Up to 4 million people may be out of work because of long Covid in the U.S, according to a report published this week by the Brookings Institution.

In lost wages, that could add up to at least $170 billion per year, the report suggests.

The research looked at people who worked full time, or the equivalent of full-time hours, before they got long Covid: an estimated 12 million people in the U.S., according to federal data.

From there, it estimated how many people were out of work or working reduced hours because of persistent health issues following a Covid infection. The report used the definition of long Covid from the Census Bureau’s Household Pulse Survey: symptoms lasting three months or longer that were not present pre-Covid.

Several surveys have attempted to quantify the impact of long Covid on employment. A working paper from the Federal Reserve Bank of Minneapolis estimated last month that 26% of people with long Covid were out of work or had reduced their working hours as of mid-2021. An international survey found that 22% of people with long Covid weren’t working because of their illness and 45% had reduced hours as of 2020. And a U.K. survey found that 16% of people with long Covid had reduced hours and 20% were on paid sick leave between April and May 2021.

Based on those findings, the Brookings report determined that 2 million to 4 million people in the U.S. are working less or not at all because of their illness.

“This is a shocking number,” said Katie Bach, the report’s author and a nonresident senior fellow at Brookings.

“If this looks like other post-viral illnesses, some people will recover, but there will be this big stock of people who don’t, and it will just continue to grow over time,” she said.

Long Covid can be hard to define, since symptoms are wide-ranging and can last months to years. Many people with the condition experience fatigue, brain fog, joint or muscle pain, heart palpitations, chest pain, dizziness, menstrual changes or changes in their ability to taste or smell. A June study from the Centers for Disease Control and Prevention found that 1 in 13 adults in the U.S., and 19% of adults who have had Covid before, have long Covid symptoms.

The U.S. considers long Covid a disability under the Americans with Disabilities Act (ADA) if it substantially limits one or more major life activities, including the ability to work.

But Bach said not all employers know to offer disability benefits to people with long Covid, and not all employees know to ask for them.

“Some employers understand vaguely that this is a factor impacting the labor market. That is very different from knowing that this is an ADA-protected condition and knowing what accommodations to give people,” she said.

People with long Covid may also have a difficult time holding onto their job even with accommodations from employers, she added.

“If you are on the line making pizzas eight hours a day, if you are a retail clerk, if you’re a certified nursing assistant in a nursing home, it is very hard to find accommodations that would allow someone with a bad case of long Covid to keep working in a job like that,” Bach said.

The report called for research into treatment options that could help people mitigate their long Covid symptoms. For now, some people go to clinics for supportive care such as physical therapy or breathing exercises.

The world also needs new or better ways to prevent people from getting Covid in the first place, Bach said. A study published in May found that current Covid vaccines may only reduce the risk of long Covid by around 15%, though other estimates are higher.

“Every time you get Covid, you risk getting long Covid. It’s not like once you’ve had Covid once, or once you’ve been vaccinated, then you’re all clear,” Bach said. “If people keep getting infected and reinfected, we will continue to have new cases of long Covid emerging.”



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