This chapter summarises the policy initiatives to support healthcare workers in order to improve the clinical management of patients living with long COVID. The focus is on the development and publication of clinical guidelines, pharmacotherapy recommendations, and training for healthcare workers. The chapter also provides an overview of the organisation of care for long COVID in 2025, and the existence or absence of care pathways.
Addressing the Costs and Care for Long COVID
The Long Shadow of the Pandemic
Abstract
Depending on the organisation of a healthcare system, the model of care for long COVID may involve a combination of health sectors to include primary care, regional specialised clinics and a national referral centre. These clinics and referral pathways require funding and co‑ordination within the healthcare system. The majority of surveyed OECD countries reported use of designated specialised clinics to organise care for patients affected by long COVID (Australia, Canada, Czechia, Finland, France, Germany, Luxembourg, the Netherlands and Sweden) (Figure 6.1). Most of these specialised clinics are organised at the regional level and are staffed by either multidisciplinary teams (where patients have access to different healthcare professionals to manage their needs), hospital medicine specialists or primary care providers. As a small country, Luxembourg reported having one national centre with multidisciplinary personnel for long COVID.
The Netherlands established its post-COVID centres of expertise with a dual mission: to provide high-quality care and to accelerate the acquisition of knowledge and experience (Erasmus MC, 2024[1]). The centres were not established to treat all patients with long COVID in the Netherlands in the short term, but to acquire and concentrate knowledge and experience quickly, and then to share this with hospitals, primary care and other healthcare providers. The intention is that effective treatments will later be covered by and implemented within the regular healthcare system.
Note: Survey question: “Has the health authority designated specialised clinics to provide care for long COVID in your country?”
Source: 2025 OECD Long COVID Mapping Policy Survey.
As of 2025, seven countries (Australia, Austria, Canada, Czechia, Norway, Poland and Sweden) declared that at least some of these clinics had closed, owing to either referral to generic healthcare pathways or a lack of funding. In some cases, there has been a shift to referring patients under the broader clinical umbrella of PAIS. Austria plans to open specialised clinics or contact points to manage patients affected more generally by PAIS. France reported that dedicated funding for long COVID centres housed within existing hospitals was being renewed to varying degrees and tended not to be maintained over time. As of 2025, Norway and Poland have discontinued their established specialised clinics, and patients are now managed in general medical clinics. Four countries (Belgium, Korea, Slovenia and Switzerland) reported not having specialised long COVID structures to provide care (Figure 6.1). Additionally, Japan reported some clinics that provide tailored care combining symptom-based medical treatment and psychological support, based on national guidelines.
The availability of and funding for specialised clinics for care of long COVID represent a changing situation. Overall, despite 12 of the 16 responding countries reporting that specialised clinics for long COVID were in place at some point during COVID‑19 pandemic, by 2025 seven countries had reported closure of these clinics owing to either referral to generic healthcare pathways or a lack of funding.
Clinical guidelines for long COVID can ensure standardised case definitions, diagnostic criteria and treatment recommendations that are evidence‑based and developed through expert consensus and literature review. The 2024 report Mapping long COVID across the EU: definitions, guidelines and surveillance systems in EU Member States found that guidelines for diagnosis and/or treatment of long COVID were available in 21 of the 34 countries examined. Common elements found across the guidelines included use of a multidisciplinary approach, ensuring a central role for primary care and the importance of rehabilitation. However, the target group for the guidelines, referral processes and specific symptoms addressed differed between guidelines. Among the 16 countries responding to the 2025 survey on long COVID, all but three (Czechia, Norway and Slovenia) reported having national clinical guidelines, although these are in development in Slovenia (Figure 6.2). Nine countries reported that the guidelines were produced by health societies, while five countries noted that they were developed or funded by the government. Similarly, in the United Kingdom, guidelines and recommendations were produced by NICE (Box 6.1). In Japan the Ministry of Health, Labour and Welfare published symptom-based clinical guidelines for long COVID.
Note: Survey question: “Are there clinical guidelines for long COVID in your country?”
Source: 2025 OECD Long COVID Mapping Policy Survey.
