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

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.

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

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.

Self-reported resolved or current LC and vaccination status.

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).

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.

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.