Work Impairment and Financial Outcomes Among Adults With vs Without Long COVID, 2025, Gottlieb et al.

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Work Impairment and Financial Outcomes Among Adults With vs Without Long COVID

Spoiler: Authors

Michael Gottlieb; Ji Chen; Huihui Yu; Michelle Santangelo; Erica S. Spatz; Nicole L. Gentile; Rachel E. Geyer; Caitlin Malicki; Kristyn Gatling; Kelli N. O’Laughlin; Kari A. Stephens; Joann G. Elmore; Lauren E. Wisk; Michelle L’Hommedieu; Robert Rodriguez; Juan Carlos C. Montoy; Ralph C. Wang; Kristin L. Rising; Efrat Kean; Jonathan W. Dyal; Mandy J. Hill; Arjun K. Venkatesh; Robert A. Weinstein; INSPIRE Group; Katherine Koo; Antonia Derden; Zohaib Ahmed; Chloe Gomez; Diego Guzman; Minna Hassaballa; Amro (Marshall) Kaadan ; Jeremiah Kinsman; Zhenqiu Lin; Shu-Xia Li; Imtiaz Ebna Mannan; Zimo Yang; Mengni Liu; Andrew Ulrich; Jocelyn Dorney ; Senyte Pierce; Xavier Puente; Wafa Salah; Graham Nichol; Jill Anderson; Mary Schiffgens; Dana Morse; Karen Adams; Tracy Stober; Zenoura Maat; Michael Willis; Zihan Zhang; Gary Chang; Victoria Lyon; Robin E. Klabbers; Luis Ruiz; Kerry Malone; Jasmine Park; Anna Marie Chang ; Nicole Renzi; Phillip Watts; Morgan Kelly; Kevin Schaeffer; Dylan Grau; David Cheng; Carly Shutty; Alex Charlton; Lindsey Shughart; Hailey Shughart; Grace Amadio; Jessica Miao; Paavali Hannikainen; Chris Chandler; Megan Eguchi; Kate Diaz Roldan; Raul Moreno; Robin Kemball; Virginia Chan; Cecilia Lara Chavez; Angela Wong; Mireya Arreguin; Ryan Huebinger; Arun Kane; Peter Nikonowicz; Sarah Sapp; Ahamed H. Idris; Samuel McDonald; David Gallegos; Katherine R. Martin; Sharon Saydah ; Ian D. Plumb; Aron J. Hall; Melissa Briggs-Hagen

IMPORTANCE
While much of the focus on long COVID (LC; defined as developing new, persistent symptoms lasting 3 months or longer after SARS-CoV-2 infection) has been on health status and quality of life, the impact on individual work productivity and financial distress are less well established.

OBJECTIVES
To assess differences in work and financial outcomes among individuals with current, resolved, and no LC up to 3 years after initial infection.

DESIGN, SETTING, AND PARTICIPANTS
This prospective, multisite, longitudinal cohort study enrolled adult participants (age ≥18 years) with at least 1 reported SARS-CoV-2 infection from December 7, 2020, to August 29, 2022. Follow-up electronic surveys were collected through April 2, 2024. Data were analyzed from January 20 to February 4, 2025.

EXPOSURE
Self-reported resolved or current LC and vaccination status.

MAIN OUTCOMES AND MEASURES
Financial toxicity was measured using Comprehensive Score for Financial Toxicity–Functional Assessment of Chronic Illness Therapy (FACIT-COST), and work impact was measured using the Work Productivity & Activity Impairment questionnaire (version 2.0).

RESULTS
Of 3663 participants (mean [SD] age, 40.2 [14.2] years; 2429 [66.3%] female), 994 (27.1%) reported current LC, 2604 (71.1%) never had LC, and 65 (1.8%) had resolved LC. Participants with current LC reported more overall work impairment due to health (mean [SD], 17.7% [25.3%] of total hours worked per week) compared with those who never had LC (mean [SD], 3.2% [11.8%] of total hours) and resolved LC (mean [SD], 5.6% [12.2%] of total hours), with significantly increased odds of any work impairment compared with those who never had LC (adjusted odds ratio [aOR], 7.24; 95% CI, 5.68-9.21). The current LC group had increased odds of missing work due to their health (aOR, 2.62; 95% CI, 1.93-3.57) and of experiencing work impairment (aOR, 11.82; 95% CI, 8.90-15.70) compared with the group who never had LC. Individuals with current LC had increased odds of having moderate to high FACIT-COST scores compared with those who never had LC (aOR, 5.20; 95% CI, 3.92-6.89) and compared with those with resolved LC (aOR, 3.16; 95% CI, 1.19-8.41). Participants who were vaccinated had lower overall work impairment (aOR, 0.71; 95% CI, 0.55-0.92), impairment while working (aOR, 0.66; 95% CI, 0.50-0.87), impairment of nonwork activities (aOR, 0.74; 95% CI, 0.57-0.96), and financial toxicity (least-squares mean difference, 1.07; 95% CI, 0.19-1.95) compared with those who were not vaccinated.

