Addressing the Costs and Care for Long COVID

1. Long COVID is a lasting, burdensome consequence of the pandemic

1.1. Estimating the true burden of long COVID remains challenging

More than five years after the onset of the COVID‑19 pandemic, widespread infection with SARS‑CoV‑2 has left millions of people worldwide living with lasting symptoms of long COVID. Long COVID is a multisystemic and complex condition that can persist for months or even years after the initial infection. Its biological mechanisms remain poorly understood (Box 1.1). Long COVID was first identified and named by patients themselves, whose advocacy and lived experience played a crucial role in shaping awareness and driving early research into the condition.

Measuring the global burden of long COVID is challenging. Estimates vary because of differences in study designs, follow-up periods, control group selection (for example, individuals testing negative for SARS‑CoV‑2 versus those with no known infection), baseline health assessments and definitions of what constitutes long COVID. Estimates are also influenced by evolving variants and subvariants, vaccine uptake, antiviral use and recurrent infections, all of which shape the likelihood of developing long COVID.

Box 1.1. What is known about the causes, symptoms and occurrence of long COVID?

Long COVID is a post‑acute infection syndrome defined by the persistence or emergence of new symptoms three months after the initial COVID‑19 illness (WHO, 2022[1]). The underlying causes and mechanisms are not yet fully understood, although biomedical studies suggest that it is an inflammatory and immune‑mediated condition, possibly linked to viral persistence. Essentially, patients who have experienced acute COVID‑19 develop long‑lasting or relapsing symptoms that may fluctuate over time, leading in some cases to significant disability.

Long COVID can affect nearly every organ system, including the cardiovascular, nervous, endocrine, immune, reproductive and gastrointestinal systems. Common manifestations include cognitive dysfunction (often referred to as “brain fog”), fatigue, dysautonomia (frequently presenting as postural orthostatic tachycardia syndrome) and post‑exertional malaise. Current evidence suggests that long COVID is not a single disease but a cluster of related subtypes with potentially distinct risk factors – genetic, environmental or otherwise – and diverse biological mechanisms.

Among people with confirmed COVID‑19 infection, the risk of developing long COVID is estimated at 5‑15% (OECD, 2025[2]; Subramanian et al., 2022[3]; Ballering et al., 2022[4]), depending on age, sex, underlying health status, vaccination, and the severity and timing of the infection. Albeit this risk has declined in more recent years with milder circulating variants of SARS‑CoV‑2 post-pandemic (de Bruijn et al., 2025[5]). Long COVID varies in duration: while some patients show gradual improvement, others experience prolonged or non‑resolving symptoms lasting months or years. Current studies indicate that between 3% and 8% of the general adult population continue to live with long COVID (OECD, 2025[2]), making it a condition with substantial implications for health systems and national economies.

1.2. Long COVID affects people, health systems and economies

Beyond its profound effects on individual health and daily living, long COVID has far-reaching implications for health systems and national economies. Many people experience marked declines in well-being, reporting limitations in work, social participation, caregiving and community engagement. Over three‑quarters of those affected report a moderate or severe impact on overall quality of life (O’ Mahony et al., 2022[6]). The condition’s frequent cognitive and physical symptoms can alter one’s sense of identity and self, while stigma and disbelief – including from some healthcare professionals – further compound distress and isolation (McNabb et al., 2023[7]; Mahbub Hossain et al., 2023[8]).

Given its widespread and persistent nature, long COVID has placed additional strain on health systems. Patients often require ongoing care and multi-specialty consultations, adding to existing service pressures. In the United States, for instance, people with long COVID are significantly more likely to report unmet care needs – due to costs, provider shortages or difficulties scheduling appointments (Karpman, Zuckerman and Morriss, 2023[9]). The absence of standardised diagnostic criteria, clinical pathways and treatment models also creates challenges for healthcare providers. Moreover, SARS‑CoV‑2 infection has contributed to a rising burden of non-communicable diseases, including cardiovascular disease and diabetes, amplifying system-wide pressures (Menges et al., 2021[10]).

The socio‑economic implications are similarly substantial. In addition to higher healthcare expenditure and disability-related costs, long COVID contributes to reduced labour participation, employment disruption and productivity loss, affecting not only individuals but also caregivers and employers. Evidence suggests that a significant proportion of those affected are unable to work or must reduce their working hours, with measurable consequences for economic output (Reuschke and Houston, 2022[11]; Gandjour, 2023[12]).