The United Kingdom’s NICE developed a case definition for long COVID that is still in partial use by a few countries, such as Germany and Belgium (see Chapter 4, Section 4.1). In addition to the NICE definition, long COVID management guidelines were developed by NICE, the Royal College of General Practitioners and the Scottish Intercollegiate Guidelines Network in 2020, and were updated in 2024. The guidelines support identification and diagnosis of long COVID, multidisciplinary rehabilitation, proactive follow-up and monitoring, integrated care pathways, and self-management (NICE, 2024[2]).
In addition, NHS England published guidance on care pathways for adults and children, which was last updated in December 2023 (NHS England, 2023[3]). NHS England worked in partnership with the British Society of Physical and Rehabilitation Medicine to establish the International Post COVID‑19 and Post Infection Conditions Society to facilitate the ongoing sharing of best practice to support people affected by long COVID (BSPRM, n.d.[4]).
In 2021, 90 long COVID clinics were established in England, alongside clinics in Scotland and Wales, to offer multidisciplinary care, diagnostic assessments and rehabilitation (Darbyshire et al., 2024[5]). However, a slowdown in referrals and funding cuts as a result of financial sustainability pressures have led to closure of a number of these clinics, with patients increasingly referred back to primary care for case management. For example, NHS North East London closed its long COVID clinics as of April 2025, while keeping referral routes to specialists available and supporting patient self-care (NHS North East London, 2025[6]). Although 13 paediatric long COVID clinics were established in 2021, only 8 of these are expected to remain open, as of 2025 (Long COVID Kids, 2025[7]).
The United Kingdom has also invested heavily in long COVID research, providing funding of more than GBP 57 million, with four trials ongoing as of 2025 (UK Parliament, 2025[8]). Funding is allocated to understanding long COVID disease mechanisms, symptoms and testing of treatments, as well as understanding whether NHS services such as long COVID clinics were effective and how to support patients in their own recovery (NIHR, 2022[9]). Furthermore, in July 2025, the National Institute of Health and Care Research announced a new funding opportunity for repurposing pharmaceutical or other interventions for the treatment of PAIS, including long COVID (ME Research, 2025[10]).
One common challenge in developing guidelines for long COVID, however, is the low level of evidence or low certainty regarding many interventions. This highlights the need for regular updating of guidelines as additional knowledge emerges: the Netherlands is doing this for the current guidelines that were developed in 2022 (Tweede Kamer, 2025[11]), as is Korea (Seo et al., 2024[12]). Canada developed and updated over 100 evidence‑based clinical guidelines for long COVID, for healthcare professionals, policymakers and the public (CAN-PCC, 2025[13]).
One area where there is a robust evidence base is the protective effect of COVID‑19 vaccination against developing long COVID. Several robust research studies have demonstrated this preventive effect, and a systematic review by the European Centre for Disease Prevention and Control has estimated that COVID‑19 vaccination reduces the risk of long COVID by almost 30%. However, implementation and communication of this evidence base into health policy have been limited in OECD countries, with few listing long COVID prevention as a benefit of COVID‑19 vaccination (Box 6.2). A lower risk of COVID‑19 infection and of developing long COVID due to the milder omicron SARS‑CoV‑2 variant in the post-pandemic era reduces the cost-effectiveness and likely uptake of pursuing a strategy of COVID‑19 vaccination of the wider population.
SARS‑CoV‑2 infection is the necessary precursor to developing long COVID. COVID‑19 vaccination protects against SARS-COV‑2 infection – particularly against the risk of severe infections. However, in the post-pandemic era, promotion of COVID‑19 vaccination has become increasingly challenging, due to lower risk of SARS‑CoV‑2 infection and reduced severity of COVID‑19 illness in the omicron era.
In addition to reducing the risk of severe COIVD‑19 illness, COVID‑19 vaccination has been consistently associated with lowered risk of developing disabling and debilitating long COVID (Watanabe et al., 2023[14]; Ceban et al., 2023[15]; Edwards and Hamilton, 2023[16]; Català et al., 2024[17]). The European Centre for Disease Prevention and Control systematic review of published evidence reported that full COVID‑19 vaccination prior to SARS‑CoV‑2 infection could reduce the risk of long COVID by 27% in the adult population, compared to no vaccination.
