at 50 sites across the United States. Teams at the trial sites will recruit participants from their health systems and surrounding communities. The current list of sites for the trials can be found on ClinicalTrials.gov (search: NCT06305793, NCT06305806 and NCT06305780) and additional sites will be added to this list as they begin enrolling participants.

Diversity among the trial participants is a high priority for RECOVER. To support diverse and inclusive representation, study sites are chosen based on geographic location, their connections to communities, and their track records for enrolling diverse research participants.

With the launch of the RECOVER-AUTONOMIC trials, RECOVER is currently testing seven treatments across four clinical trials and continues to enroll participants. Those interested in learning more about RECOVER clinical trials should visit trials.recovercovid.org .

About RECOVER : The National Institutes of Health Researching COVID to Enhance Recovery (NIH RECOVER) Initiative brings together clinicians, scientists, caregivers, patients, and community members to understand, diagnose, and treat long COVID. RECOVER has created one of the largest and most diverse groups of long COVID study participants in the world. In addition, RECOVER clinical trials are testing potential interventions across five symptom focus areas. For more information, please visit recovercovid.org . 

HHS Long COVID Coordination: This work is a part of the National Research Action Plan , a broader government-wide effort in response to the Presidential Memorandum directing the Secretary for the Department of Health and Human Services to mount a full and effective response to long COVID. Led by Assistant Secretary for Health Admiral Rachel Levine, the Plan and its companion Services and Supports for Longer-term Impacts of COVID-19 report lay the groundwork to advance progress in the prevention, diagnosis, treatment, and provision of services for individuals experiencing long COVID.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov .

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Scientists Offer a New Explanation for Long Covid

By Pam Belluck

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A team of scientists is proposing a new explanation for some cases of long Covid, based on their findings that serotonin levels were lower in people with the complex condition.

In their study , published on Monday in the journal Cell, researchers at the University of Pennsylvania suggest that serotonin reduction is triggered by remnants of the virus lingering in the gut. Depleted serotonin could especially explain memory problems and some neurological and cognitive symptoms of long Covid, they say.

Why It Matters: New ways to diagnose and treat long Covid.

This is one of several new studies documenting distinct biological changes in the bodies of people with long Covid — offering important discoveries for a condition that takes many forms and often does not register on standard diagnostic tools like X-rays.

The research could point the way toward possible treatments, including medications that boost serotonin. And the authors said the biological pathway that their research outlines could unite many of the major theories of what causes long Covid: lingering remnants of the virus, inflammation, increased blood clotting and dysfunction of the autonomic nervous system.

“All these different hypotheses might be connected through the serotonin pathway,” said Christoph Thaiss, a lead author of the study and an assistant professor of microbiology at the Perelman School of Medicine at the University of Pennsylvania.

“Second of all, even if not everybody experiences difficulties in the serotonin pathway, at least a subset might respond to therapies that activate this pathway,” he said.

“This is an excellent study that identifies lower levels of circulating serotonin as a mechanism for long Covid,” said Akiko Iwasaki, an immunologist at Yale University. Her team and colleagues at the Icahn School of Medicine at Mount Sinai recently published a study that identified other biological changes linked to some cases of long Covid, including levels of the hormone cortisol. These studies could point to specific subtypes of long Covid or different biological indicators at different points in the condition.

The Back Story: A series of disruptions set off by bits of virus in the gut.

Researchers analyzed the blood of 58 patients who had been experiencing long Covid for between three months and 22 months since their infection. Those results were compared to blood analysis of 30 people with no post-Covid symptoms and 60 patients who were in the early, acute stage of coronavirus infection.

Maayan Levy, a lead author and assistant professor of microbiology at the Perelman School of Medicine, said levels of serotonin and other metabolites were altered right after a coronavirus infection, something that also happens immediately after other viral infections.

But in people with long Covid, serotonin was the only significant molecule that did not recover to pre-infection levels, she said.

The team analyzed stool samples from some of the long Covid patients and found that they contained remaining viral particles. Putting the findings in patients together with research on mice and miniature models of the human gut, where most serotonin is produced, the team identified a pathway that could underlie some cases of long Covid.

Here’s the idea: Viral remnants prompt the immune system to produce infection-fighting proteins called interferons. Interferons cause inflammation that reduces the body’s ability to absorb tryptophan, an amino acid that helps produce serotonin in the gut. Blood clots that can form after a coronavirus infection may impair the body’s ability to circulate serotonin.

Depleted serotonin disrupts the vagus nerve system, which transmits signals between the body and the brain, the researchers said. Serotonin plays a role in short-term memory, and the researchers proposed that depleted serotonin could lead to memory problems and other cognitive issues that many people with long Covid experience.

“They showed that one-two-three punch to the serotonin pathway then leads to vagal nerve dysfunction and memory impairment,” Dr. Iwasaki said.

There are caveats. The study was not large, so the findings need to be confirmed with other research. Participants in some other long Covid studies, in which some patients had milder symptoms, did not always show depleted serotonin, a result that Dr. Levy said might indicate that depletion happened only in people whose long Covid involves multiple serious symptoms.

What’s Next: A clinical trial of Prozac.

Scientists want to find biomarkers for long Covid — biological changes that can be measured to help diagnose the condition. Dr. Thaiss said the new study suggested three: the presence of viral remnants in stool, low serotonin and high levels of interferons.

Most experts believe that there will not be a single biomarker for the condition, but that several indicators will emerge and might vary, based on the type of symptoms and other factors.

There is tremendous need for effective ways to treat long Covid, and clinical trials of several treatments are underway. Dr. Levy and Dr. Thaiss said they would be starting a clinical trial to test fluoxetine, a selective serotonin reuptake inhibitor often marketed as Prozac, and possibly also tryptophan.

“If we supplement serotonin or prevent the degradation of serotonin, maybe we can restore some of the vagal signals and improve memory and cognition and so on,” Dr. Levy said.

Pam Belluck is a health and science writer whose honors include sharing a Pulitzer Prize and winning the Victor Cohn Prize for Excellence in Medical Science Reporting. She is the author of “Island Practice,” a book about an unusual doctor. More about Pam Belluck

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Long COVID: answers emerge on how many people get better

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More than three years after SARS-CoV-2 began its global spread, an estimated 65 million or more people 1 are still living with the often devastating effects of long COVID — and scientists are still struggling to understand this complex condition.

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COVID-19 ’s total cost to the economy in US will reach $14 trillion by end of 2023 – new research

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Jakub Hlávka received funding from Centers for Disease Control and Prevention and the U.S. Department of Homeland Security to conduct COVID-19-related research.

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The Research Brief is a short take about interesting academic work.

The big idea

The economic toll of the COVID-19 pandemic in the U.S. will reach US$14 trillion by the end of 2023, our team of economists , public policy researchers and other experts have estimated.

Putting a price tag on all the pain, suffering and upheaval Americans and people around the world have experienced because of COVID-19 is, of course, hard to do. More than 1.1 million people have died as a result of COVID-19 in the U.S., and many more have been hospitalized or lost loved ones . Based on data from the first 30 months of the pandemic, we forecast the scale of total economic losses over a four-year period, from January 2020 to December 2023.

To come up with our estimates, our team used economic modeling to approximate the revenue lost due to mandatory business closures at the beginning of the pandemic. We also used modeling to assess the economic blows from the many changes in personal behavior that continued long after the lockdown orders were lifted – such as avoiding restaurants, theaters and other crowded places.

Workplace absences, and sales lost due to the cessation of brick-and-mortar retail shopping, air travel and public gatherings, contributed the most. At the height of the pandemic, in the second quarter of 2020, our survey indicates that international and domestic airline travel fell by nearly 60%, indoor dining by 65% and in-store shopping by 43%.

We found that the three sectors that lost the most ground during the first 30 months of the pandemic were air travel, dining, and health and social services, which contracted by 57.5%, 26.5% and 29.16%, respectively.

These losses were offset to a degree by surges in online purchases, a series of large fiscal stimulus and economic relief packages and an unprecedented expansion of the number of Americans working from home – and thus were able to keep doing jobs that might otherwise have been cut.

From 2020 to 2023, the cumulative net economic output of the United States will amount to about $103 trillion . Without the pandemic, the total of GDP over those four years would have been $117 trillion – nearly 14% higher in inflation-adjusted 2020 dollars, according to our analysis.

We also simulated four different possible economic outcomes had the number of COVID-19 deaths been different because of either more or less successful public health strategies in the first 30 months of the pandemic.

The direct health expenses, driven mostly by hospitalization costs in these scenarios, would have totaled $20 billion in a best-case scenario in which 65,000 Americans would have died from January 2020 to June 2022. In the worst-case scenario, about 2 million would have died during that period, with $365 billion in direct health-related expenses.

Based on our findings, most economic losses were not due to these health care expenditures.

Why it matters

The COVID-19 pandemic’s economic consequences are unprecedented for the U.S. by any measure. The toll we estimate that it took on the nation’s gross domestic product is twice the size of that of the Great Recession of 2007-2009. It’s 20 times greater than the economic costs of the 9/11 terrorist attacks and 40 times greater than the toll of any other disaster to befall the U.S. in the 21st century to date.

Although the federal government has now lifted its COVID-19 Public Health Emergency declaration , the pandemic is still influencing the U.S. economy . The labor force participation rate , which stood at 62.6% in April 2023, has only recently neared the February 2020 level of 63.3%.

What is not known

We modeled only the pandemic’s standard economic effects. We didn’t estimate the vast array of economic costs tied to COVID-19 , such as lost years of work after an early death or a severe case of long-COVID-19.

We also didn’t assess the costs due to the many ways that the disease has affected the physical and mental health of the U.S. population or the learning loss experienced by students .

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Long COVID? Prospects for economic scarring from the pandemic

Philip barrett.

1 International Monetary Fund, Washington District of Columbia, USA

Giacomo Magistretti

Evgenia pugacheva, philippe wingender, associated data.

