The public health and economic burden of long COVID in Australia, 2022–24: a modelling study, 2024, Constantino et al.

[Nightsong]

Abstract
Objective: To estimate the number of people in Australia with long COVID by age group, and the associated medium term productivity and economic losses.

Study design: Modelling study: a susceptible–exposed–infected–recovered (SEIR) model to estimate the number of people with long COVID over time following single infections, and a labour supply model to estimate productivity losses as a proportion of gross domestic product (GDP).

Setting: Australia, 2022–2024.

Main outcome measures: Estimated number of people infected with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) during 2022–2023 (based on serosurvey data) who have long COVID, 2022–2024, by age group; estimated GDP loss during 2022 caused by reduced labour supply attributable to long COVID.

Results: Our model projected that the number of people with long COVID following a single infection in 2022 would peak in September 2022, when 310 341–1 374 805 people (1.2–5.4% of Australians) would have symptoms of long COVID, declining to 172 530–872 799 people (0.7–3.4%) in December 2024, including 7902–30 002 children aged 0–4 years (0.6–2.2%). The estimated mean labour loss attributable to long COVID in 2022 was projected to be 102.4 million (95% confidence interval [CI], 50.4–162.2 million) worked hours, equivalent to 0.48% (95% CI, 0.24–0.76%) of total worked hours in Australia during the 2020–21 financial year. The estimated mean GDP loss caused by the projected decline in labour supply and reduced use of other production factors was $9.6 billion (95% CI, $4.7–15.2 billion), or 0.5% of GDP. The estimated labour loss was greatest for people aged 30–39 years (27.5 million [95% CI, 16.0–41.0 million] hours; 26.9% of total labour loss) and people aged 40–49 years (24.5 million [95% CI, 12.1–38.7 million] hours; 23.9% of total labour loss).

Conclusion: Widespread SARS‐CoV‐2 infections in Australia mean that even a small proportion of infected people developing long COVID‐related illness and disability could have important population health and economic effects. A paradigm shift is needed, from a sole focus on the immediate effects of coronavirus disease 2019 (COVID‐19) to preventing and treating COVID‐19 and treating long COVID, with implications for vaccine and antiviral policy and other mitigation of COVID‐19.

Med J Aust 2024; 221 (4): 217-223. || doi: 10.5694/mja2.52400
https://www.mja.com.au/journal/2024...-long-covid-australia-2022-24-modelling-study
PDF: https://www.mja.com.au/system/files/issues/221_04/mja252400.pdf
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Associated news coverage:
ABC News (Australia): "Long COVID has cost the Australian economy billions in lost work hours, new research says" (link)

 

[Hutan]

For example, recent World Health Organization recommendations that healthy people under 18 years of age do not require COVID-19 vaccination boosters, that children under 5 years of age are not a priority for primary vaccination, and that primary vaccination should be discretionary, were informed by the estimated number needed to vaccinate to prevent hospitalisations and deaths;15 long COVID was not considered by the WHO assessment. Quantitative projections of the prevalence of long COVID and estimates of its impact could broaden public health strategies.

That's an interesting point - that the WHO's recommendations about vaccination didn't consider a possible lower risk of Long Covid.

The Australian Technical Advisory Group on Immunisation (ATAGI) did not consider long COVID in its February 2024 vaccination guidelines, and recommended booster doses only for people aged 65 years or older, and for those under 65 years of age who are severely immunocompromised.35

They note that Australia also didn't consider Long Covid in making a decision about immunisation.

We did not include re-infection with SAR-CoV-2 as a factor in our model.

Not considering the risk of Long Covid with re-infections seems like a major omission, given a couple of papers have suggested that the risk of Long Covid stays roughly the same with each infection. That suggests that the economic impact is likely to be larger than predicted here, and ongoing.

(The point that previous Covid-19 infections don't substantially reduce the risk of Long Covid raises the question about whether vaccination really does reduce the risk of Long Covid. It probably reduces the risk of tissue damage caused by severe disease, but I don't think it is very clear yet whether previous infections reduce the risk of ME/CFS-like disease.)

It was projected that 0.59–2.24% of children aged 0–4 years (7902–30002 children) would have long COVID weeks per year; 0.5–2.0% of children and adolescents aged 0–19 years (16936–61789) and 0.7–3.6% of people aged 20 years or older (155590–811010) were projected to have long COVID in December 2024 (Box 3).

I don't think we have a lot of evidence that very young children get Long Covid, certainly not ME/CFS-like LC. Later in the paper, they say

Vaccinating children aged 0–4 years is also important. In Denmark, the incidence of long COVID was reported to be higher among children aged 0–3 years than older children;36

That's interesting - would be worth having a look at that reference.
Kikkenborg Berg S, Palm P, Nygaard U, et al. Long COVID symptoms in SARS-CoV-2-positive children aged 0–14 years and matched controls in Denmark (LongCOVIDKidsDK): a national, cross-sectional study. Lancet Child Adolesc Health 2022; 6: 614-623.

