Long Covid is exerting a silent drag on work and health, say officials and economists who warn that a struggle to count the costs of the condition is leaving authorities “shooting in the dark”.
The impact of long Covid — defined as symptoms that continue or develop three months after an initial infection, and last at least two months — has dealt a long-lasting blow to the productivity of health systems, with ripple effects on the wider workforce.
But four years after the emergence of the pandemic, attempts to assess how large and enduring the hit will be are hampered by a dearth of data that accurately quantifies the effects of long Covid on the labour market and the finances of healthcare providers.
“We have growing evidence that the burden of long Covid is still exacerbating pressure on our health systems,” said Hans Kluge, European regional director of the World Health Organization. “But countries are not monitoring and reporting data consistently. We need better reporting, surveillance and diagnostics, but also data on hospitalisations, mortality and healthcare costs.”
Without this, he warned, “we will continue to shoot our policy bullets in the dark”. The WHO aims to determine the extent of long Covid among health workers involved in rehabilitating Covid patients in Armenia, Georgia, Italy, Poland and the UK.
One EU estimate suggests that long Covid may have cut labour supply in the bloc by up to 0.5 per cent in 2022, the equivalent of more than 1mn full-time workers. Studies in the US and UK have reached broadly similar conclusions — suggesting the condition has driven the recent increase in workplace absence in many countries.
But no one knows how many people who stopped or scaled back work because of long Covid have been forced to leave their jobs for good — and how many have been able to return, either in a reduced role or gradually resuming their previous responsibilities.
Tiko Bakhtadze, a 36-year-old nurse based in Tbilisi, Georgia, who fell severely ill with the virus early in the pandemic, suffered protracted long Covid symptoms that meant for a period she “wasn’t as productive as I used to be”.
Persistent memory problems, for example, meant she had to take detailed notes when she returned to work. Bakhtadze has now largely recovered, insisting she never let her patients down or compromised their safety.
It is far from clear how long economies will be affected. An estimated 36mn people across WHO’s European region, which covers 53 countries with a total population of almost 1bn, may have experienced long Covid symptoms in the first three years of the pandemic, said Kluge. He added that the condition’s prevalence was about 1.7 per cent of the EU population in 2021 and nearly 3 per cent in 2022.
In the US, the Census Bureau’s Household Pulse Survey shows that 1.7 per cent of American adults were reporting “significant activity limitations” as a result of long Covid in February and early March this year.
Robust data is sparse, however, making it hard to tell whether long Covid is a growing problem, or one mostly affecting people who fell ill early in the pandemic and have not recovered.
A rare data release last month from the UK’s Office for National Statistics — which ran a fresh study of trends in self-reported Covid-19 symptoms over the winter — found that 2mn people, or 3.3 per cent of the population in England and Scotland, described themselves as having long Covid. Half of those had contracted it more than two years earlier. Among working-age adults, 0.5 to 1 per cent of the overall population said long Covid reduced their ability to carry out daily activities a lot, the data showed.
The insurers Aviva and Legal & General both said long Covid claims through their income protection schemes were now too low as a share of the total to be able to provide figures.
While UK business groups say employers are increasingly concerned about the rising cost of medical cover for their staff as NHS waiting lists push people towards private healthcare, long Covid does not loom large in conversations about workplace health.
But the extent of the problem is not always visible to employers, as some people have left the workforce for good while others feel there is a stigma attached to long Covid, making them reluctant to disclose it to their boss.
Scientific research suggests the impact of long Covid on employees could be significant — particularly from cognitive impairment, or so-called brain fog. Up to 28 per cent of people infected with Covid go on to suffer from long Covid and almost one in four of those experience brain fog, according to the latest international findings from the journal General Hospital Psychiatry.
One in six UK manufacturers cited Covid-19 and self-isolation as a main reason for long-term employee absences in 2023, according to a survey of 152 companies by Make UK, an industry body.
The burden may be at its most severe in healthcare. Hiring temporary workers to cover staff absences proved costly. In Germany, official data shows that in 2021, the number of temporary healthcare workers grew 8.7 per cent from a year earlier, driven largely by the need to replace health workers off sick or leaving the profession.
In the UK, an estimated 5,000 to 10,000 NHS staff were off sick with long Covid in 2023, according to analysis by the BBC, while a separate study by researchers at the universities of Portsmouth and Southampton estimated that long Covid had led to 80,000 people leaving the workforce by March 2022.
Matthew Taylor, chief executive of the NHS Confederation that represents health leaders across England, Wales and Northern Ireland, said “the evidence is that long Covid is slightly more prevalent among health workers” because of the greater likelihood they contracted the original “wild type” of the virus.
But he added: “We’re still quite a long way from understanding the extent of the impact on the general population’s health and the resource issues generated by actually providing support for people with long Covid.”
Deepening the uncertainty surrounding the condition, it is not always possible to disentangle the impact of long Covid from that of Covid itself and a myriad of other viruses, as well as the deterioration in mental health suffered by many health staff who worked through the pandemic.
Carmen Scheibenbogen, a clinical immunologist who runs an outpatient clinic at Berlin’s Charité hospital, which specialises in long Covid and myalgic encephalomyelitis or chronic fatigue syndrome, said the average number of sick days taken by healthcare staff in Germany had doubled between 2020 and 2023.
This was not solely the result of Covid — other respiratory infections such as flu and respiratory syncytial virus played a part — but even illnesses that appeared to have another cause might in reality be attributable to long Covid, she pointed out.
With long Covid cases likely to be “under-reported”, a subset of patients diagnosed with problems such as depression or muscle pain were also likely to be suffering from the condition, Scheibenbogen said.
The condition’s emergence offers important lessons for health systems, employers and policymakers, said David Cutler, professor of applied economics at Harvard University.
“We need better treatment, helping primary care doctors treat long Covid better. We also need to help employers learn how to enable employees suffering from it to work in the most productive way possible.”
Cutler added that deeper research was also required into the best therapies for people with long Covid. “It’s a lot of people, it’s a big deal, and it’s under the radar,” he said.
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