This paper examines the potential persistent effects (scarring) of the COVID‐19 pandemic on the economy and the channels through which they may occur. Our findings from a broad set of historical recessions confirm that recessions are associated with persistent output losses and that the greatest scarring has occurred following financial crises. The amount of scarring following pandemic and epidemic recessions in the sample is in between that of typical recessions and financial crises. Results on the channels show that the productivity channel is important, as all types of recessions have been followed by persistent losses to total factor productivity.

Abbreviations

1. introduction.

The COVID‐19 pandemic led to a severe global recession that is unique in many ways. The contraction in 2020 was very sudden and deep compared to previous global crises, even as the policy response in many countries was swift and sizable. The pandemic crisis also stands out for its differential impacts across sectors and countries, complex channels of transmission, and high uncertainty about the recovery path. The extent of scarring (persistent damage to supply potential) 1 following the recession differs across countries, as the health crisis interacts with countries' economic structures (such as the importance of “high‐contact” sectors, where people are in close proximity) and varying policy responses.

The change in economic forecasts following the pandemic suggest a sizeable amount of scarring is expected. Forecasts based on IMF ( 2022 ) envision output losses, relative to pre‐pandemic projections, at about 3% for the world economy by 2024, with much more adverse effects in emerging market and developing economies relative to advanced economies (AEs) (red bars in Figure  1 ). At the same time, the lasting damages over a comparable period from the global financial crisis (GFC) were larger, at almost 8.7% for the world (blue bars in Figure  1 ). A key feature of the pandemic is that systemic financial instability was avoided, lessening some of the adverse effects.

Medium‐Term Output Losses (percent difference from precrisis forecast). Bars show the percent difference in real GDP 4 years after the crisis and anticipated GDP for the same period prior to the crisis for the indicated group. For the COVID‐19 crisis, it compares the April 2022 WEO vintage forecast for 2024 versus that from the January 2020 vintage (prior to the pandemic). For the global financial crisis (GFC), it compares the April 2013 vintage for 2012 versus the October 2007 vintage (prior to the start of the US recession at end‐2007). AEs, advanced economies; EMDEs, emerging market and developing economies; EMEs, emerging market economies; LICs, low‐income countries. Source : International Monetary Fund, World Economic Outlook; and authors' calculations

Nevertheless, the atypical features of the current crisis—its severity, differential impacts, complex transmission, and high uncertainty—make assessment of the economic effects of COVID‐19 challenging. This paper aims to shed light on the potential main channels of scarring post‐COVID‐19 and implications for the medium‐term outlook. We ask what can we learn about prospects for scarring from historical experience with recessions? What are the most relevant channels in the current setting (productivity, labor, capital)? We draw lessons from previous recessions including those associated with past pandemics and epidemics, financial crises, natural disasters, and violent conflict outbreaks.

Previous literature has found that output losses following recessions are persistent, particularly after financial crises, with differential impact across country groups. Cerra and Saxena ( 2008 ) find that currency crises lead to permanent output losses 10 years after onset, with more adverse impacts for middle‐ and low‐income countries, and that banking crises or concurrent twin crises have even more adverse effects. Moreover, Blanchard et al. ( 2015 ) find that recessions in general, and also those associated with financial crises and oil price increases, are often followed not only by a lower output level, but also lower growth, implying that the scarring effect increases over time. Ball ( 2014 ) likewise points to significant scarring following the GFC, with an adverse effect on output growth. Abiad et al. ( 2009 ) and Chen et al. ( 2019 ) also document larger output losses following banking crises in general and the GFC, respectively, stemming from lasting declines in capital per worker, total factor productivity (TFP), and employment.

Several recent studies focus on the economic impact of past pandemics and epidemics. Jordà et al. ( 2020 ), who study six European economies over centuries, starting with the Black Death in the 14th century, find that macroeconomic effects of pandemics persist for decades, leading to a decline in real interest rates, indicating a disproportionate effect on the labor force relative to other factors of production such as land. Ma et al. ( 2020 ) study GDP, unemployment, and trade following six modern health crises, and find that, following the initial decline, the bounce‐back in output is rapid, but remains below pre‐recession level 5 years after the shock. Emmerling et al. ( 2021 ) and Cuesta Aguirre and Hannan ( 2021 ) come to similar conclusions based on the analysis of five health crises in the 21st century, and posit that the COVID‐19 pandemic is likely to lead to significant scarring. Barro et al. ( 2020 ) attempt to disentangle the effects of the Spanish flu and WWI deaths 2 and find that GDP per capita declined by 6% as the result of the pandemic, which was on par with the 8.4% decline associated with the war. The aforementioned studies utilize local projections (Jordà,  2005 ) or vector autoregressions (VAR) to identify the impact of a given event (such as a pandemic or a financial crisis) on the economy. Using a different approach, Eichengreen et al. ( 2021 ) study the factors that affect the length of the recovery following a recession by first identifying recession episodes (267 recessions across 39 countries) and classifying them into (i) supply‐shock or demand‐shock driven, (ii) global or local, (iii) financial crisis or normal recessions. The authors conclude that negative supply and demand shocks during the COVID‐19 pandemic are likely to lead to a prolonged recovery.

Our main contributions to the literature on the economics effects of recessions are twofold. First, we conduct a comprehensive analysis of past recessions, using a broader sample of 586 recession episodes from 115 countries over 1957–2019, and differentiate between different types of crises (past pandemics and epidemics, financial crises, natural disasters, and violent conflict outbreaks). Some previous studies have compared different types of financial crises and recent studies focus on the COVID‐19 recession. However, we employ a unified framework in which all types of recessions are analyzed within the same regression via interaction terms, allowing us to account for potential co‐occurrence of several types of crisis events. Of the sample of 586 recessions, 108 coincided with a pandemic or epidemic (see Appendix Table  a2 for the list of pandemics and countries affected). Of these 108 recessions, 34 co‐occurred with a financial crisis, 20 with a natural disaster, and 2 with a violent conflict. Second, we study the channels through which persistent damage occurs, by analyzing the effects of recessions on the supply‐side components of GDP. Previous studies have explored the channels of impact following only financial crises. Understanding the channels of impact following both “typical” recessions, which are not coincident with a particular kind of crisis, as well as following pandemics and other crises provides a better framework for understanding the potential for scarring post‐COVID‐19 recessions.

Our findings from the broad set of historical recessions confirm that recessions are associated with persistent output losses and that the greatest scarring has occurred following financial crisis recessions. The amount of scarring following the pandemic and epidemic recession in the sample is in between that of typical recessions and financial crises. Given that the COVID‐19 crisis is global and more severe than those previous pandemics, however, the amount of scarring is likely to be greater. The policy response to the COVID‐19 pandemic was unprecedented, with large fiscal policy responses in AEs in particular (IMF,  2021a ), suggesting the impact may be more akin to typical recessions in these countries. Results on the channels of scarring show that that the productivity channel is particularly important, as all types of recessions have been followed by persistent losses to TFP.

The rest of the paper is organized as follows: Section  2 describes the data used in the analysis, Section  3 looks at the impact of past recessions on aggregate output and the channels of impact, also differentiating recessions by their depth and duration, and Section  4 concludes.

The historical analysis relies on the Penn World Table (PWT) 10.0 database (Feenstra et al.,  2015 ; Inklaar & Timmer,  2013 ), from which we draw on data for real GDP per capita (at constant prices in 2017 US dollars) that we use to identify recession episodes and to quantify the aggregate impact of those recession episodes on the economy. We also look at the supply‐side channels of scarring (capital, labor, and productivity) using PWT data on capital stock (per person engaged), number of persons engaged (as employment‐population ratio), and TFP.

Recession episodes and the corresponding peaks and troughs of the cycle are identified using the Harding and Pagan ( 2002 ) algorithm on annual real GDP per capita, with a window of 1 year, minimum phase length of 1 year, and minimum cycle length of 2 years. While the standard approach for business cycle dating is typically done using quarterly data, the use of annual data allows for the identification of cycles for a larger sample of countries, in particular including developing economies for which quarterly data is often not available. Recessions identified using this approach for the United States match those reported by the NBER.

Recessions are further classified by co‐occurrence of a particular type of a crisis, namely: a financial crisis, an epidemic or pandemic, a disaster, or a violent conflict. Each recession can be associated with several types of crises, or with no crisis, in which case it is referred to as a “typical” recession (which is 202 out of 586 recessions). We look at crisis events in the year when they occur, and to further associate a recession with a crisis we check whether the crisis event has occurred within [ t − 2; t + 2] of the recession. This is to account for cases when a crisis occurs at the end of the calendar and could not yet affect economic activity in that year but has an impact the following year, or has a slow ramp‐up (e.g., a disease outbreak might be initially reported only in a few isolated locations, and spread to other places later), or there are delays in reporting (e.g., initial cases of a disease might be not diagnosed, but with better monitoring in the following years the presence of the disease in the country is noticed).

The incidence of financial crises is taken from Laeven and Valencia ( 2018 ) for the period going back to 1970, and Reinhart et al. ( 2016 ) for years prior to 1970. In both cases, financial crises include banking crises, currency crises, and sovereign debt crises. Past modern epidemics and pandemics (and outbreaks) include the Hong Kong flu, SARS, H1N1, MERS, Ebola and are identified for countries in which cases have been reported (see Appendix Table  a2 for the list of pandemics and countries affected). 3 Disasters are identified using the Emergency Events Database (EM‐DAT) when a country in a given year has experienced disasters that led to damages exceeding 1% of GDP or affected 5% of population (including deaths). Finally, a country is defined as being in conflict if in a given year there are battle‐related deaths that exceed 100 people per one million population (Novta & Pugacheva,  2021 ).

Throughout the text, countries are classified into AEs and EMDEs. Country list and samples are provided in Appendix Table  a1 .

3. ANALYSIS OF HISTORICAL RECESSIONS

3.1. aggregate impact.

This section looks at the aftermath of previous recessions, distinguishing between more typical downturns and those associated with financial crises, epidemics or pandemics, violent conflicts, or natural disasters, to get a sense of how long‐lived their effects have been and the supply‐side channels (capital, labor, and productivity) through which they occur.

