Addressing the Costs and Care for Long COVID

Executive summary

Long COVID – a post-acute infection syndrome characterised by persistent symptoms such as cognitive dysfunction (“brain fog”) and fatigue – continues to cast a long shadow more than five years after the pandemic struck, with its direct medical and indirect economic costs set to weigh heavily on EU and OECD economies through the next decade.

Long COVID imposes a heavy cost on health systems and economies

Long COVID affected around 75 million people, more than 5% of the OECD population on average, at the peak of the pandemic in 2021 with healthcare costs hitting USD 53 billion. Prevalence of long COVID and associated healthcare costs have fallen since the height of the pandemic but remain significant.

While prevalence of long COVID is projected to remain below 1% from 2025 to 2035 (affecting 0.6‑1.0% of the OECD and EU population), the direct healthcare costs for tackling long COVID – even under conservative assumptions – will remain high: around USD 11 billion a year.

Additionally, the indirect economic costs of long COVID are set to far outweigh the associated healthcare costs from 2025 to 2035. Long COVID will continue to dent workforce participation and productivity at a time of modest economic growth and population ageing. These losses are rooted in illness-related absenteeism, presenteeism and people dropping out of the workforce. Studies suggest that long COVID leads to employment disruption in around one in five affected workers. That is equivalent to a 5‑10% loss of labour input per affected individual during the first year of infection.

In total, projected losses of 0.1‑0.2% of GDP, which assume low or moderate residual transmission of the virus leading to new cases of long COVID, could create a major drag on the economy amounting to USD 135 billion per annum over the next decade, comparable to the entire annual health budget of the Netherlands or Spain.

Spotlighting better care and reintegration into the workforce

This report shines a spotlight on ways to improve patients’ health and support their reintegration into the workforce to reduce economic losses.

Firstly, strengthening awareness, diagnosis, treatment, and organisation of the healthcare provided for patients with long COVID is vital:

• Recognition, diagnosis, and care for long COVID remains uneven across OECD and EU countries, which leads to suboptimal management of the condition. Training for healthcare professionals is a priority. Clinical guidelines that reflect patient expectations and lived experience make a real difference to their lives and prospects.

• Longterm planning and vision are lacking for long COVID. Few countries have adopted a long COVID strategy or plan. National initiatives are most advanced in Germany and the Netherlands.

• There is a need to develop care pathways for patients with long COVID. Only six countries (Austria, Belgium, France, Germany, Luxembourg, and the Netherlands) have formal, nationally defined care pathways. Clearer referral pathways and better-integrated guidelines have significant potential to improve care and provide valuable lessons to the broader people‑centred care agenda.

• Valuable lessons from long COVID can be drawn to improve preparedness for the next pandemic. It highlights the need for timely surveillance, longitudinal patient follow‑up, and integration of long‑term consequences into pandemic response planning. Continued investment in research, data systems and multidisciplinary care models will improve support for affected patients and enhance preparedness and resilience in tackling future health crises.

Secondly, long COVID is not just a medical problem. It is equally a social and economic challenge. For now, the policy response to long COVID remains largely confined to the health sector. Cross-sectoral co‑ordination involving employment, education and social protection is limited. The scope for better cross-sectoral co‑ordination is significant.

While medical costs are generally covered by universal health coverage systems, social protection measures for patients with long COVID – particularly those with persistent work limitations – rely on formal assessments of the individual’s functioning capacity. Adequate awareness of disability due to long COVID is therefore important to ensure equitable access to disability support. Strategic investment and planning are needed to strengthen social protection to support reintegration into the workforce and mitigate associated workforce losses.

Thirdly, a co‑ordinated and coherent approach to tackling long COVID is crucial to help patients recover. Continued international collaboration is also essential to develop and refine evidence‑based clinical guidelines, standard definitions and national care pathways that can reduce the social and economic burden of long COVID.

Overall, better care, co‑ordination, planning, and pathways developed specifically for and with people affected by long COVID can steer patients back to good health and economic opportunities and help shorten the long shadow cast by the pandemic.