Have Dominated Survey Research Over the Last Thirty Years and Continue to Be Used

Since the depths of the COVID-19 pandemic through today, news about labor shortages and missing workers has dominated headlines . The question everyone still seems to be asking is: Why?

In January 2022, Brookings Metro published a report that assessed the impact of long Covid on the labor market. Data on the condition's prevalence was limited, so the report used various studies to make a conservative estimate: 1.6 million full-time equivalent workers could be out of work due to long Covid. With 10.6 million unfilled jobs at the time, long Covid potentially accounted for 15% of the labor shortage.

This June, the Census Bureau finally added four questions about long Covid to its Household Pulse Survey (HPS), giving researchers a better understanding of the condition's prevalence. This report uses the new data to assess the labor market impact and economic burden of long Covid, and finds that:

• Around 16 million working-age Americans (those aged 18 to 65) have long Covid today.
• Of those, 2 to 4 million are out of work due to long Covid.
• The annual cost of those lost wages alone is around $170 billion a year (and potentially as high as $230 billion).

These impacts stand to worsen over time if the U.S. does not take the necessary policy actions. With that in mind, the final section of this report identifies five critical interventions to mitigate both the economic costs and household financial impact of long Covid.

Around 16 million working-age Americans likely have long Covid today

The Census Bureau's June to July 2022 HPS survey found that 16.3 million people (around 8%) of working-age Americans currently have long Covid.¹ This report uses HPS data rather than Current Population Survey (CPS) data—which is generally more robust—because the HPS asks questions specific to long Covid , and the CPS does not. The CPS asks about six specific manifestations of disability, which will likely identify some cases of long Covid, but almost certainly not all.²

A recent Federal Reserve Bank of Minneapolis study corroborates the HPS figure. Using a longitudinal survey, it found that 24.1% of people who have contracted COVID-19 experienced symptoms for three months or more, which the author defined as long Covid.³  And according to the Centers for Disease Control and Prevention, about 70% of Americans have contracted COVID-19. If 24.1% of them have had long Covid, 34 million working-age Americans have, at some point, had long Covid.

The Minneapolis Fed study found that 50% of respondents had recovered from long Covid. If we exclude that 50%, we are left with around 17 million people who may currently have long Covid—very near the HPS estimate of 16.3 million.⁴

As many as 4 million workers are likely out of work due to long Covid

Mild symptoms, employer accommodations, or significant financial need can all keep people with long Covid employed. But in many cases, long Covid impacts work. Understanding that impact requires three data points.

First, we need to know what percentage of people with long Covid have left the workforce or reduced their work hours. Estimates vary:

• The Minneapolis Fed study cited above found that 25.9% people with long Covid have had their work "impacted" (meaning that they are either out of work or working reduced hours).
• A survey from the United Kingdom's Trades Union Congress (TUC) found that 20% of people with long Covid were not working, and an additional 16% were working reduced hours.
• A study published in The Lancet, found that 22% of people with long Covid were unable to work due to ill health, and another 45% had to reduce hours worked.

Second, we need to know how many people with long Covid were working in the first place. Since this report focuses on working-age Americans, we will use that group's labor force participation rate of 75% . So, of the 16.3 million working-age Americans with long Covid, we can assume 12.2 million were in the labor force.

Third, we need to calculate the reduced hours of the people with long Covid who kept working. The Minneapolis Fed study found that, on average, they reduced their hours by 10 hours a week; using that number and a 40-hour work week, we can assume that these workers reduced their hours by 25%.

Using the Minneapolis Fed, TUC, and Lancet data on extent of work reductions gives us 2 million, 3 million, and 4 million full-time equivalent workers out of the labor force due to long Covid, respectively. The midpoint of this range—3 million full-time equivalent workers—is 1.8% of the entire U.S. civilian labor force .⁵

This may sound unbelievably high, but it is not inconsistent with the experiences of comparable economies. For example, a Bank of England representative recently stated that labor force participation has dropped by around 1.3% across the entire 16- to 64-year-old population (not just those who are working), and that the majority of that impact is from the rise in long-term sickness—which he suspected was long Covid. Meanwhile, one-quarter of U.K. companies cite long Covid as one of the main causes of long-term staff absence.

It is also not inconsistent with the current labor market experience in the U.S., where employers in face-to-face industries such as education , transportation, food service, hospitality, and health and social care are facing persistent labor shortages . And as economist Jason Furman recently pointed out , labor market participation is still around 1 percentage point lower than demographics would predict.