The analysis of the impact of a recession relies on local projections (Jordà,  2005 ) to estimate the dynamic effects of the various types of recessions. This approach employs a set of regressions to estimate the impact of current covariates on future outcomes at different horizons. Local projections have been advocated by Montiel Olea and Plagborg‐Møller ( 2021 ) and Plagborg‐Møller and Wolf ( 2021 ), among others, as a flexible and robust alternative to vector autoregressions (VAR). The specification is based on the following equation:

in which ( y i , t + h − y i , t − 1 ) represents cumulative growth in log points in real GDP per capita (or another dependent variable) at different horizons ( h  = 0,…7), where h  = 0 represents the contemporaneous effect; D i , t is a dummy for recession onset (first year after the peak); E i , t is a dummy for occurrence of a crisis event for each of the following types: financial crisis, an epidemic or pandemic, a disaster, or a conflict; the interaction terms D i , t ∗ E i , t − 2 , t + 2 capture different types of crisis events that happened within t − 2 to t + 2 of a given recession (see further details on the timing in the Data section); X i , t is a set of controls that includes two lags of the dependent variable's growth rate, one lag of log GDP in constant US dollars, and two lags of credit‐to‐GDP ratio; µ i h and θ t h are country and year fixed effects (dummy variables that take the value of 1 for a given country, and zero otherwise; and dummy variables that take the value of 1 for a given year, and zero otherwise) that control for time‐invariant country characteristics and time‐specific common global shocks, respectively. The impact of a typical recession is given by β 1 h , and the impact of a recession associated with a crisis event E is given by β 1 h + β 2 E , h + β 3 E , h . Regressions are estimated separately for each horizon on a fixed sample. Thus, the number of observations, countries, and recession episodes is the same at all horizons and across all dependent variables. In all regressions, the left‐hand‐side variable has been winsorized at 0.5/99.5 percentiles to mitigate the effect of outliers.

The estimation results are presented in Table  1 columns 1–5, and depicted in Figure  2 panel 1. The coefficients show the cumulative impact of a recession relative to the baseline, thus the return of the impulse response to zero signifies that the dependent variable has recovered to its pre‐recession level. While the path of output differs by the type of recession, the estimates are negative and mostly statistically significant across all horizons, indicating that recessions are associated with permanent output losses, on average.

Medium‐term output losses and channels of impact

Note : The reported coefficients represent the impact of a recession associated with a particular crisis ( β 1 for typical recessions, and β 1 + β 2 + β 3 for other types of recessions, as per Equation ( 1 )). The dependent variables are cumulative growth of real GDP per capita, total factor productivity, capital per worker, employment‐population ration in the horizon year h after a recession. Regressions are estimated separately for each horizon. All regressions include interaction terms for recession types (financial crisis, pandemic, disaster, conflict, or typical recession that occurred due to other reasons) and controls for two lags of the dependent variable's growth rate, one lag of log GDP per capita (in constant US dollars), and two lags of credit‐to‐GDP ratio, country and year fixed effects. Past modern pandemics or epidemics include Hong Kong flu, SARS, H1N1, MERS, Ebola (see Appendix Table  a2 for more details). Standard errors are clustered at the country level.

* p < 0.1; ** p < 0.05; *** p < 0.01.

Source : Authors' calculations.

Medium‐Term Output Losses and Channels of Impact (percentage points). The solid lines represent the estimated cumulative impulse response functions and shaded areas represent 90 percent confidence intervals. Time since the shock (in years) on the x‐axis. Past modern pandemics and epidemics include Hong Kong flu, SARS, H1N1, MERS, Ebola (see Appendix Table  a2 for more details). Sources : Penn World Table 10.0; and authors’ calculations.

Recessions associated with financial crises lead to more negative outcomes (column 3), as has also been shown in the previous literature (Cerra & Saxena,  2008 ). The path of output after past modern epidemic or pandemic recessions (column 2) is in between that of typical recessions and financial crisis recessions. However, the COVID‐19 crisis is global and more severe than those previous pandemics. The impact of natural disasters (column 4) and violent conflict (column 5) is likewise negative and severe on impact, with effects persisting for several years following the crisis; in later horizons, the effect remains negative but no longer statistically significant, which could be attributed to the positive effects of post‐disaster reconstruction efforts and sample limitations as data for fragile states is often not available. In the following analysis, due to space considerations and our focus on the effects of past pandemics or epidemics and associated recessions, we skip the presentation of results on the impact of natural disasters and violent conflict, for which the findings in general are consistent with the literature.

3.2. Depth and duration

Drawing on the observation that the COVID‐19 crisis is characterized by its unprecedented depth, and will differ in how long it lasts across country groups, with faster recovery projected in AEs (see IMF,  2021a ), each recession episode is further characterized by its depth (defined as the loss in real GDP per capita between the peak and the trough in percentage terms) and duration (defined as the number of years between the peak and the trough). In the sample, past recession durations range between 1 and 10 years, with 60% of recessions lasting one year and 90% of recessions lasting not more than three years for both AEs and EMDEs. We define the depth of a recession as the loss between the peak and the first year of the recession, to ease the comparison across recessions of different duration. Under this definition, the median recession is associated with a 2.2% decline in per capita output in the first year. Recessions are classified as high (low) depth when they fall above (below) the median loss.

Our analysis of the differential effects of recession depth and duration is based on a modified version of regression Equation ( 1 ) that includes interaction terms for recessions of (1) high depth and 1 year duration, (2) low depth and 1 year duration, (3) high depth and more than a year duration, (4) low depth and more than a year duration. The interaction terms are included for all recession types. Table  2 shows the estimated coefficients for short‐duration typical recessions of different depth. Overall, deep recessions—those with a greater initial impact—result in greater scarring, as expected. However, controlling for the initial depth of the recession, shows that recoveries proceed differently in AEs and EMDEs. In AEs, there is a rebound following deep recessions and no permanent output loss after several years (column 3 and red line in Figure  3 , panel 2). Emerging market and developing economies, however, experience protracted downturns and permanent losses, on average (column 5 and red line in Figure  3 , panel 3). 4

Medium‐term output losses by recession depth (short duration)

Note : The dependent variable is cumulative growth of real GDP per capita in the horizon year h after a recession. Regressions are estimated separately for each horizon. All regressions include interaction terms for recession types (financial crisis, pandemic, disaster, conflict) and recession depth (high and low depth recessions are split based on the median loss, with separate interaction terms for recessions that last only 1 year and those that last longer than 1 year), as well as controls for two lags of the dependent variable's growth rate, one lag of log GDP per capita (in constant US dollars), and two lags of credit‐to‐GDP ratio, country and year fixed effects.

* p  < 0.1; ** p  < 0.05; *** p  < 0.01.

Medium‐Term Output Losses by Recession Depth (Short Duration) (percentage points). Figure shows the results for “typical” recessions. The solid lines represent the estimated cumulative impulse response functions and shaded areas represent 90 percent confidence intervals. High and low‐depth recessions are split based on the median per‐capita output loss. Short duration recessions last not more than 1 year. Time since the shock (in years) on the x‐axis. Source : Penn World Table 10.0; and authors' calculations.

3.3. Channels of impact

Previous literature suggests that permanent damage to an economy's supply potential following a recession can occur through a number of channels. 5 First through the labor channel, as unemployment may remain higher even after the recession (Blanchard & Summers,  1986 ) and could result in a smaller labor force as discouraged workers exit. Human capital accumulation and future earnings can be affected by skill deterioration during extended periods of unemployment, delayed labor market entry for young workers, and negative effects on educational achievement in the longer term. 6 Second through the capital channel, as weak investment could result in both slower physical capital accumulation and slower technology adoption that hampers productivity growth. Greater scarring through the physical capital channel could also materialize as the result of capital being stranded and corporate debt buildup constraining future investment (IMF,  2021b ). Lastly, productivity could also be permanently affected by the loss of firm‐specific know‐how as a result of bankruptcies and their spillovers (Bernstein et al.,  2019 ), the effects of a decline in research and development and innovation during a recession, and an increase in resource misallocation (Adler et al.,  2017 ; Furceri et al.,  2021 ).

Focusing on the supply‐side channels, we look at the components of the Cobb‐Douglas production function. We estimate Equation ( 1 ) with each of TFP, capital per worker, and the employment‐population ratio as the dependent variable, to show the impact of recessions on each of these three components. The results for the World are presented in Table  1 . The analysis shows that medium‐term losses in GDP per capita for typical recessions can be primarily attributed to losses in TFP (column 6). Employment per capita also declines before recovering somewhat in the medium‐term (column 16). For financial crisis recessions, there is significant, persistent damage to all factors: TFP (column 8), capital‐to‐worker ratio (column 13), and employment per capita (column 18), consistent with the findings of Abiad et al. ( 2009 ). For the GFC, Adler et al. ( 2017 ) found the subsequent widespread decline in TFP growth was the main contributor to output losses relative to the precrisis trend.

Tables  3 and ​ and4, 4 , and Figure  4 report impulse response functions for AEs and emerging market and developing economies separately. For typical recessions and financial crises, the channels of impact are broadly the same across country groups, except that employment per capita losses play a role in AEs, on average, and not EMDEs. In modern era epidemics and pandemics, productivity losses were the main contributor to output losses in both AEs and EMDEs.

Medium‐term output losses and channels of impact: Advanced economies

Note : The dependent variables are cumulative growth of real GDP per capita, total factor productivity, capital per worker, employment‐population ration in the horizon year h after a recession. Regressions are estimated separately for each horizon. All regressions include interaction terms for recession types (financial crisis, pandemic, disaster, conflict, or regular recession that occurred due to other reasons) and controls for two lags of the dependent variable's growth rate, one lag of log GDP per capita (in constant US dollars), and two lags of credit‐to‐GDP ratio, country and year fixed effects. Past modern pandemics or epidemics include Hong Kong flu, SARS, H1N1, MERS, Ebola (see Appendix Table  a2 for more details). Standard errors are clustered at the country level.

