Study: Long COVID is a Significant Financial, Medical Burden

Although the COVID-19 pandemic’s economic impact continues to be widely studied and debated, its financial toll for individual patients is less understood. To address this gap, Rush University Medical Center analyzed self-reported data from more than 3,600 participants in the INSPIRE (Innovative Support for Patients with SARS-CoV-2 Infections Registry) to assess return-to-work, work productivity, and financial toxicity.

The INSPIRE study found that individuals with long COVID-19 experienced worse financial and employment outcomes, lasting up to three years after their initial infection. Notably, vaccination against COVID-19 was associated with strikingly improved work and financial outcomes. The study, “Work Impairment and Financial Impact among Adults With vs. Without Long COVID,” was published Aug. 12 in JAMA Network Open.

INSPIRE is a CDC-funded multi-center collaboration including eight academic medical centers seeking to better understand COVID-19’s long-term effects.  

“While much of the focus in Long COVID research has been on the medical impact, we must also consider the sustained financial burden faced by those whose symptoms persist,” said lead author Michael Gottlieb, M.D., an emergency medicine physician and vice chair of research at Rush University Medical Center. Gottlieb and co-authors suggest that a better understanding of the economic challenges millions of Americans face can lead to better workplace policies, disability support systems, and health care strategies.  

Of the more than 777 million reported COVID-19 cases worldwide, data compiled by the Agency for Healthcare Research and Quality suggest that approximately 13% of patients experience persistent symptoms lasting three months or longer, a condition commonly referred to as long COVID.

Gottlieb and colleagues working on the INSPIRE research already have contributed valuable scientific data about the medical nature of Long COVID, such as identifying that it is not a single condition but rather four distinct symptom patterns, called phenotypes, which can help guide treatments. INSPIRE’s unique, long-standing self-reported survey structure also helps researchers better understand and measure the financial burdens associated with the illness and, importantly, the beneficial effect of prior vaccination. Researchers used survey responses to track the degree of missed work and work impairment and a tool long used by cancer researchers to calculate “financial toxicity,” which estimates the negative consequences experienced by patients due to the cost of medical care.  

Three years of study data revealed that those with Long COVID continue to experience significantly higher odds of missing more work per week than those who did not have Long COVID. Nearly half of participants currently experiencing Long COVID had not returned to full-time work within three years of their initial infection.  

Financial toxicity scores also showed that those with Long COVID had more than three-times higher odds of moderate-to-high financial toxicity compared to those whose Long COVID symptoms had resolved, and more than five-times higher odds compared to those who never experienced Long COVID. 

Authors noted that this financial strain could be caused by medical expenses, job loss, reduced work-hours due to limited work capacity, or lower work productivity resulting in reduced bonuses or raises.  

Gottlieb emphasized that vaccination status had a clear impact on rates of work impairment and financial toxicity scores with markedly better outcomes in the vaccinated patients compared with the unvaccinated patients. This is consistent with other recent research from the team which also identified improved physical and mental health outcomes among those who were vaccinated against COVID.

“Throughout all or our research, whether someone was vaccinated was shown to be strongly associated with more symptom reduction and measurably better quality of life,” Gottlieb concluded. “The COVID-19 vaccine kept us healthier—both physically and financially.”