Long-term COVID affects more than just health; it markedly impacts many people’s ability to work and, as a result, their financial stability.
What does it mean to live with long COVID (LC)? The fatigue that won’t lift. The brain fog. The good days and the bad with no obvious pattern. Then add to that the reality of trying to hold down a job or watching income shrink while bills stay the same.
A recent study published in JAMA Network Open aimed to quantify the effects of poor health from LC on work productivity and financial distress. Nearly 3700 adults in the US were tracked by researchers for up to 3 years after their initial SARS-CoV-2 infection. The findings indicate the need for post-pandemic assistance programmes and vaccination education.
Long COVID and employment
Around 13% of people who contract COVID-19 go on to develop LC, defined as persistent symptoms lasting three months or longer. Previous research has shown that LC can be devastating for an individual’s quality of life. Less well understood is how it affects people’s ability to work and its impact on their personal finances. Previous research has been limited by small sample size, short follow-up periods, the use of unvalidated tools, and the absence of US-based studies. Given that America has a distinct work culture and a population of over 340 million, an understanding of the domestic picture matters. Gottlieb and colleagues set out to provide it.
The study analysed data from INSPIRE (Innovative Support for Patients with SARS-CoV-2 Infections Registry), a large prospective cohort study run across eight major US healthcare institutions. Of the 6044 patients initially enrolled, 3663 were included in this study and were divided into 3 groups: resolved LC (65), ongoing LC (994), and those who never had LC (2604). Patients completed a follow-up survey in 2024, which was 18–40 months after their initial infection, well into the post-acute phase. Work productivity was assessed using the WPAI questionnaire, capturing missed work and on-the-job impairment, while financial impact was measured via the FACIT-COST scale, where lower scores indicate greater financial hardship.
What they found—and the vaccination effect
Nearly half of all participants with current LC had not returned to full-time work even up to three years after initial infection. Among those who continued working, an average of 17.7% of total weekly working hours were affected by work impairment, equivalent to losing more than a full working day each week. Life outside of work was also affected, with the current LC group reporting daily activity impairment for an average of 16.4% of total hours, compared to just 2.4% among those who had never had LC. Those with current LC were also more than five times as likely to experience moderate to high financial toxicity, possibly driven by direct medical expenses, reduced hours, decreased productivity, and potential loss of performance-related pay.
Notably, among participants with current LC, 15.4% were vaccinated before developing LC and nearly all study participants (95.1%) had received at least 1 dose of a COVID-19 vaccine, with most (71.2%) reporting 3 to 5 doses. Participants vaccinated before their initial infection had meaningfully lower odds of overall work impairment, impairment while working, and disruption to daily activities, as well as lower financial toxicity on the FACIT-COST scale. This indicates that vaccination need not completely prevent LC from having a meaningful impact on work productivity, finances, and life outside of work. Vaccination was also associated with improved employment and financial outcomes, even among participants who later developed LC.
Key Findings at a Glance
Long COVID has:
- 7.2× higher odds of any work impairment vs no LC
- 5.2× higher odds of moderate–high financial toxicity vs no LC
- 17.7% of total working hours impaired in the current LC group
Please see Table 2 of the manuscript for further details of findings.
Not so fast
As with any study, there are limitations to bear in mind. LC status was self-reported rather than clinically confirmed, which may introduce some misclassification, though this approach aligns with current guidance for defining LC, which places considerable importance on patient experience. The study population skewed female, White, non-Hispanic/Latino and younger than the broader US population, limiting how far the findings can be generalised. Participants were also required to have access to an internet-capable device, which may have excluded those with fewer technological resources. The resolved LC group was small (65 participants), which reduced statistical precision. Given this was an exploratory study, no adjustments were made for multiple comparisons, so findings should be interpreted with that in mind.
Why does it matter?
The results of this investigation reflect not just individual hardships of work productivity and financial outcomes for those with LC; they reveal a significant and ongoing economic burden at a societal level. These results have highlighted the need for post-pandemic assistance programmes for people living with LC. The current analysis also increases the understanding of immunisation benefits into the economic domain, adding a compelling new dimension to the case for vaccinations beyond clinical outcomes alone. Workplace accommodation policies that consider the realities of a changing, unexpected condition must be implemented, with more flexible and remote working arrangements, prolonged disability support, and adjusted timetables. Long COVID is not a short-term problem that has passed, and people living with it need targeted, lasting support.
Take home messages
1. Long COVID negatively impacts employment and financial well-being, increasing work impairment, absenteeism, and financial strain for up to three years after infection compared with those who have never had LC.
2. COVID-19 vaccination is associated with better work and financial outcomes, even among people who develop LC, thereby strengthening the economic case for vaccination alongside its clinical benefits.
3. There is a need for post-pandemic assistance programmes and workplace support structures that reflect the real-world ongoing burden of LC.
Guest author: Tayyibah Ali, PhD.
Reviewer: Barbara Fahmy, MS OTR, MPA
This article was written as part of a series of ‘journal club’ summaries for Scientific Writers Ltd and is based on the following publication.
Title: Work Impairment and Financial Outcomes Among Adults With vs Without Long COVID
First author: Gottlieb M, et al.
Journal: JAMA Network Open
Date online: 12 August 2025
DOI: 10.1001/jamanetworkopen.2025.26310
Other references: Ahrnsbrak R, Fang Z. Prevalence of Long COVID Among Adults Who Have Ever Had COVID-19, by Selected Demographic and Socioeconomic Characteristics, U.S. Civilian Noninstitutionalized Population, Spring 2023. Available from: https://meps.ahrq.gov/data_files/publications/st557/stat557.shtml. Accessed June 23, 2026.
Disclosure: The Grammarly app was used to edit and proofread this article.