Medium‐term output losses and channels of impact: Emerging market and developing economies

Medium‐Term Output Losses and Channels of Impact: Across advanced economies (AEs) and Emerging Market and Developing Economies (percentage points). The solid lines represent the estimated cumulative impulse response functions and shaded areas represent 90 percent confidence intervals. Time since the shock (in years) on the x‐axis. Past modern pandemics and epidemics include Hong Kong flu, SARS, H1N1, MERS, Ebola (see Appendix Table  a2 for more details). AEs, advanced economies; EMDEs, emerging market and developing economies. Source : Penn World Table 10.0; and authors' calculations.

The impact of the COVID‐19 pandemic could be even larger than suggested by the analysis of past recessions. From the labor side, some high‐contact sectors may shrink permanently. Moreover, widespread school closures have occurred across countries, with disproportionately adverse impacts on schooling in low‐income countries and those less prepared to switch to virtual learning. Productivity‐decreasing resource mismatches from the COVID‐19 crisis, across sectors and occupations, may likewise be larger than in previous crises, depending on how permanent the asymmetric losses are. 7 Productivity could also be negatively affected by a decline in competition, if the market power of large companies increases due to small business closures in high‐contact sectors and even more broadly. 8 At the same time, the pandemic has spurred increased digitalization and innovation in production and delivery processes, likely helping to offset the adverse productivity shock in some countries, as others lack the prerequisite widespread and reliable connectivity (Njoroge & Pazarbasioglu,  2020 ).

4. CONCLUSIONS

The historical record suggests that most recessions leave persistent scars—largely through lower productivity growth and, particularly in the case of financial crises, slower capital accumulation. There is high uncertainty around the current outlook, over both the short and medium term. The extent of scarring following COVID‐19 also depends on factors unique to a pandemic‐driven downturn and inherently hard to predict: the path of the pandemic (whether transmission of new variants outpaces vaccinations) and the scale of activity disruptions from restrictions needed to lower transmission. Moreover, repeated shocks have beleaguered the global economy as it began to recover from the pandemic recession and high uncertainty surrounds the outlook.

At the same time, the relative financial stability following the COVID‐19 shock so far is encouraging, as the greatest scarring in the past has occurred in recessions associated with financial crises. The expected losses are lower than what was seen during the GFC, consistent with the swift policy response that supported incomes and helped contain financial sector disruptions. However, emerging market and developing economies, in particular, are expected to have deeper scars than AEs (Figure  1 ), partly reflecting their greater sectoral exposure to the pandemic shock and more muted policy response (Das et al.,  2022 ).

The picture of divergent recoveries, with a larger likelihood and extent of scarring in many of the same countries that have limited ability to provide further fiscal support, suggests a challenging path ahead. Experience from past recessions underscores the importance of avoiding financial distress as the COVID‐19 policy response evolves. To prevent scarring that could result from future financial instability, measures that support credit provision should be maintained while ensuring balance sheet resilience and adequate buffers. To maximize the use of limited fiscal space, policymakers should tailor their responses, targeting support to the most‐affected sectors and firms. Policies that reverse the setback to human capital accumulation, boost job creation, and facilitate worker reallocation will be key to addressing long‐term output losses, supply chain issues, and the rise in inequality. Policies to promote competition, innovation, and technology adoption would also lift productivity growth and boost investment.

Supporting information

Supplementary Material 1

ACKNOWLEDGMENTS

We are grateful to John Bluedorn, Petya Koeva Brooks, Gita Gopinath, and Malhar Nabar for invaluable guidance and support, and to Weicheng Lian for helpful discussions. We thank Srijoni Banerjee, Savannah Newman, and Jungjin Lee for outstanding research support. Some of the analysis presented in this paper was published in Chapter 2 of the April 2021 World Economic Outlook, International Monetary Fund. The views expressed in this article are those of the authors and should not be attributed to the IMF, its Executive Board, or its management.

Economies Included in the Analysis

Source : Authors’ compilation.

List of Pandemics/epidemics/outbreaks

Note : Countries marked with *are included in the regression sample given availability of data on real GDP per capita, total factor productivity, capital stock per worker, and employment‐population ratio.

Sources : Incidence of the Hong Kong flu is taken from Cockburn et al. ( 1969 ), SARS from the World Health Organization ( 2003 ), H1N1 from flucount.org ( 2009 ), MERS from European Centre for Disease Prevention and Control ( 2015 ), Ebola from the World Health Organization ( 2016 ).

Barrett, P. , Das, S. , Magistretti, G. , Pugacheva, E. & Wingender, P. (2022) Long COVID? Prospects for economic scarring from the pandemic . Contemporary Economic Policy , 1–16. Available from: 10.1111/coep.12598 [ CrossRef ]

1 Such supply damage could result from the loss of economic ties in production and distribution networks arising from job destruction and firm bankruptcies.

2 While the Spanish flu of 1918–1920 was a global and severe pandemic, comparable to COVID‐19 from an epidemiological perspective, it is difficult to draw meaningful comparisons regarding the effects of the COVID‐19 pandemic as it (i) occurred against the backdrop of WWI—US real GDP, for example, rose by 9 percent in 1918 and 1 percent the following year, even as the pandemic raged, and (ii) killed an estimated 40 million people worldwide, which far exceeds the death toll associated with COVID‐19.

3 Incidence of the Hong Kong flu is taken from Cockburn et al. ( 1969 ), SARS from the World Health Organization ( 2003 ), H1N1 from flucount.org ( 2009 ), MERS from the European Centre for Disease Prevention and Control ( 2015 ), Ebola from the World Health Organization ( 2016 ). The regression analysis described in Section  3 uses 1957–2019 data sample to estimate the impact of disease‐related recessions within a seven year horizon after onset. Zika virus epidemic of 2015–2016 is not included in the analysis since only a few years of data following onset were available.

4 IMF ( 2012 ) shows that economic performance in many emerging market and developing economies improved substantially over the preceding 2 decades, after relatively deep and protracted downturns in the 1970s and 1980s. The analysis finds that the improvement is due largely to greater policy space and improved policy frameworks, with inflation targeting and a countercyclical fiscal policy significantly increasing both the length of expansions and speed of recoveries after recessions.

5 See Cerra et al. ( 2020 ) for a review of the related literature.

6 Parental job losses can adversely affect children's schooling and future labor market outcomes (Oreopoulos et al.,  2008 ; Stuart,  2022 ). In the short‐term, however, reduced labor market opportunities during recessions can lead to higher educational attainment for high school and college‐aged students.

7 Productivity could improve, however, if reallocation forces shift resources from unviable businesses in lower‐productivity, high‐contact sectors toward higher‐productivity service sectors and industry. Bloom et al. ( 2020 ) finds that, in the United Kingdom, this positive between‐firm reallocation effect is likely to only partially offset the negative within‐firm effects. The study estimates private sector TFP to be 5 percent lower at the end of 2020 than it would have been, and likely to remain 1 percent lower in the medium term.

8 See Bernstein et al. ( 2020 ), for example, which documents this “flight to safety” of consumers and job‐seekers toward known brands and large companies in the US labor market. At the same time, new business formation in the United States reached a record high in the third quarter of 2020 (Brown,  2020 ).

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What we know about long COVID — from brain fog to physical fatigue

Margaret Cirino

Regina G. Barber

Rebecca Ramirez

Brit Hanson

Millions of people are affected by long COVID, a disease that encompasses a range of symptoms — everything from brain fog to chronic fatigue — and that manifests differently across patients. The Washington Post/The Washington Post via Getty Images hide caption

Millions of people are affected by long COVID, a disease that encompasses a range of symptoms — everything from brain fog to chronic fatigue — and that manifests differently across patients.

At a recent Senate hearing on long COVID , Rachel Beale took to the stage and shared her experience managing her symptoms for the past three years. "Long COVID has affected every part of my life," said the Virginia resident. "I wake up every day feeling tired, nauseous and dizzy. I immediately start planning when I can lay down again."

Beale is far from alone.

Many of her experiences have been echoed by others dealing with long COVID. It's a constellation of debilitating symptoms that range from brain fog and intense physical fatigue to depression and anxiety. Many people have lost months or years to this illness and describe extreme frustration at the lack of answers.

Doctors, too, feel unmoored by the lack of answers. "You do sort of feel like you're out in the wilderness," says Rasika Karnik, the medical director of UChicago Medicine's post-COVID. "It's hard to look a patient in the eyes and say 'we're not quite sure yet' and to keep repeating that."

There are currently no validated treatments for long COVID. There is not a widely established biomarker that can be used to diagnose it. Care clinics are hard to get into — and even if you do get in, most scientists believe this isn't just one illness in the first place.

But there's new, promising research that sheds light onto some long COVID symptoms. In one study on physical fatigue , researchers at Vrije University in Amsterdam compared muscle biopsies of patients with and without long COVID and found that the problem lies not with lung or heart functioning, but with the muscles' abilities to take up oxygen in the blood.

And another team of researchers at the University of Pennsylvania were able to pinpoint one possible cause of brain fog: a drop in serotonin levels . They were also able to reverse brain fog symptoms in mice.

There is a growing network of scientists who are pushing research forward — many with private funding from philanthropists. Congress has allocated more than a billion dollars for long COVID research, and there's been some new funding announced by the NIH recently. But patient advocates say that solving a problem of this scale will take continued attention and even more funding.

Have more COVID questions you want us to cover? Email us at [email protected] — we'd love to hear from you.

Listen to Short Wave on Spotify , Apple Podcasts and Google Podcasts .

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This episode was produced by Margaret Cirino. It was edited by Brit Hanson and Rebecca Ramirez. David Greenburg was the audio engineer.

• post-pandemic
• physical fatigue
• chronic illness

Primary site

The evidence base, covid-19’s total cost to the u.s. economy will reach $14 trillion by end of 2023.