Although this reduction in risk may seem modest, at a population level, the health benefits to patients and cost savings to healthcare systems in terms of prevented long COVID cases could be substantial in terms of absolute numbers. This preventive benefit against long COVID, in both health and economic terms, therefore, warrants consideration in national COVID‑19 vaccine policy recommendations. Policymakers must account for likely population uptake and cost-effectiveness of the strategy when deciding whom to recommend for COVID‑19 vaccination. The WHO lists vaccination, in addition to other hygiene measures as a preventive measure against developing long COVID, while the US CDC lists this benefit for those considering COVID‑19 vaccination.
Source: ECDC (2025), Does COVID‑19 vaccination reduce the risk and duration of post COVID‑19 condition? https://www.ecdc.europa.eu/en/publications-data/does-covid-19-vaccination-reduce-risk-and-duration-post-covid-19-condition; CDC (2025), Staying Up to Date with COVID‑19 Vaccines, https://www.cdc.gov/covid/vaccines/stay-up-to-date.html; WHO (2025), Post COVID‑19 condition, https://www.who.int/news-room/fact-sheets/detail/post-covid-19-condition-(long-covid).
The evidence base for pharmaceutical treatment of long COVID is currently limited. Some existing medications are used off-label as treatment options to address certain pathophysiological consequences of long COVID, while others are known to provide symptomatic benefits to patients when prescribed appropriately. National pharmacotherapy recommendations can help to inform healthcare workers about how to treat patients affected by long COVID safely and effectively.
Three countries (Canada, Finland and Switzerland) have guidelines recommending pharmacotherapy for treatment of long COVID symptoms (Figure 6.3). Canada’s guidelines team produced over 30 evidence‑based clinical recommendations related to pharmacotherapy, classified by populations targeted and drug class (CAN-PCC, 2025[13]). A further five countries (Austria, Czechia, Germany, Poland and Sweden) recommend prescribing certain drugs on an off-label basis to address some of the underlying biological mechanisms responsible for long COVID. In Austria, the national reference centre has published an off-label recommendation drug list for PAIS. Germany’s therapy compass provides an overview of options for drugs that can help treat various symptoms associated with long COVID (Federal Ministry of Health, 2024[18]), and is working on development of off-label use of medications in long COVID treatment (Chapter 5, Box 5.1). Countries can also refer to existing recommendations on validated treatments for sequalae or comorbidities that patients affected by long COVID usually present. Japan’s symptom-based clinical guidelines do not specify pharmacotherapy strategies, including off-label drug use.
Note: Survey question: “Do clinical guidelines recommend prescribing pharmacotherapy for treatment of long COVID?”
Slovenia did not answer the question.
Source: 2025 OECD Long COVID Mapping Policy Survey.
Care pathways are structured plans that outline the main steps in the care of patients with a specific clinical problem. They are helpful in managing complex conditions such as long COVID, where symptoms vary widely between patients, and care can involve a range of different medical specialties.
Six countries (Austria, Belgium, France, Germany, Luxembourg and the Netherlands) reported having an official care pathway for long COVID patients (Figure 6.4). Expansion of the current pathway is under way in Austria as per the recommendations of the country’s Action Plan. In France, while recommendations for the model of care pathway exist, no official structure is operationally in place to co‑ordinate the care accordingly. In the case of the Australia and Canada, care pathways were developed at the regional level, aligned with the organisation of the healthcare system. In the Netherlands, a national care pathway was recently launched (Post-COVID Netwerk, 2026[19]), and will be updated regularly and co‑ordinated within the Post-COVID Network Netherlands. Within the post-COVID expertise centres, selected patients are treated according to a care pathway designed within these centres (UMCNL, 2026[20]). Similarly, Ireland’s long COVID model of care, launched in 2021 and centred on primary care, community rehabilitation and specialised clinics, was undergoing revision as of December 2024 to ensure it best meets the needs of patients (Health Service Executive;, 2024[21]).
Half of the countries responding to the 2025 survey do not yet have a long COVID care pathway. In Poland, such a pathway existed under the former post-COVID rehabilitation programme. However, referrals to relevant specialists are currently based on individual decision making of the primary care physician. Similarly, in Sweden, primary care is the main designated provider of care for patients with long COVID, although this is challenged by substantial knowledge gaps among primary care providers.