CONCLUSIONS AND RELEVANCE
In this prospective cohort study of adults with SARS-CoV-2 infection, participants with current self-reported LC reported worse work impairment, missed work, and financial distress compared with those who never had LC, while vaccination was associated with improved work outcomes and less financial distress even among individuals with LC. These data underscore the need for postpandemic assistance programs, as well as vaccination to decrease societal harms.

Link | PDF | JAMA Network Open | Open Access

 

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Work impairment and financial outcomes among adults with vs without long COVID

About The Study: In this prospective cohort study of adults with SARS-CoV-2 infection, participants with current self-reported long COVID (defined as developing new, persistent symptoms lasting 3 months or longer after SARS-CoV-2 infection) reported worse work impairment, missed work, and...

www.eurekalert.org

News Release 12-Aug-2025

Work impairment and financial outcomes among adults with vs without long COVID​

JAMA Network Open

Peer-Reviewed Publication
JAMA Network


About The Study: In this prospective cohort study of adults with SARS-CoV-2 infection, participants with current self-reported long COVID (defined as developing new, persistent symptoms lasting 3 months or longer after SARS-CoV-2 infection) reported worse work impairment, missed work, and financial distress compared with those who never had long COVID, while vaccination was associated with improved work outcomes and less financial distress even among individuals with long COVID. These data underscore the need for post-pandemic assistance programs, as well as vaccination to decrease societal harms.

 

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Study: Long COVID remains a substantial financial and medical burden

Rush University Medical Center researchers who for years have been refining the clinical understanding of Long Covid (defined as persistent symptoms for more than three months) today shared findings showing that people experiencing those persistent symptoms also incurred more medical expenses...

www.eurekalert.org

News Release 12-Aug-2025

Study: Long COVID remains a substantial financial and medical burden​

But being vaccinated lessened financial and employment impact

Peer-Reviewed Publication
Rush University Medical Center

(Chicago, Ill Aug 12, 2025) While the economic impact of the COVID-19 pandemic continues to be widely studied and debated, the financial toll of the COVID-19 pandemic 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 the long-term effects of COVID-19.

“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, MD, an emergency medicine physician and vice chair of research at Rush University Medical Center Gottlieb and co-authors suggest that 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 cases of COVID-19 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 which is 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 their 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. The COVID-19 vaccine kept us healthier — both physically and financially.”

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Journal​

JAMA Network Open

DOI​

10.1001/jamanetworkopen.2025.26310

Method of Research​

Randomized controlled/clinical trial

Subject of Research​

People

Article Title​

“Work Impairment and Financial Impact among Adults With vs. Without Long COVID”

Article Publication Date​

12-Aug-2025

COI Statement​

None from lead author. But co-authors report: Dr Gentile reported grants from the National Center for Complementary and Integrative Health (NCCIH), National Institute on Aging, and Agency for Healthcare Research and Quality (AHRQ) outside the submitted work. Dr Geyer reported grants from AHRQ and NCCIH outside the submitted work. Dr Elmore reported serving as Editor-in-Chief of Primary Care for UpToDate. Dr Wisk reported grants from National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and National Institute of Mental Health (NIMH) outside the submitted work. Dr Montoy reported grants from Substance Abuse and Mental Health Services Administration (SAMHSA), the US Food and Drug Administration (FDA), and grants from National Institute of Neurological Disorders and Stroke (NIHDS) during the conduct of the study. Dr Rising reported grants from the Centers for Disease Control and Prevention (CDC) and National Institutes of Health (NIH) outside the submitted work. Dr Venkatesh reported grants from SAEM Foundation outside the submitted work. No other disclosures were reported.