Editor’s note:  This blog was published by  The Conversation  on May 16, 2023. A version of it was also published by the Los Angeles Times .   

The big idea

The economic toll of the COVID-19 pandemic in the U.S.  will reach US$14 trillion  by the end of 2023,  our team  of  economists ,  public policy researchers  and  other experts  have estimated.

Putting a price tag on all the pain, suffering and upheaval Americans and people around the world have experienced because of COVID-19 is, of course, hard to do. More than  1.1 million people  have died as a result of COVID-19 in the U.S., and many more have been hospitalized  or lost   loved ones . Based on data from the first 30 months of the pandemic, we forecast the scale of total economic losses over a four-year period, from January 2020 to December 2023.

To come up with our estimates, our team used economic modeling to approximate the revenue lost due to mandatory business closures at the beginning of the pandemic. We also used modeling to assess the economic blows from the many changes in personal behavior that continued long after the lockdown orders were lifted – such as avoiding restaurants, theaters and other crowded places.

Workplace absences, and sales lost due to the cessation of brick-and-mortar retail shopping, air travel and public gatherings, contributed the most. At the height of the pandemic, in the second quarter of 2020, our survey indicates that international and domestic airline travel fell by nearly 60%, indoor dining by 65% and in-store shopping by 43%.

We found that the three sectors  that lost the most ground  during the first 30 months of the pandemic were air travel, dining, and health and social services, which contracted by 57.5%, 26.5% and 29.16%, respectively.

These losses were offset to a degree by surges in online purchases, a series of large  fiscal stimulus and economic relief packages  and an unprecedented expansion of the number of  Americans working from home  – and thus were able to keep doing jobs that might otherwise have been cut.

From 2020 to 2023, the cumulative net economic output of the United States will amount to about  $103 trillion . Without the pandemic, the total of GDP over those four years would have been $117 trillion – nearly 14% higher in inflation-adjusted 2020 dollars, according to our analysis.

We also simulated four different possible economic outcomes had the number of COVID-19 deaths been different because of either more or less successful public health strategies in the first 30 months of the pandemic.

The direct health expenses, driven mostly by hospitalization costs in these scenarios, would have totaled $20 billion in a best-case scenario in which 65,000 Americans would have died from January 2020 to June 2022. In the worst-case scenario, about 2 million would have died during that period, with $365 billion in direct health-related expenses.

Based on our findings, most economic losses were not due to these health care expenditures.

Why it matters

The COVID-19 pandemic’s economic consequences are unprecedented for the U.S. by any measure. The toll we estimate that it took on the nation’s gross domestic product is  twice the size of that of the Great Recession  of 2007-2009. It’s 20 times greater than the economic costs of the 9/11 terrorist attacks and 40 times greater than the toll of any other disaster to befall the U.S. in the 21st century to date.

Although the federal government has now  lifted its COVID-19 Public Health Emergency declaration , the  pandemic is still influencing the U.S. economy . The  labor force participation rate , which stood at 62.6% in April 2023, has only recently neared the February 2020 level of 63.3%.

What is not known

We modeled only the pandemic’s standard economic effects. We didn’t estimate the vast array of  economic costs tied to COVID-19 , such as lost years of work after an early death or a severe case of long-COVID-19.

We also didn’t assess the costs due to the many ways that the disease has affected the physical and mental health of the U.S. population or the  learning loss experienced by students .

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Related work.

Macroeconomic Consequences of the COVID-19 Pandemic

Spatial Transmission of the Economic Impacts of COVID-19 Through International Trade

Stanford University

Are Long COVID Sufferers Falling Between the Tracks?

• Beth Duff-Brown

Researchers who study long COVID say its debilitating symptoms are often misdiagnosed by clinicians and dismissed by employers or loved ones because so little is known about the new syndrome. The results can be devastating for individuals and their families — and for the economy.

It reminds Stanford Medicine’s Hector Bonilla , MD, of another little-understood condition that the medical world still struggles to treat correctly.

“I’ve been working on chronic fatigue syndrome for almost eight years; when long COVID came along it was like déjà vu,” said Bonilla, a clinical associate professor and an infectious disease physician who is a co-director of the Stanford Post-Acute COVID-19 Syndrome Clinic. “This is nothing new. We’ve been ignoring these problem for decades -- so it’s time to pay attention.”

Nearly 1.2 million people have died from COVID-19, accounting for 2.2% of all deaths since the pandemic began, according to the Centers for Disease Control and Prevention. The CDC believes at least 5,000 people have died from long COVID, but it is trying to get a better account by issuing new autopsy guidelines for reporting long COVID as the cause of death.

Today, an estimated 16 million working-age people have long COVID, 4 million of whom can’t work due to the debilitating symptoms. One of the worst things a long COVID patient can hear from their primary care physician, said Bonilla, is that they just need more sleep and to improve their diet and exercise. This attitude, he said, recalls the early days of CFS, when more physical activity was a common recommendation.

Long COVID and chronic fatigue syndrome symptoms are similar: severe exhaustion, brain fog, chest pain, coughing and difficulty breathing. Some patients experience cardiac and gastrointestinal issues, as well as loss of taste and smell and elevated levels of depression and anxiety. 

Bonilla was joined recently by Gopi Shah Goda , PhD, a health economist who is a senior fellow at the Stanford Institute for Economic Policy Research . While she is researching the economic impact of the syndrome, Bonilla is focused on helping patients and letting them know they are not alone.

“You have to validate them,” Bonilla said. “You have to say, `Yes, I hear you and you are not alone; there are millions of people with the same problems you’re having.’”

He said he’s seen patients who have lost their homes and are living out of their cars, couples who are divorcing because one spouse doesn’t believe the other is truly sick.

The Economic Impact

Goda calculates that on top of the quarter-million people of working age who died from COVID-19, at least twice that number have disappeared from the workforce. In a study published by the Journal of Public Economics , Goda estimates the average individual earnings loss due to long COVID-19 is $9,000 and the total lost labor supply has amounted to $62 billion annually.

That’s nearly half of the estimated productivity losses from cancer or diabetes. Yet, the Stanford experts say, those diseases receive billions of research dollars annually while long COVID research remains woefully underfunded.

“If you think about the budgets for some of the parts of the NIH [National Institutes of Health] that are funding research on cancer and diabetes, it’s in the billions, and the amount that has been invested in long COVID is more in the millions,” Goda said.

Stanford’s long COVID clinic , which opened in May of 2021, received a grant last year of $1 million annually for five years from the U.S. Department of Health and Human Services to expand access to care for people with long COVID -- particularly those from underserved, rural, vulnerable and minority populations that were disproportionately impacted by the pandemic.

Goda believes many long COVID sufferers are falling through the cracks because clinicians aren’t certain how to categorize their illnesses, so workers could be losing out on disability insurance through their employers or Social Security Disability Insurance.

The COVID-19 public health emergency expired in May 2023, and the CDC earlier this month lifted the five-day isolation guidance for those who test positive for COVID-19. Both Bonilla and Goda said they hoped this would not lead to relaxations that make workers more vulnerable, particularly those who have no access to paid leave.

No Approved Treatment But Hope on Horizon

Experts say 37% of COVID survivors report having at least one long COVID symptom in the 90 to 180 days after their initial infection.

But like chronic fatigue syndrome, there are no tests or approved treatments for long COVID, though Bonilla said he’s seeing some positive results in his clinic by treating patients with off-label, low-dose naltrexone -- a pain reliever and anti-inflammatory -- and low doses of the antipsychotic drug Abilify.

There are also efforts to raise awareness about the need for more research that could lead to a cure. March 15 marked the second annual Long COVID Awareness Day , and the NIH is eager to get people with long COVID to join its CureID   research program.

In addition, the U.S. Senate Committee on Health, Education, Labor and Pensions held a hearing in January on long COVID, with committee chair Sen. Bernie Sanders (I-Vermont) acknowledging that Congress needs to do more.

“There’s a sense that something is going on in America which is serious that we’re not addressing,” Sanders said. “So I just want to say to our panelists and all those who are dealing with long COVID: We hear you what you’re experiencing, and we take it seriously. We think we Congress has not done anywhere near enough, and we hope to turn that around.” 

Goda submitted a statement to the committee for that hearing, emphasizing the need for more mitigation policies and programs to help workers remain in the workforce.

“Despite COVID’s harmful impact on the U.S. workforce overall, there are some signs of good news,” she said in her statement. “So far, employment and labor force participation rates increased faster among those who report having a disability, likely because of new opportunities to work from home and the tight labor markets.” 

She noted there are also lower rates of COVID-19 related work absences. Between January and October of 2023, likely COVID-19 related absences from work were 16% higher than pre-pandemic levels. This was a sharp drop from 61% during March 2020 through December 2022.

Still, Bonilla said, while long-COVID may be getting more national recognition, many patients don’t have access to health care or live far from clinics, such as native Americans, those in rural communities, and undocumented workers.

“There are people who have no voice, and nobody is talking about them,” he said.

Health Policy Forum: The High Cost of Cancer Care

Rebalancing public health powers and individual liberty in the age of covid.

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New research into treatment and diagnosis of long COVID

15 new studies across the UK will expand research into long COVID to support thousands of vulnerable people, backed by nearly £20 million through the NIHR.

• 15 new studies across UK to expand research that will support thousands of vulnerable people
• Nearly £20 million for research projects will help improve understanding of long COVID and identify effective treatments
• Projects include the largest long COVID trial to date which will involve over 4,500 people

Thousands of people suffering with long COVID will benefit from new research programmes backed by £19.6 million to help better understand the condition, improve diagnosis and find new treatments.

An extensive programme of 15 new research studies, backed by government funding through the National Institute for Health Research ( NIHR ), will allow researchers across the UK to draw together their expertise from analysing long COVID among those suffering long-term effects and the health and care professionals supporting them.

The latest research shows that although many people make a full recovery following COVID-19, a significant proportion of people continue to experience chronic symptoms for months. These groundbreaking studies aim to help those people affected return to their normal lives.