The estimated mean labour loss attributable to long COVID was lowest for people aged 10–19 years, most of whom are not in the workforce (0.7 million [95% CI, 0.3–1.1 million] hours)

Incredibly, they don't seem to have taken into account the fact that a parent or a spouse often has to give up work to look after a person with ME/CFS. Again, this suggests the estimate of economic impact will be larger than reported. Yes, later in the paper they confirm this omission:

Our two GDP loss estimates do not account for unmeasured economic losses, including healthy employees who cannot work because they are caring for non-employees (eg, children or older people),

 

[Hutan]

For 2022, the share of cases of non-recovery from long COVID was uniformly distributed in the range 11.0–22.3%, and the share of cases of slow recovery was uniformly distributed in the range 35.9–42.0%.13,27

The economic impact of long COVID is therefore likely to be greater than that of other leading causes of disease because it affects working age people.

SARS-CoV-2 re-infections and further epidemic waves could increase the burden of chronic disease and its economic impact.

Nor do they include losses caused by long COVID beyond six months; productivity losses caused by changes to the work environment, such as working from home; and losses arising from the imperfect mobility of labour between sectors and regions in response to changes caused by COVID-19, such as unfilled health care or education jobs.

To reiterate - the costs do not include losses caused by long Covid beyond six months! The analysis completely ignores the lifetime loss of productivity that a substantial proportion of people who develop Long Covid likely face.

 

[Hutan]

I appreciate that the authors thought this was a topic worthy of working on, and I also appreciate some of their recommendations. But, there are too many substantial omissions to make the results credible. The model they have used is incredibly simplistic - it would not be terribly hard to make a more complex one with realistic recovery rates, a consideration of the rates and impacts of a range of severities, and an acknowledgement of the impact of a person with Long Covid on the productivity of their family members.

 

[oldtimer]

Thank you @Hutan. I really appreciate all your analyses.

 

[rvallee]

ABC news posted it on twitter and almost all the comments are either "it's the vaccines" or "it's the lockdowns / breakdown of society because of pandemic measures". As is tradition. And as we know, most MDs seem to have the same opinion. It's a complete omerta on the medical forums, where any mention of LC usually leads to being banned, comments deleted, threads locked down, or at best downvoted.

It's absurd how medicine is completely blind to the harm they are causing with their arbitrary disbelief of chronic illness. It's completely surpassed the impact of the MMR vaccine Lancet debacle, proably 100x already. This is likely the most impactful boon for the conspiracy crowds in all of history. Paid for by our taxes.

Even worse is that half the blame is on the "lockdowns" / mental health, which is basically the most common takeaway you hear from MDs and public health authorities. And this is where real disinformation becomes powerful: when it erases the notion that truth even exists, that everyone lies, no one tells the truth. When the lies authorities tell overlap with similar lies from bad faith actors, their entire credibility is erased. And they're totally oblivious to it. They'd rather blame TikTok "sickfluencers" than do any self-reflection.

And yeah this is so important:

The economic impact of long COVID is therefore likely to be greater than that of other leading causes of disease because it affects working age people.

The typical burden of illness is that about 90% of total health care costs for an individual are spent in the last few months of their lives before they succumb to illness. But this usually happens after the age of retirement. Here the burden is actually two-fold: it affects people of working and child-rearing age, but it also makes morbidity for older people worse. Which is also an added burden on adults who care for elderly parents. And to systems that can't even meet half the demand to begin with.

I really wonder where the calculation that killing old people out of working age is effectively a cost-saving approach plays in. I cannot accept that it's not part of it, but they obviously aren't counting the fact that it affects working age people, making that calculation completely wrong because it offets all the "savings". This is a huge undercount for sure. Disasters that are so costly that they affect a significant % of GDP are rare. And this one is entirely the fault of the authorities and experts in charge of it. Masterful gambit, sirs and madams.

 

[Nightsong]

Just to point out that there was an earlier paper from 2023 that attempted to quantify the economic effects of ME/CFS in Australia that may be useful for comparison. That paper used a small patient cohort (n=175; 48 consented to records access; 23 carers completed), and self-reported diary entries - albeit designed in collaboration with a patient-advisory group - to estimate cost burden; I suspect that, as the authors acknowledge, their methodology also underestimated the economic effect. Severity of disability was the most significant factor associated with the total per-patient costs. A few snippets:

Patients incurred a direct cost of $6655 (10% of total costs) per annum, with $3672 for direct non-medical costs and $2983 for direct medical costs. The largest component of direct non-medical costs was costs of everyday living ($1820), followed by costs of special diets ($636) and home modifications ($631). The largest component of direct medical costs was for healthcare professional visits and investigations ($1226), followed by costs for non- prescription ($887) and prescription medications ($580).

Annual indirect costs of ME/CFS were $46 731 (74% of total costs) per patient, with most due to costs from lost wages ($42190). Annual mean productivity loss due to absenteeism and presenteeism was $1608 and $2933 per patient, respectively.
Annual informal care costs were $6923 (11% of total costs) per patient, with costs from lost wages ($2939) and presenteeism ($2673) comprising more than 80% of these costs.

Annual societal costs per person with ME/CFS were estimated to be $63400. Using the primary care-based prevalence rate of 0.104%, [4] the total societal costs for ME/CFS in Australia were estimated to be $1.38billion per annum. Adopting the higher community-based prevalence rate of 0.76%, [3] total societal costs increased to $10.09 billion per annum. Costs were highest for individuals categorised as having severe disability and fatigue

(ETA: Seems there was a separate thread for this one.)