The economic burden of lost wages is approaching $200 billion a year—and likely to rise

Using the average U.S. wage of $1,106 per week, the estimated 3 million people out of work due to long Covid translates to $168 billion a year in lost earnings. This is nearly 1% of the total U.S. gross domestic product . If the true number of people out of work is closer to 4 million, that is a $230 billion cost.

Harvard University economist David Cutler arrived at a nearly identical number using a different methodology. His study cited research that 12% to 17% of COVID-19 patients are still experiencing three or more symptoms 12 weeks after onset, and that the labor force reduction among those with significant impairment is 70%. Using COVID-19 case counts and labor force participation rates, Cutler estimated that 3.5 million people are out of work due to long Covid, for a five-year lost wage cost of $1 trillion , or around $200 billion per year.

Critically, this number does not represent the full economic burden of long Covid, because it does not include impacts such as the lower productivity of people working while ill, the significant health care costs patients incur, or the lost productivity of caretakers. Cutler estimated that medical care and lost quality of life related to long Covid cost an additional $544 billion each year.

Long Covid isn't the only post-viral illness impacting the U.S. economy. For example, a 2015 Institute of Medicine report found that 835,0000 to 2.5 million people in the U.S. had ME/CFS —a complex, disabling illness often triggered by a virus. In fact, many patients with long Covid meet the criteria for ME/CFS.

The speed at which this economic burden grows will depend on three factors:

• The availability and accessibility of improved treatment options that increase the long Covid recovery rate or move people from "severely ill" to "moderately" or "mildly" ill
• Whether vaccines reduce the odds of getting long Covid
• Whether repeat infections carry additional long Covid risk

Unfortunately, the latest news on these is not good. While doctors and researchers learn more about the underlying causes of long Covid every day, there is no standardized, generally accepted treatment for it. A recent study suggests vaccines reduce the risk of long Covid by only 15% . And while we don't yet know the risk of contracting long Covid after repeat infections, one recent study found that every repeat infection increases the probability of long-term health consequences.

Together, these three factors suggest that if long Covid patients don't begin recovering at greater rates, the economic burden will continue to rise. To give a sense of the magnitude: If the long Covid population increases by just 10% each year, in 10 years, the annual cost of lost wages will be half a trillion dollars.

But there is a fourth factor that can ease this burden and help those who continue to suffer from long Covid: Policy interventions that reduce the workforce impact of long Covid, as detailed in the next section.

Policy actions can mitigate the economic drag of long Covid and protect household finances

There are at least five critical government interventions that can reduce the economic burden of long Covid: better prevention and treatment options, expanded paid sick leave, improved workplace accommodations, wider access to disability insurance, and enhanced data collection on long Covid's economic effects.

Better prevention and treatment options

First, we need better and more accessible prevention and treatment options. On prevention, some scientists are calling for a second "Operation Warp Speed" focused on nasal vaccines that reliably prevent COVID-19 infection. Until we have such vaccines, it makes good economic sense to encourage or mandate the use of masks , air purifiers, and other interventions known to reduce spread.

Even with such prevention options, people will continue to get infected, and some of them will end up with long Covid. We need knowledgeable, affordable health care providers to help them recover, or at least improve. Today, waiting lists at the country's few long Covid clinics can be months long . As Dr. David Kaufman, a physician who has spent years treating post-viral illnesses, including long Covid, told me, "The post-pandemic crisis cannot be addressed without thousands more physicians encouraged, trained, and supported to treat patients with these chronic complex diseases."

Of course, physicians need treatments to offer, and for that, we need research into the causes of enduring post-Covid illness. "We need to understand the root cause drivers of long Covid to design the clinical trials with the most appropriately targeted therapeutics, and combinations of therapeutics, to help these patients," said Dr. Amy Proal, a microbiologist who has published multiple papers about long Covid. "That's what would get people back to work."

This month, the White House released a National Research Action Plan on Long Covid , and Congress dedicated $1.15 billion in National Institutes of Health (NIH) funding to study the disease. Yet the grants are challenging and slow to get , and overall, the government's record on supporting such work is poor; as of 2021, the NIH had budgeted less than $20 million annually for research on ME/CFS, another post-viral illness.

More speed, more money, and more trials are needed to understand the pathophysiology of long Covid (and other post-viral illnesses) and identify treatments. Given the annual cost of lost wages alone, such research funding is likely to have a high return on investment.

Expanded paid sick leave

Currently, 27% of private sector workers in the U.S. (around 30 million people ) lack access to any form of paid sick leave. The situation is worse for more vulnerable workers: Among the bottom 25% of earners, only 52% have access to paid sick leave.