The projects will focus on:

• better understanding the condition and identifying it
• evaluating the effectiveness of different care services
• better integrating specialist, hospital and community services for those suffering with long COVID
• identifying effective treatments, such as drugs, rehabilitation and recovery, to treat people suffering from chronic symptoms
• improving home monitoring and self-management of symptoms, including looking at the impact of diet
• identifying and understanding the effect of particular symptoms of long COVID, such as breathlessness, reduced ability to exercise and ‘brain fog’

Health and Social Care Secretary Sajid Javid said:

Long COVID can have serious and debilitating long-term effects for thousands of people across the UK which can make daily life extremely challenging. This new research is absolutely essential to improve diagnosis and treatments and will be life-changing for those who are battling long-term symptoms of the virus. It will build on our existing support with over 80 long COVID assessment services open across England as part of a £100 million expansion of care for those suffering from the condition and over £50 million invested in research to better understand the lasting effects of this condition.

Professor Nick Lemoine, Chair of NIHR ’s long COVID funding committee and Medical Director of the NIHR Clinical Research Network (CRN), said:

This package of research will provide much needed hope to people with long-term health problems after COVID-19, accelerating development of new ways to diagnose and treat long COVID, as well as how to configure healthcare services to provide the absolute best care. Together with our earlier round of funding, NIHR has invested millions into research covering the full gamut of causes, mechanisms, diagnosis, treatment and rehabilitation of long COVID.

The selection process for this broad range of innovative studies into long COVID involved people with lived experience at every stage and their input has been invaluable in shaping the outcome of this call and the research projects which will receive funding.

The projects include:

• STIMULATE-ICP at University College London Hospitals NHS Trust which will be the largest long COVID trial to date, recruiting more than 4,500 people with the condition. With £6.8 million of funding, the project will test the effectiveness of existing drugs to treat long COVID by measuring the effects of 3 months’ treatment, including on people’s symptoms, mental health and outcomes such as returning to work. It will also assess the use of MRI scans to help diagnose potential organ damage, as well as enhanced rehabilitation through an app to track their symptoms
• the immunologic and virologic determinants of long COVID at Cardiff University with nearly £800,000, which will look at the role of the immune system in long-term disease and whether overactive or impaired immune responses could drive long COVID by causing widespread inflammation
• ReDIRECT at University of Glasgow backed by nearly £1 million, which will assess whether a weight management programme can reduce symptoms of long COVID in people who are overweight or obese
• LOCOMOTION at University of Leeds with £3.4 million, which focuses on identifying and promoting the most effective care, from accurate assessments in long COVID clinics to the best advice and treatment in surgeries, as well as home monitoring methods that can show flare-ups of symptoms. The research aims to establish a gold standard of care that can be shared across England and the rest of the UK
• EXPLAIN at University of Oxford backed by £1.8 million, which will seek to diagnose ongoing breathlessness in people with COVID-19 who were not admitted to hospital, using MRI scans to trace inhaled gas moving into and out of the lungs to assess their severity and whether they improve over time

UK government Minister for Scotland Iain Stewart said:

Long COVID is a terrible illness affecting thousands of people across the UK, and as it’s such a new disease, there’s still a lot we don’t know about it. This UK government funding, which is supporting studies led by the University of Glasgow and University of the West of Scotland, will help us make progress in understanding long COVID and hopefully improve treatment and support for patients right across the UK.

UK government Minister for Wales Simon Hart said:

The development and distribution of the vaccine means we can now see an end to the pandemic and Wales has played a significant part via Wrexham’s Wockhardt facility where the Oxford/AstraZeneca vaccine continues to be produced. Following this investment I hope Cardiff University can play a similarly important role in understanding and countering the long-term effects of the virus as we emerge from the pandemic.

Supportive quotes

Professor Amitava Banerjee, Professor in Clinical Data Science and Honorary Consultant Cardiologist, University College London, Chief investigator of the STIMULATE-ICP (Symptoms, trajectory, inequalities and management: understanding long COVID to address and transform existing integrated care pathways) trial, said:

Individuals with long COVID have long been asking for recognition, research and rehabilitation. In our 2-year study across 6 clinical sites around England, we will be working with patients, health professionals, scientists across different disciplines, as well as industry partners, to test and evaluate a new ‘integrated care’ pathway from diagnosis to rehabilitation, and potential drug treatments in the largest trial to date. We will also be trying to improve inequalities in access to care and investigating how long COVID compares with other long-term conditions in terms of use of healthcare and burden of disease, which will help to plan services.

Dr Dennis Chan, Principal Research Fellow, Institute of Cognitive Neuroscience, University College London, Chief investigator of the CICERO (Cognitive Impairment in long COVID: PhEnotyping and RehabilitatiOn) project, said:

Cognitive impairment, referred to informally as ‘brain fog’, is a major component of long COVID that compromises people’s daily activities and ability to return to work. The aim of this study is twofold; first, to understand better the nature of this ‘cognitive COVID’ in terms of the cognitive functions affected and the associated brain imaging changes, and second, to test whether neuropsychological rehabilitation can improve people’s outcomes. If this study is successful we will not only understand much better the way in which COVID affects the brain but also provide NHS services with new tools to help people recover from their cognitive difficulties.

Professor Fergus Gleeson, Professor of Radiology and Consultant Radiologist, Oxford University, Chief Investigator of EXPLAIN (HypErpolarised Xenon Magnetic Resonance PuLmonary Imaging in PAtIeNts with Long-COVID) project, said:

Following on from our earlier work using hyperpolarised xenon MRI in patients following hospitalisation with COVID-19 pneumonia, where we showed that their lungs may be damaged even when all other tests were normal, it is critical to determine how many patients with long COVID and breathlessness have damaged lungs, and if and how long it takes for their lungs to recover. Hyperpolarised xenon MRI is a safe scanning test that requires the patient to lie in the MRI scanner and breathe in one litre of the inert gas xenon that has been hyperpolarised so that we can see it using MRI. The scan takes a few minutes and does not require radiation exposure, so it may be repeated over time to see lung changes. Using this technique, we can see the xenon – which behaves in a very similar way to oxygen – move from the lungs into the blood stream. In this way, we can see if there has been damage to the airways in the lungs, or to the areas where oxygen crosses into the blood stream, which appears to be the area damaged by COVID-19.

Background information

The projects were funded following a UK-wide research call for ambitious and comprehensive research into understanding and addressing the longer-term physical and mental health effects of COVID-19 in non-hospitalised people and will build on the existing research already commissioned to look at long COVID.

In February 2021, 4 projects funded by NIHR and UK Research and Innovation (UKRI) were announced, following the first research call.

The UK began the commissioning of long COVID research in 2020 and some projects are already producing results that are informing the understanding of long COVID. This research call adds to the existing investment of over £30 million of research funding taking the total investment to £50 million.

The National Institute for Clinical Excellence ( NICE ) has issued official guidance on best practice for recognising, investigating and rehabilitating patients with long COVID. According to NICE guidance:

long COVID describes signs and symptoms that continue or develop after acute COVID-19. It includes both ongoing symptomatic COVID-19 (from 4 to 12 weeks) and post-COVID-19 syndrome (12 weeks or more).

In October 2020, NHS England and Improvement launched a 5-point plan for long COVID. There are now 89 specialist post COVID-19 clinics operating in England.

On 15 June 2021, NHSEI published a new 10-point plan and announced an additional £100 million expansion of care for patients with long COVID.

Annex A: Study summaries

Developing and testing the best ways to diagnose, treat and provide rehabilitation for people with long covid.

Dr Amitava Bannerjee, University College of London – £6.8 million.

The wide-ranging symptoms of long COVID are debilitating and need coordinated care from specialists, hospitals and community services.

The STIMULATE-ICP (Symptoms, trajectory, inequalities and management: understanding long COVID to address and transform existing integrated care pathways) trial, developed with the help of patient organisations, will be the largest long COVID trial to date, recruiting more than 4,500 people with the condition.

This project will test the efficacy of existing drugs to treat long COVID, and measure the different effects of 3 months’ treatment on patients with regards to their symptoms, mental health and outcomes such as returning to work.

It will also assess the use of MRI scans to help diagnose potential organ damage in those recovering from the coronavirus, as well as enhanced rehabilitation – the provision of joined-up specialist care centred around an app for patients allowing them to track their symptoms.

Optimising standards of care for long COVID in hospitals, doctors’ surgeries and at home

Dr Manoj Sivan, University of Leeds – £3.4 million.

Although there are 83 long COVID clinics in England, most people have not had access to them, and face long waiting times to be seen.

The LOCOMOTION (long COVID multidisciplinary consortium: optimising treatments and services across the NHS) project focuses on identifying and promoting the most effective care, ranging from accurate assessments in these clinics to the best advice and treatment in surgeries, as well as home monitoring methods that can show flare-ups of symptoms.

Drawing from the experiences of current long COVID patients and NHS professionals, the research aims to establish a ‘gold standard’ of care that can be shared across England and the rest of the UK.

Analysis will be conducted in 10 long COVID clinics, at home and in doctors’ surgeries, and the study will track referrals and evaluate different services through patient interviews to make sure they are efficient, accessible and cost-effective. Specialists in healthcare inequality will also ensure that views are sought and recorded from people who are not visiting clinics.

Explaining why long COVID patients experience breathlessness and a reduced ability to exercise

Professor Fergus Gleeson, University of Oxford – £1.8 million.

One of the most prevalent and persistent symptoms among long COVID patients has been discomfort in breathing following physical activity.

The EXPLAIN (Hyperpolarised xenon magnetic resonance pulmonary imaging in patients with Long-COVID) project will seek to diagnose ongoing breathlessness in coronavirus patients who were not admitted to hospital, using MRI scans to trace inhaled gas moving into and out of the lungs.

A 15-minute scan using low levels of xenon gas will display lung function and – if abnormalities are found – comparisons of data across different groups of participants recruited from Oxford and Sheffield can help assess their severity and whether they improve over time.

