The Current and Future Burden of Long COVID in the United States, 2025, Bartsch

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Dolphin

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https://academic.oup.com/jid/advanc...nfdis/jiaf030/7972782?redirectedFrom=fulltext

Sarah M Bartsch, Kevin L Chin, Ulrich Strych, Danielle C John, Tej D Shah, Maria Elena Bottazzi, Kelly J O’Shea, McKaylee Robertson, Colleen Weatherwax, Jessie Heneghan, Marie F Martinez, Allan Ciciriello, Sarah Kulkarni, Kavya Velmurugan, Alexis Dibbs, Sheryl A Scannell, Yanhan Shen, Denis Nash, Peter J Hotez, Bruce Y Lee, The Current and Future Burden of Long COVID in the United States, The Journal of Infectious Diseases, 2025;, jiaf030, https://doi.org/10.1093/infdis/jiaf030



22 January 2025

Abstract

Background

Long coronavirus disease (COVID), which affects an estimated 44.69–48.04 million people in the United States, is an ongoing public health concern that will persist as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to spread.

Methods

We developed a computational simulation model representing the clinical course, health effects, and associated costs of a person with long COVID.

Results

Simulations show that the average total cost of a long COVID case can range from $5084–$11 646 (assuming symptoms only last 1 year) with 92.5%–95.2% of these costs being productivity losses. Therefore, the current number of long COVID cases could cost society at least $2.01–$6.56 billion, employers at least $1.99–$6.49 billion in productivity losses, and third-party payers $21.0–$68.5 million annually (6%–20% probability of developing long COVID). These cases would accrue 35 808–121 259 quality-adjusted life-years (QALYs) lost and 13 484–45 468 disability-adjusted life-years (DALYs) and would rise as COVID-19 incidence increases.

Conclusions

The current health and economic burden of long COVID may already exceed that of a number of other chronic diseases and will continue to grow each year as COVID-19 cases increase. This could be a significant drain on businesses, third-party payers, the healthcare system, and society.
 
https://www.eurekalert.org/news-releases/1077514

News Release 19-Mar-2025
Long COVID could be costing U.S. $2.0-$6.5 billion annually

The cost of an individual long COVID-19 case can range from $5,084 to $11,646 per year

Peer-Reviewed Publication
CUNY Graduate School of Public Health and Health Policy


New York, NY | March 19, 2025: The current number of long COVID-19 cases may already be costing the U.S. $2.01-6.56 billion dollars per year, according to a study recently published in the Journal of Infectious Diseases. The study also showed that each long COVID case tended to cost society between $5,084 and $11,646. These estimates are based on a computer simulation model developed by the Public Health Informatics, Computational and Operations Research (PHICOR) team based at the CUNY Graduate School of Public Health and Health Policy (CUNY SPH) working with researchers from the CUNY Institute for Implementation Science in Population Health (ISPH) and Baylor College of Medicine.

“Our results quantify the already significant burden of long COVID on society,” says the study’s senior author, CUNY SPH Professor Bruce Y. Lee, MD, MBA, executive director of PHICOR and the CUNY SPH Center for Advanced Technology and Communication in Health (CATCH). “This includes productivity losses that are hitting businesses around the country and healthcare costs that are further straining our healthcare system. These costs could end up trickling down to everyone who pays insurance premiums and taxes.”

The computational model simulates a person with a specified age getting infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), having probabilities of developing long COVID, and if long COVID does result, having probabilities of suffering different long COVID symptoms over time. Each symptom can lead to the person being less productive at school or work and needing different tests, treatments, and visits to clinics, emergency rooms, and hospitals. The model can then track and tabulate the accompanying costs such as productivity losses and healthcare costs.

Running the model showed that a given long COVID case tended to cost society somewhere in the $5,084 to $11,646 range per year. The vast majority of these costs (around 95%) were productivity losses with around a quarter of these being from absenteeism and the rest being from presenteeism, wherein employees come to work, but are less productive. Running all the COVID-19 cases to date through the model generated estimates that there are currently 44.69 to 48.04 million long COVID cases in the U.S., which would cost the country $2.01 to $6.56 billion each year. The vast majority of costs(98.6%) were productivity losses or missed days from work or school and direct medical costs (doctors appointments, medical care, etc.) comprised 1.04% of total costs. This was based on the assumption that 6% of those with COVID-19 will go on to have long COVID. Studies have suggested that anywhere from 6% to 20% of those infected with SARS-CoV-2 have eventually developed long COVID. Increasing this probability from 6% to 10% results in average total societal costs per year increasing to $3.34 billion.

“We are only now fully understanding the burden of human disease and illness resulting from long COVID,” says Peter J. Hotez, MD, PhD, professor and dean of the National School of Tropical Medicine at Baylor College of Medicine and co-author of the study. “As bad as COVID has been in terms of deaths and hospitalizations, it could be eventually matched or even exceeded by the chronic disability from this constellation of sequelae and conditions.”

Declaration of Conflict of Interest: No financial disclosures have been reported by the authors of this paper.

Sarah M Bartsch, Kevin L Chin, Ulrich Strych, Danielle C John, Tej D Shah, Maria Elena Bottazzi, Kelly J O’Shea, McKaylee Robertson, Colleen Weatherwax, Jessie Heneghan, Marie F Martinez, Allan Ciciriello, Sarah Kulkarni, Kavya Velmurugan, Alexis Dibbs, Sheryl A Scannell, Yanhan Shen, Denis Nash, Peter J Hotez, Bruce Y Lee, The Current and Future Burden of Long COVID in the United States, The Journal of Infectious Diseases, 2025;, jiaf030.

