Organisation for Economic Cooperation and Development (OECD) report: Addressing the Costs and Care for Long COVID: The Long Shadow of the Pandemic

[Andy]

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.

Full report

 

[rvallee]

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.

Uh, it is? Must have missed it.

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

Continued? Must have missed that, too.

Only six countries (Austria, Belgium, France, Germany, Luxembourg, and the Netherlands) have formal, nationally defined care pathways

This will definitely come as a surprise to people living in those countries. I don't think "not interested, here's some biopsychosocial crap" is a defined care pathway.

Thirdly, a co‑ordinated and coherent approach to tackling long COVID is crucial to help patients recover

Yes, please, that would be nice. It would have been nicer from the start, it is what thousands of people demanded from the start, and millions since, backed by numerous studies and reports, but it sure would be nice to do those normal things that are super obvious. It's odd how few people seem to find it remarkable that no such thing has happened despite the fact that it was predicted, and evidence has only confirmed the need. Ah well. I guess continuing to cover up the massive failure of psychosomatic ideology is just that important.

Speaking of international institutions, the WHO has been a total non-entity aside from an initial low burst of interest that died out in weeks. What an odd way to deal with a major crisis where experts have had everything they need to do better for literal decades.

 

[Andy]

Mentions of ME/CFS.

"4.5. Chronic fatigue syndrome and depressive disorder are often used as alternatives for diagnostic coding to long COVID

Patients and healthcare workers have often reported difficulties in obtaining and making a formal diagnosis of long COVID in their country. Other diagnoses associated with – or occurring as a consequence of – the condition can be easier to confer from a diagnostic coding and medico-administrative perspective in some countries. This may in part account for the currently under-reported disease burden of long COVID.

Alternative diagnostic coding can help patients living with long COVID access the health and social welfare services they need for their condition, albeit via a different route. However, alternative coding also contributes to underestimating the disease burden, and to a lack of awareness and recognition of the impact of long COVID on patients and society.

The main alternative diagnosis to formal long COVID diagnosis is myalgic encephalomyelitis (ME) or chronic fatigue syndrome (CFS) (reported by 11 countries), followed by depressive disorder (reported by nine countries) and dysautonomia (reported by seven countries). Diabetes or heart disease were noted as alternative diagnoses by 4-5 countries each. Austria reported that ICD-10 coding for long COVID and ME/CFS are often used to code for post-acute infection syndrome (PAIS) in patients – sometimes interchangeably throughout a patient’s care journey.

To report long COVID, the ICD-10 Clinical Modification Guideline on Post COVID-19 Condition instructs that alongside the code U09.9 (“Post COVID-19 condition”, unspecified), one or more codes should be used to indicate related specific symptoms or conditions (WHO, 2022[11]). This dual coding practice was reported by three countries (Canada, Germany and Poland). The eleventh revision of the ICD provides a specific code for long COVID – RA02 (Post COVID-19 condition) – which serves as a link between symptoms or conditions that are listed and the COVID-19 aetiology (WHO, 2022[12])."

 

[Andy]

"5.1. Few countries have a national plan or strategy in place to address long COVID

Given the prevalence of long COVID as a long-term condition with health, social and economic consequences for patients and the population as a whole (see Chapter 2), an overarching strategy is important for organisation of health and social welfare services and to identify research priorities.

In 2025, only four countries (Australia, Austria, Canada and the Netherlands) reported having a national plan or strategy to address the long-term consequences of long COVID (Figure 5.1). Norway and Poland both had national plans for rehabilitation of patients affected by SARS-CoV-2, but these were discontinued. As of 2025, development of a national plan or strategy is under consideration in Czechia, France, Slovenia and Switzerland. In Australia, the government is awaiting results from a national OUTPOST study under way to guide development of a new long COVID plan. Switzerland is considering a national strategy to improve the health situation of people with ME/CFS and long COVID, with a motion passed in the Federal Council and the National Council."

 

[Andy]

"The German Federal Ministry of Health launched the BMG Long COVID Initiative in July 2023

The Ministry of Health launched two multi-year funding initiatives (2024-2028) for health services research on long COVID. Their scope includes clinical presentations of post-acute infection syndromes such as chronic fatigue syndrome (ME/CFS), as well as symptoms related to a COVID-19 vaccination."

 

[Andy]

"7.3. Notable progress on long COVID recognition and research has been made, but work remains to improve responses at the national level

This report provides an update on the status of long COVID initiatives under way in OECD countries in 2025, five years after the COVID-19 pandemic began. As a new and emerging condition, long COVID poses a double challenge to health systems in the need both for a scientific evidence base to inform effective clinical management and health policies, and for adaptation or reorganisation of healthcare resources to incorporate this condition into existing services.

Since 2022, considerable progress has been made in official recognition and diagnosis of this condition, through national health policy and adaptation of international definitions. The majority of countries rely on the WHO definition, although recognition of paediatric long COVID is still lacking in many countries. Appropriate coding of long COVID in health systems can also help in assessing the disease burden and providing insights into the care patterns, treatment and outcomes of patients at a population level. While most countries rely on ICD-10 coding, practices are inconsistent owing to the diagnostic challenges of long COVID, a lack of awareness of the condition among clinicians and a lack of availability of relevant diagnostic codes. As such, ME/CFS and depressive disorder are often conferred as alternative diagnoses for reporting purposes"

 

[Yann04]

Despite being a bit “The economy” brained this is quite a good report.

Also agree with @rvallee that the progress made is probably overstated.

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

What treatment?

Thirdly, a co‑ordinated and coherent approach to tackling long COVID is crucial to help patients recover.

As if we have any idea what “helps patients recover”…

 

[Yann04]

From @ME/CFS Science Blog. A good thread going over this.

 

[Utsikt]

2) It estimates that around 10% of people infected by COVID-19 got Long Covid but that this risk decreased with successive variants over time.

What does this mean?

I thought the cumulative risk increased over time. They might be talking about the risk per infection.

And do we really know enough to say that the risk per infection will continue to decrease
or at least stabilise? What happens when you’ve been infected with 20 different variants?

This seems very optimistic to me. I guess that’s kind of good in the sense that the estimates can’t be dismissed as unrealistically negative, but at the same time it might really under-estimate the effect.