Some EXPLAIN patients will also have a separate scan to see if heart damage can be identified. If the MRI scans separate patients with and without lung disease, further CT scans can be analysed, using artificial intelligence and blood samples to identify associated conditions and inform the development of treatments.

Understanding and treating ‘brain fog’

Dr Dennis Chan, University College London – £1.2 million

Up to three quarters of people who experience long-term symptoms after COVID-19 report problems with memory, attention or other cognitive functions – symptoms known collectively as ‘brain fog’.

The CICERO (Cognitive Impairment in long COVID: PhEnotyping and RehabilitatiOn) project will first determine which elements of brain function are most affected in people with long COVID. The relationship between brain function and other symptoms of long COVID, such as fatigue and anxiety, will be explored, and MRI scanning will be used to identify the affected brain networks.

The researchers will then develop and test a new rehabilitation strategy to help people recover from the cognitive aspects of long COVID and return to normal life and working ability. This will support production of a freely available COVID-19 Cognitive Recovery Guide on how best to offer the new rehabilitation approach depending on the patient’s symptoms.

Co-designing personalised self-management for patients at home

Professor Fiona Jones, Kingston University – £1.1 million.

Long COVID describes more than 200 different symptoms that can interact and fluctuate. Although fatigue and problems with brain function are the most common symptoms, each patient can experience a different set of symptoms.

The LISTEN (Long COVID Personalised Self-managemenT support – co-design and EvaluatioN) project will work in partnership with people who have long COVID to design and evaluate a package of self-management support that can be personalised to individual needs.

The researchers will first work with people living with or recovered from long COVID, plus a social enterprise with expertise in reaching seldom heard populations, to design the package and associated patient and training resources.

The team will then test the self-management package alongside up to 6 one-to-one virtual coaching sessions from trained rehabilitation practitioners, to test whether the treatment improves how people with long COVID feel and how they cope with everyday activities. The researchers will also evaluate how the package could be implemented more widely, with the aim that self-management for people with long COVID can be delivered at scale.

ReDIRECT: Remote Diet Intervention to Reduce long COVID symptoms Trial

Dr David Blane, University of Glasgow – £999,679.

The immunologic and virologic determinants of long COVID

Professor David Price, Cardiff University – £774,457.

Quality-of-life in patients with long COVID: harnessing the scale of big data to quantify the health and economic costs

Dr Rosalind Eggo, London School of Hygiene and Tropical Medicine – £674,679.

Percutaneous Auricular Nerve Stimulation for Treating Post-COVID Fatigue (PAuSing-Post-COVID Fatigue)

Dr Mark Baker, Newcastle University – £640,180.

Immune analysis of long COVID to inform rational choices in diagnostic testing and therapeutics

Professor Daniel Altmann, Imperial College - £573,769.

Understanding and using family experiences of managing long COVID to support self care and timely access to services

Professor Sue Ziebland, University of Oxford – £557,674.

Development of a robust T cell assay to retrospectively diagnose SARS-CoV-2 infection and IFN-γ release assay as diagnostic and monitoring assay in Long COVID patients

Dr Mark Wills, University of Cambridge – £372,864.

Using Activity Tracking and Just-In-Time Messaging to Improve Adaptive Pacing: A Pragmatic Randomised Control Trial

Professor Nicholas Sculthorpe, University of the West of Scotland – £317,416.

Impact of COVID-19 vaccination on preventing long COVID: a population-based cohort study using linked NHS data

Professor Daniel Prieto-Alhambra, University of Oxford – £224,344.

Long COVID Core Outcome Set (LC-COS) project

Dr Tim Nicholson, King’s College London – £139,619.

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Study: Long COVID affects 8% of those with COVID-19, is more common in women

New national data in France reveals that, by the World Health Organization (WHO) definition, the prevalence of long COVID is 4.0% in the French population overall and 8.0% among people who had COVID-19.

Among the 8.0%, the prevalence varied from 5.3% in men who had COVID-19, to 14.9% among the unemployed, and 18.6% of those with a history of hospitalization for COVID-19. The study is published in Clinical Microbiology and Infection .

The study is based on a cross-sectional survey of 10,615 participants conducted in August through November 2022. The WHO defines long COVID as "continuation or development of new symptoms 3 months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least 2 months with no other explanation."

A total of 5,781 (54.5%) of study participants reported ever having a SARS-CoV-2 infection. Among those with lasting symptoms, fatigue was the most common, followed by sleep disorders, anxiety, and joint pain. According to the WHO definition, long COVID prevalence was 4.0% (95% confidence interval [CI], 3.6% to 4.5%) in the overall population.

Prevalence twice as high in women

"Prevalence was more than twice as high in women than in men and 68% higher in unemployed people; it was two to three times lower among elderly participants and lower among participants living alone," the authors wrote.

Prevalence was more than twice as high in women than in men and 68% higher in unemployed people.

Prevalence dropped to 2.4% when the WHO definition was strengthened with requiring at least moderate impact on daily activities (95% CI, 2.1% to 2.8%), and dropped further to 1.2% when the definition included only participants reporting strong or very strong impact of symptoms on daily activities.

More than half of those with WHO-defined long COVID were infected during the Delta wave, but the authors said ongoing surveillance of long COVID should take place. "Long COVID and especially the forms with a strong impact on daily activities will continue to represent a significant burden for the societies and healthcare systems of most countries, thus warranting ongoing surveillance," they concluded.

Vietnam confirms H5N1 in man's avian flu death

Vietnam's health ministry today announced that a recently reported H5 avian flu infection in Khanh Hoa province was the H5N1 subtype, according to a statement translated and posted by Avian Flu Diary, an infectious disease news blog.

The infection involved a 21-year-old college student whose H5 infection was initially reported last week by the media and was confirmed by provincial health authorities.

Today's health ministry statement has new details about the case, including that the patient died from his infection on March 23. Officials also said that an epidemiologic investigation found that the man had trapped wild birds near his home before and after the Lunar New Year holiday. No sick or dead poultry, however, were reported near the family's home.

No other cases have been detected during monitoring of the patient's contacts.

Questions remain about H5N1 clade

So far, it's not clear which H5N1 clade is involved in the man's infection. The older clade (2.3.2.1c)—still circulating in some parts of Asia—has recently been connected to a spate of illnesses in Cambodia, many of them fatal. The newer clade (2.3.4.4b) affecting poultry in multiple world regions has also infected people in rare instances, mainly those who had exposure to infected birds or mammals.

Vietnam's last H5N1 case, reported in October 2022 from Phu Tho province, was its first since 2014. The clade involved was not reported in that case, either.

The health ministry said the country continues to report sporadic H5N1 detections in poultry and that agriculture ministry data show that six avian flu outbreaks have been reported across six provinces, including Khanh Hoa, where the man lived.

FDA OKs Invivyd's COVID preventive Pemgarda for emergency use

The Food and Drug Administration (FDA) on March 22 granted emergency use authorization (EUA) for Invivyd's monoclonal antibody to prevent COVID-19 in immunocompromised patients, which fills a gap following the withdrawal of Evusheld in January 2023.

The monoclonal antibody, called pemivibart (Pemgarda), is authorized for pre-exposure prophylaxis in adolescents and adults with moderate-to-severe immunocompromise, such as solid-organ transplant recipients and those with blood cancers. The drug is given as a 4,500-milligram intravenous infusion. The company had submitted its EUA request in early January.

The FDA based its EUA on clinical trials that suggested pemivibart had neutralizing activity against SARS-CoV-2 variants, including JN.1, which is currently dominant in the United States and abroad.

In its announcement , the company, based in Massachusetts, also said pemivibart is its first pre-exposure monoclonal antibody to receive an EUA based on a novel, rapid, and repeatable immunobridging trial design, which it said will help address ongoing viral evolution.

Drug will be available for ordering soon

Dave Hering, Invivyd's chief executive officer, said in the statement that the company expects to have the product available for ordering "imminently" and that an initial supply has already been packaged and is awaiting release at a US-based third-party logistics provider.

He also added that the company has plans to explore pemivibart as a treatment for symptomatic COVID infection.

CDC releases ventilation guidance for curbing indoor respiratory virus spread

As part of its updates on strategies to battle respiratory viruses, the US Centers for Disease Control and Prevention (CDC) on March 22 detailed steps that people can take to reduce the number of respiratory particles that circulate in indoor air. The ventilation guidance update comes as respiratory disease levels such as flu and COVID are declining from a late December peak.

The CDC said ventilation, alongside vaccination and practicing good hand hygiene, is one of the core strategies for protecting people against respiratory illness. "People can still get sick after ventilating a space, so it is important to use ventilation as one part of a multi-layered approach to protect ourselves against getting sick from respiratory viruses," the CDC said.

Steps for improving ventilation are useful year-round, but are especially helpful when virus levels are high in the community, when people are exposed, sick, or recovering, or when people have risk factors for severe illness, the agency added.

Tips for optimizing HVAC systems, adding other steps

The guidance emphasizes the importance of bringing in fresh outdoor air and ensuring that air conditioning and heating systems are operating properly, preferably with filters rated MERV-13 or higher. It also describes other steps that can be added, including air circulation, proper exhaust venting, air cleaners, and ultraviolet air treatment.

The CDC also said portable carbon dioxide monitors can help determine the staleness or freshness of indoor air. "If possible, move activities outdoors to lower the risk of virus transmission," the CDC said.

Chick-Fil-A to modify its policy on antibiotic use

Fast-food chain Chick-Fil-A says a change is coming to its policy on antibiotic use in its chicken supply.

In a statement issued over the weekend, Chick-Fil-A says it will shift its policy this spring from No Antibiotics Ever to No Antibiotics Important to Human Medicine. That means the company will allow its chicken suppliers to use antibiotics intended for animals to treat sick birds and flocks but will not allow the use of antibiotics that are also used in human medicine.

A Chick-Fil-A official told the Associated Press that the decision reflects concerns about the company's ability to acquire a sufficient supply of antibiotic-free chickens.