Note: Survey question: “Is there currently an official care pathway for long COVID patients in your country?”
Source: 2025 OECD Long COVID Mapping Policy Survey.
As noted in Chapter 4, Section 4.4, in order for healthcare workers to be able to recognise and code long COVID accurately, there is a need for awareness and validation of the condition among healthcare professionals, to create understanding of how it presents clinically and what follow-up diagnostic investigations and treatments should be offered to patients. This is particularly the case as the pathophysiological mechanisms of the condition are not yet fully elucidated, and there is no known curative treatment for long COVID. As such, healthcare workers can feel unsure of how to manage the condition to assist patients in achieving the best possible quality of life. Training that acknowledges uncertainties while building clinical competency to diagnose, communicate and care for patients currently living with long COVID is thus essential.
Only Austria and Canada reported having national training initiatives for long COVID (Figure 6.5). In Austria, a national reference centre for post viral syndromes was inaugurated in 2024, which is hosting training events for healthcare workers and insurance professionals involved in PAIS treatment (Bundesministerium Arbeit, Soziales, Gesundheit, Pflege und Konsumentenschutz, 2024[22]). In Canada, as part of the Knowledge Mobilization project’s efforts, the Canadian Guidelines for Post-COVID‑19 Condition team produced a series of training resources for healthcare workers, including options that qualify for continuing medical education credits (CAN-PCC, 2025[23]).
Note: Survey question: “Is there specific long COVID training for healthcare workers?”
Source: 2025 OECD Long COVID Mapping Policy Survey.
Other countries have some training in specific areas. For example, in the Netherlands, occupational therapists are offered specific training on long COVID, and the C-support organisation offers publicly available training aimed at primary care physicians, as well as occupational and medical insurance physicians and social care nurses, among others (C-Support, 2021[24]). In Germany, training opportunities are available from organisations such as the PAIS CARE training series offered by the PAIS CARE Network (Charité – Universitätsmedizin Berlin, 2025[25]). In some parts of Australia, healthcare workers can specialise in post-infective fatigue syndrome, which covers long COVID. Nonetheless, many OECD countries – including Belgium, Korea, Norway and Sweden – lack dedicated opportunities for long COVID training for healthcare workers. Similarly, in Slovenia and Poland, general educational activities such as webinars or conferences may include issues related to long COVID but it is not discussed as the main topic.
Training healthcare workers can validate the experience of millions of people living with long COVID across the EU and other OECD countries, and is crucial for recognition and appropriate management of the condition. To address the unmet need for greater awareness of and tools to manage long COVID, the OECD – in partnership with the WHO Regional Office for Europe and WHO Academy – is developing an online training course on long COVID aimed at primary care professionals, freely accessible to healthcare professionals across the world (Box 6.3).
One of the main actions of the long COVID initiative of the European Commission is to develop training for healthcare professionals and support guideline development. The need for both healthcare worker training and evidence‑based clinical guidelines on long COVID remain top priorities in the 2025 OECD policy mapping survey.
The WHO Regional Office for Europe and the OECD, in collaboration with the WHO Academy, are developing a pilot training course on long COVID essentials. The online course aims to develop the following competencies for healthcare workers by explaining:
the epidemiology and pathophysiology of long COVID
how best to make and communicate a preliminary diagnosis of long COVID to patients
how to select clinical assessments for patients with suspected long COVID
The course is aimed at a primary care audience, but may be taken by other healthcare workers in different sectors of the healthcare system. The learning objectives and topics covered were chosen and validated by a steering committee of long COVID clinicians, therapists, patient experts and policymakers from 12 OECD countries. This pilot aims to provide healthcare workers with foundational knowledge and confidence to recognise, communicate with and manage patients living with long COVID they may encounter in clinical practice. Central to the course design is the ethos that training should be informed by the experience and expertise of both healthcare workers and patients who have lived with and worked with this condition, in order to provide evidence‑based and patient-centred care. Further modules may be developed on specific topics related to long COVID in the future.
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