1.3. This report examines the socio‑economic impact and policy responses to long COVID across OECD and EU Member countries

While current estimates of the economic impact of long COVID remain limited and fragmented, available evidence suggests that the cumulative consequences are considerable and likely to persist over time. Further research is required to better quantify these effects and support effective policy responses.

This report presents the OECD Secretariat’s analysis of the anticipated socio‑economic consequences of long COVID across OECD and EU Member countries over the next decade (Chapters 2 and 3). It also provides an overview of how countries currently define, recognise and manage long COVID within their health systems (Chapters 4, 5 and 6). The analysis examines differences in diagnostic criteria, clinical management and financing approaches; identifies good practices in integrated and patient-centred care; and highlights systemic challenges and priority areas for further action (Chapter 7). Finally, Chapter 8 outlines key policy options countries may consider to address this public health challenge, and draws lessons relevant to broader health-system strengthening efforts.

The findings are based on a dedicated microsimulation model developed for the quantitative analysis (Box 2.3), combined with qualitative insights from the 2025 OECD Long COVID Policy Mapping Survey, launched in July 2025 and complemented by desk research. Responses were received from health policymakers and experts in 11 EU countries through the Network of Expertise on Long COVID (NELC) – Austria, Belgium, Czechia, Finland, France, Germany, Luxembourg, the Netherlands, Poland, Slovenia and Sweden – and from 5 additional OECD countries via the Healthcare Quality and Outcomes Working Party (Australia, Canada, Korea, Norway and Switzerland).

References

[4] Ballering, A. et al. (2022), “Persistence of somatic symptoms after COVID-19 in the Netherlands: an observational cohort study”, The Lancet, Vol. 400/10350, pp. 452-461, https://doi.org/10.1016/s0140-6736(22)01214-4.

[5] de Bruijn, S. et al. (2025), “Post-COVID-19 condition in individuals infected with SARS-CoV-2 in autumn 2023 in the Netherlands: a prospective cohort study with pre- and post-infection data”, The Lancet Regional Health - Europe, Vol. 59, p. 101472, https://doi.org/10.1016/j.lanepe.2025.101472.

[12] Gandjour, A. (2023), “Long COVID: Costs for the German economy and health care and pension system”, BMC Health Services Research, Vol. 23/1, p. 641, https://doi.org/10.1186/S12913-023-09601-6.

[9] Karpman, M., S. Zuckerman and S. Morriss (2023), “Health Care Access and Affordability Among US Adults Aged 18 to 64 Years With Self-reported Post–COVID-19 Condition”, JAMA Network Open, Vol. 6/4, pp. e237455-e237455, https://doi.org/10.1001/jamanetworkopen.2023.7455.

[8] Mahbub Hossain, M. et al. (2023), “Living with “long COVID”: A systematic review and meta-synthesis of qualitative evidence”, PloS one, Vol. 18/2, https://doi.org/10.1371/JOURNAL.PONE.0281884.

[7] McNabb, K. et al. (2023), ““It was almost like it’s set up for people to fail” A qualitative analysis of experiences and unmet supportive needs of people with Long COVID”, BMC public health, Vol. 23/1, https://doi.org/10.1186/S12889-023-17033-4.

[10] Menges, D. et al. (2021), “Burden of post-COVID-19 syndrome and implications for healthcare service planning: A population-based cohort study”, PloS one, Vol. 16/7, https://doi.org/10.1371/JOURNAL.PONE.0254523.

[6] O’ Mahony, L. et al. (2022), “Impact of Long COVID on health and quality of life”, HRB Open Research, Vol. 5, https://doi.org/10.12688/HRBOPENRES.13516.1/DOI.

[2] OECD (2025), “The prevalence and impact of Long COVID in the primary care population: Findings from the OECD PaRIS survey”, OECD Publishing, Paris, https://doi.org/10.1787/119b0e8f-en.

[11] Reuschke, D. and D. Houston (2022), “The impact of Long COVID on the UK workforce”, Applied Economics Letters, Vol. 30/18, pp. 2510-2514, https://doi.org/10.1080/13504851.2022.2098239.

[3] Subramanian, A. et al. (2022), “Symptoms and risk factors for long COVID in non-hospitalized adults”, Nature Medicine, Vol. 28/8, pp. 1706-1714, https://doi.org/10.1038/s41591-022-01909-w.

[1] WHO (2022), Post COVID-19 condition (Long COVID), World Health Organization, https://www.who.int/europe/news-room/fact-sheets/item/post-covid-19-condition.