Media contact:
Alexis Dibbs
dibbs.alexis@gmail.com

About CUNY SPH
The CUNY Graduate School of Public Health and Health Policy (CUNY SPH) is committed to promoting and sustaining healthier populations in New York City and around the world through excellence in education, research, and service in public health and by advocating for sound policy and practice to advance social justice and improve health outcomes for all.

About PHICOR
Since 2007, PHICOR, Public Health Informatics, Computational, and Operations Research (www.PHICOR.org) has been developing computational methods, models, and tools to help decision makers better understand and address complex systems in health and public health. Follow @PHICORTeam on Facebook, LinkedIn, YouTube, and Twitter for updates.

About the CUNY ISPH
The CUNY Institute for Implementation Science in Population Health (ISPH) was founded on the notion that substantial improvements in population health can be efficiently achieved through better implementation of existing strategies, policies, and interventions across multiple sectors. With that in mind, we study how to translate and scale up evidence-based interventions and policies within clinical and community settings in order to improve population health and reduce health disparities. cunyisph.org

About Baylor College of Medicine
Baylor College of Medicine (www.bcm.edu) in Houston is recognized as a health sciences university and is known for excellence in education, research and patient care. Baylor is a top-ranked medical school and is listed 20th among all U.S. medical schools for National Institutes of Health funding and No. 1 in Texas. Located in the Texas Medical Center, Baylor has affiliations with seven teaching hospitals and jointly owns and operates Baylor St. Luke’s Medical Center, part of St. Luke’s Health. Currently, Baylor has more than 3,000 trainees in medical, graduate, nurse anesthesia, physician assistant, orthotics and genetic counseling as well as residents and postdoctoral fellows.

Journal
Journal of Infectious Diseases

DOI
10.1093/infdis/jiaf030

Article Title
The Current and Future Burden of Long COVID in the United States

Article Publication Date
22-Jan-2025

https://twitter.com/user/status/1902858724659880239
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rvallee said:
How the hell does this add up when so many people are completely unable to work, thus losing 100% of their income and the productivity that comes from it? Or how any of this adds up to such a low total amount? It's orders of magnitude off.
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Like given how high salaries are in the US, and how high medical costs are too. An upper (“middle”) class getting severe ME from COVID, requiring family member to mostly quit job to be carer + medical costs, could easily cost 300k per year. (225k lost salaries, 75k various medical costs, disability/ carer allowance, welfare etc.)
 
The average US salary is $66,000, so $10,000 would account for 2 months of lost productivity due to the absence from work.

I don’t have access to the paper, but I’m almost suspecting that they might have used taxes instead or income? The average tax rate is 14.5 %. Of 66k, that’s about $10,000.

All numbers are from google’s top results.
 
Only skimmed very briefly but it's apparent that many of the assumptions they have made are rather conservative - e.g. they assume a probability of leaving the workforce entirely and apply a half-cycle correction (which effectively assigns about half a year of lost wages on average for those who drop out); but I assume many LC cases may exit the workforce right away and/or remain unemployed for well over a year. They also limited their model to the group of 19 symptoms defined by the CDC, and assumed constant symptom severity for the modelled period. And the direct medical costs are probably not going to be as typical as it's assumed (some pwLC in the US undergo a lot of diagnostic testing & some seem to have to seek out some of the few private specialists in this area & their care may not be covered as well by insurance).

They also use symptom-based proxy studies (seeking health conditions to represent each long COVID symptom) which leads to some unusual assumptions (e.g. in the supplementary data's disability weights table it shows they have used mild heart failure as a proxy for similar disability to PEM).
 
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Nightsong said:
they assume a probability of leaving the workforce entirely and apply a half-cycle correction (which effectively assigns about half a year of lost wages on average for those who drop out);
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That still can’t explain how the upper bound per person is 11k. 11k is 1/6 of the average yearly wage.
Dolphin said:
Running the model showed that a given long COVID case tended to cost society somewhere in the $5,084 to $11,646 range per year.
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Unless tended means that they’ve just shown some kind of median value and the actual spread is a lot wider.

If that’s the case, it’s very misleading. Nobody will read the abstract and suspect that the cost can be at least 6 times higher.
 
Utsikt said:
That still can’t explain how the upper bound per person is 11k. 11k is 1/6 of the average yearly wage.
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And they're not using an average, it's a spread, so the upper-bound can actually go in the millions when it comes to people with very high wages, such as pro athletes. Some of those wages are insured, but if a pro athlete goes into retirement, such as pro hockey player Jonathan Toews, then it's still an upper bound of millions.

Those would be outliers, and obviously not involved in most studies, but there are areas of the US with very high wages because of very high costs of living, and those upper ranges would be in the hundreds of thousands per year.

Hell, even the lower bound barely makes sense, it's barely half of minimum wage.

It makes no sense at all.
 
rvallee said:
And they're not using an average, it's a spread, so the upper-bound can actually go in the millions when it comes to people with very high wages, such as pro athletes. Some of those wages are insured, but if a pro athlete goes into retirement, such as pro hockey player Jonathan Toews, then it's still an upper bound of millions.

Those would be outliers, and obviously not involved in most studies, but there are areas of the US with very high wages because of very high costs of living, and those upper ranges would be in the hundreds of thousands per year.

Hell, even the lower bound barely makes sense, it's barely half of minimum wage.

It makes no sense at all.
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I understand that they are only using an average, but that’s about the only thing I understand!
 
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