A consumer-driven shift

Chick-Fil-A is one of several fast-food chains that, along with the country's biggest poultry producers, have made the move to antibiotic-free chicken in response to consumer pressure over the past decade. Use of medically important antibiotics in poultry production has significantly fallen during that period. According to the most recent report from the Food and Drug Administration's Center for Veterinary Medicine, poultry accounted for only 2% of medically important antibiotic sales in 2022.

Antibiotic stewardship advocates argue that widespread use of medically important antibiotics in food-producing animals is contributing to the emergence and spread of antimicrobial resistance.

In July 2023, Tyson Foods made a similar announcement , saying it was dropping its No Antibiotics Ever label from some of its chicken products and would use a new label clarifying that its chickens are not given medically important antibiotics. The company said it made that decision because it was reintroducing ionophores, which are not considered medically important antibiotics, into its chickens' diets.

People more often are origin of infectious diseases in animals than vice versa, data suggest

People pass twice as many viruses to domestic and wild animals than animals pass to people, concludes a study today in Nature Ecology & Evolution .

University College London (UCL) researchers analyzed genomic data on nearly 12 million viruses in 32 viral families using network and evolutional analyses to characterize the mutations behind recent vertebrate species jumps.

Most emerging and re-emerging infectious diseases are caused by viruses that circulate naturally in nonhuman vertebrates. "When these viruses cross over into humans, they can cause disease outbreaks, epidemics and pandemics," they authors wrote. "While zoonotic host jumps have been extensively studied from an ecological perspective, little attention has gone into characterizing the evolutionary drivers and correlates underlying these events."

Viral strains that jump species had to mutate more

About twice as many species jumps were inferred to be from people to animals rather than the other way round, a pattern consistent across most viral families.  "We further observe that the extent of adaptation associated with a host jump is lower for viruses with broader host ranges," they wrote. "Finally, we show that the genomic targets of natural selection associated with host jumps vary across different viral families, with either structural or auxiliary genes being the prime targets of selection."

The genomic targets of natural selection associated with host jumps vary across different viral families, with either structural or auxiliary genes being the prime targets of selection.

In a UCL news release , lead author Cedric Tan, a PhD student at the UCL Genetics Institute, said, "When animals catch viruses from humans, this can not only harm the animal and potentially pose a conservation threat to the species, but it may also cause new problems for humans by impacting food security if large numbers of livestock need to be culled to prevent an epidemic, as has been happening over recent years with the H5N1 bird flu strain."

"Additionally, if a virus carried by humans infects a new animal species, the virus might continue to thrive even if eradicated among humans, or even evolve new adaptations before it winds up infecting humans again," he added.

In case you missed it

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New research reveals the devastating toll of living with long COVID

By Stephen Beech via SWNS

Long COVID can cause "devastating" tiredness and have a bigger impact on quality of life than some cancers, warns new research.

Fatigue is the symptom that most significantly impacts the daily lives of patients with the "invisible" condition, according to the findings of the pioneering study.

The research, published in BMJ Open , examined the impact of long COVID on the lives of more than 3,700 British patients referred to a long COVID clinic and used a digital app as part of their NHS treatment for the condition.

Patients were asked to complete questionnaires on the app about how long COVID was affecting them – considering the impact of the illness on their day-to-day activities, levels of fatigue, depression, anxiety, breathlessness, "brain fog" and their quality of life.

The research team, led by University College London (UCL) and the University of Exeter scientists, found that many long COVID patients were seriously ill and, on average, had fatigue scores worse or similar to people with cancer-related anemia or severe kidney disease.

Their health-related quality of life scores were also lower than those of people with advanced metastatic cancers, such as stage IV lung cancer.

Overall, the researchers found that the impact of long COVID on the daily activities of patients was worse than that of stroke patients and was comparable to that of people with Parkinson’s Disease.

Study co-leader Dr. Henry Goodfellow , of UCL, said: “Up to around 17 percent of people who get COVID go on to develop long COVID. However, the impact of the condition on patients’ day-to-day lives isn’t fully understood.

“Our results have found that long COVID can have a devastating effect on the lives of patients – with fatigue having the biggest impact on everything from social activities to work, chores and maintaining close relationships.”

Not only does long COVID negatively impact the lives of patients on an individual level, the research team also believes that it could have a "significant" economic and social impact on the country.

To be referred to a long COVID clinic, a patient must have had symptoms in keeping with long COVID for at least 12 weeks after an acute infection.

More than 90 percent of long COVID patients using the app were aged 18 to 65 and just over half (51 percent) said they had been unable to work for at least one day in the previous month, with one in five (20 percent) unable to work at all.

Almost three out of four of the patients (71 percent) were female. As working-age women make up a majority of the health and social care workforce, the researchers say the impact of long COVID on their ability to function may add extra pressure to already stretched services.

Dr. Goodfellow said: “We hope that a greater understanding of the symptoms and impact of long COVID in these patients will help the NHS and policymakers to target limited resources by adapting existing services and designing new ones to better meet the needs of patients with long COVID.”

Around 1.4 million people in the UK had symptoms of long COVID as of July 2022, according to the Office for National Statistics (ONS).

Alongside fatigue, patients typically experience breathlessness, anxiety, depression and brain fog.

The study is the first to report on the impact of the condition on day-to-day functioning and health-related quality of life in patients who have been referred for specialist rehabilitation in long COVID clinics across England.

Dr. Goodfellow added: “Our findings show that fatigue should be an important focus for clinical care and the design of rehabilitation services.

“Post-COVID assessment services should consider focusing on assessing and treating fatigue to maximize the recovery and return to work for sufferers of long COVID.”

Co-author Professor William Henley, of the University of Exeter Medical School, said: “Long COVID is an invisible condition, and many people are left trying to manage significant changes to how they can function.

"Shockingly, our research has revealed that long COVID can leave people with worse fatigue and quality of life than some cancers, yet the support and understanding is not at the same level."

Henley added: "We urgently need more research to enable the development of evidence-based services to support people trying to manage this debilitating new condition.”

The study was conducted alongside researchers at Southampton University, University of Exeter, Barts Health NHS Trust, University College London Hospitals NHS Trust, Royal Free Hospital, London, and Living With Ltd.

The post New research reveals the devastating toll of living with long COVID appeared first on Talker .

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Long Covid may be nothing unique in the future – but its effects today are still very real

While the long-term risk from a current infection is 10 times less than it was in 2020-21, a lot of people are still suffering after getting Covid early in the pandemic

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L ong Covid is one of the most controversial topics remaining about the pandemic. Depending on who you ask, it is either a real and current threat to the health of the globe, or a relatively minor issue that we should pay little attention to in the future. It is hard to weigh in on the topic without passionate advocates taking issue with the things that you say, which is true of quite a lot of the conversations we have had over the course of the pandemic.

A recent study from Queensland has injected further discord into this already complicated space. The press release about the study says that, in a large observational study, people who had tested positive for Covid-19 when the Omicron variant was spreading were no more likely to report ongoing symptoms or serious problems in their daily life than either people who tested negative or those who tested positive for influenza. This follows similar previous work by the same team showing almost identical results. According to Dr John Gerrard, one of the authors of the paper and Queensland’s chief health officer, the findings call into question the entire conceptualisation of long Covid, arguing that it may be “time to stop using terms like ‘long Covid’” .

This has caused a number of articles arguing that long Covid is causing unnecessary fear, because of little difference between long-term symptoms caused by Covid-19 and other common viral infections.

The first issue here is that it’s hard to know what to make of the research. The results being reported are an early news release about a presentation that is going to happen at the European Congress of Clinical Microbiology and Infectious Diseases in April. In other words, we have no idea how robust this paper is, nor how useful the data may be. The fact that there are so many news stories about this unpublished, unpresented finding is itself something of a problem.

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However, the reports on these findings are consistent with a range of other papers that have been published on Covid-19 in the last few years. We know that the risk of long Covid is strongly related to how severe initial infections are. In 2020, when Covid-19 was many times more problematic than flu, long Covid was fairly common, but after successful vaccination campaigns, effective new medications and wide-scale infection, the risk from a Covid-19 infection has gone down substantially. The risk of getting long Covid from an infection is now somewhere around 10 times less common than it was in 2020. Given the decrease in severity of Covid-19, it’s not unlikely that rates of long-lasting symptoms are similar between Covid-19 and influenza in 2024. As I’ve been saying for years , much of this comes down to how we define long Covid, and how we know which long-term symptoms are actually caused by Covid-19.

In other words, you could reasonably argue that Dr Gerrard is correct. The problem, however, is that a lot of people were infected in 2020 and 2021, before we had vaccines and treatments to reduce the severity of the disease. There is no question that a large group of people are still suffering serious problems from their initial Covid-19 infection, many of them years after first getting sick. Australia doesn’t have a national estimate of how many, but data from the UK suggests that about 0.5% of the country might have their day-to-day activities significantly limited by ongoing symptoms, while more than 1.0% have been experiencing symptoms for over two years. While it’s not a big percentage, that is still a lot of people – a similar rate in Australia would mean at least 100,000 Aussies suffering similarly. These people have been left largely without hope, because we still don’t really know why they have long Covid, and have no effective interventions to treat their disease.

And herein lies the problem with long Covid discussions. There are two separate conversations going on at the same time. We can talk about the future, which seems a bit brighter – long Covid rates are down drastically, and people who get infected with Covid-19 now are about as likely to experience serious, long-lasting issues as people who got the flu in 2019. But we also have to acknowledge the large number of people seriously injured by Covid-19 in the early stages of the pandemic who may never recover their health.

There may be nothing unique about long Covid in the future – even without this new report the evidence is strong that Covid-19 is now quite similar in risk to influenza per infection – and perhaps we should start talking more about post-viral conditions as a category rather than focusing on those symptoms caused by Covid-19 alone. But if we do, it is important that we do not leave behind the numerous people suffering seemingly endless problems caused by Covid-19 years ago.

Gideon Meyerowitz-Katz is an epidemiologist working in chronic disease in Sydney’s west, with a particular focus on the social determinants that control our health

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