When workers do not have access to paid sick leave, they are more likely to go to work sick. This likely increases the spread of COVID-19, which leads to more infections and reinfections, and therefore, more long Covid.

By requiring employers to give all workers access to paid sick leave, Congress could reduce the spread of COVID-19, improve families' economic security, and, potentially, reduce the rate at which COVID-19 infections turn into long Covid.

Congress could also consider more targeted policies, potentially even with government support for small employers. For example, employees with no option to work remotely could have higher mandatory sick time allowances.

Improved employer accommodations

One of the paradoxes of the pandemic is that, while the number of disabled Americans has risen by nearly 8% , the share of disabled Americans participating in the labor force has also increased, by about 13% . While we do not know for sure why more disabled people are participating in the labor force, one likely explanation is the pandemic shift to remote work, which makes employment more accessible for many with disabilities.

The increasing labor force participation of disabled Americans demonstrates the power of workplace accommodations. The Department of Labor has been clear in its guidance that long Covid can qualify as a disability under the Americans with Disabilities Act (ADA), thereby making those workers eligible for workplace accommodations.

However, more could be done to inform employers that the ADA covers long Covid and recommend potential accommodations. For example, the Department of Labor and Census Bureau could conduct research on the economic and firm-level benefits of providing accommodations to people with long Covid, and relevant agencies could provide lists of high-impact accommodations, such as flexibility on deadlines, longer or more frequent breaks, flexible hours, and remote work.

Unfortunately, such accommodations are likely to be most difficult to pursue for the people who need it most: low-wage workers, who often live paycheck to paycheck and can't afford to lose earnings. Low-wage jobs tend to be physically demanding, inflexible when it comes to hours, and ineligible for remote work. While accommodations absolutely can and should be made (for example, allowing cashiers to sit instead of stand; giving restaurant workers more flexibility to swap shifts on days they're not feeling well; assigning certified nursing assistants to less physically demanding duties), many of these workers will ultimately need disability coverage.

Wider access to disability insurance

Reports suggest that long Covid patients are struggling to secure approval for Social Security Disability Insurance (SSDI) benefits. Without the safety net of SSDI and accompanying Medicare benefits, it may be even more difficult for workers with long Covid to access appropriate medical care and return to productivity.

In terms of SSDI approval, there are two challenges: 1) the need to show objective evidence of illness, which can be challenging for people with long Covid; and 2) the requirement that the illness is expected to last at least 12 months, as it is unclear how to demonstrate this with long Covid.

It may also be the case that people don't know that they are eligible to apply for SSDI when they have long Covid. They may not even realize that long Covid is what's making them sick.

Congress could improve access to SSDI and related Medicare benefits for long Covid patients by:

• Waiving the 12-month requirement
• Releasing specific guidance concerning the assessment of long Covid and other post-viral illness claims—for example, regarding the burden of proof of illness
• Eliminating the 24-month Medicare waiting period

• Committing to expedited reviews of long Covid SSDI claims
• Ensuring broader dissemination of information regarding both SSDI and, for those already on SSDI, back-to-work programs such as Ticket to Work

Enhanced data collection

Finally, to fully assess long Covid's labor market impact and track the efficacy of any interventions, better data collection is required. Adding long Covid questions to the Household Pulse Survey was a start; however, policymakers also need to understand the impact of long Covid on work and the role that SSDI plays in alleviating the condition's burden.

To fill this data gap, the Census Bureau and Bureau of Labor Statistics (BLS) should introduce questions about long Covid's impact on work to the HPS, as well as to the Current Population Survey, which has a higher sample size, rigor, and reliability compared to the HPS.

The Census Bureau and BLS should also work with NIH teams researching long Covid, as well as patient advocacy groups such as Body Politic and the Patient-Led Research Collaborative , to define the questions, which should focus on the information policymakers most need, including:

• The number of full-time equivalent workers currently not working due to long Covid (including those working at reduced hours)
• Average time off or reduced hours
• Workplace accommodations that would enable long Covid patients to increase working hours
• Applications, approvals, and rejections for SSDI among long Covid patients

With 16.3 million working-age Americans afflicted and annual wage losses totaling nearly $200 billion, long Covid is already a meaningful drag on U.S. economic performance and household financial health. And absent intervention, the situation is likely to worsen. The government should take the threat of long Covid as seriously as the numbers show it to be, starting with the recommendations above and continuing until we can fully treat and neutralize the condition's economic and personal health impacts.

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Source: https://www.brookings.edu/research/new-data-shows-long-covid-is-keeping-as-many-as-4-million-people-out-of-work/

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