Early on in the COVID-19 pandemic, it became clear that a subset of individuals with acute COVID-19 illness did not fully recover and experienced a constellation of lingering symptoms — typically fatigue and cognitive problems– after the acute symptoms resolved. These persistent symptoms have been called post-acute sequelae of COVID-19, post–COVID-19 syndrome, or most commonly long COVID. While we still do not understand exactly what contributes to these symptoms, it is clear that many individuals with long COVID have not been able to return to their previous level of functioning.
At the outset of the pandemic, Roy Perlis, MD MSc, Director of the Center for Quantitative Health at MGH, and colleagues launched the COVID States Project. This is a joint project conducted by researchers from Mass General, Harvard University, Northeastern University, Rutgers University, and Northwestern University that has used periodic internet-based surveys to assess the impact on COVID-19 on the American public. (A complete archive of their reports can be found at covidstates.org.)
Examining the prevalence and impact of long COVID, Perlis and colleagues analyzed data from 8 waves of this large-scale internet survey conducted between February 5, 2021, and July 6, 2022, from individuals aged 18 years or older across 50 States and the District of Columbia. The cohort included 15,308 survey respondents reporting test-confirmed COVID-19 illness at least two months prior to completing the survey.
In this group, 2236 of the respondents, nearly 15%, reported having COVID symptoms persisting more than two months after experiencing the acute illness. The most common long COVID symptoms were fatigue (52.2%), brain fog or memory loss (45.7%) and loss of smell (43.7%).
Fortunately, fewer people are dying and being hospitalized in the US, but it would be premature to assume that the impact of the pandemic is really diminishing—it’s just shifting. As much as we all want to move on, a lot of us can’t move on yet, and [we] need to be thinking about interventions for people who are still struggling with long COVID.
Individuals self-reporting long-COVID symptoms were more likely to be unemployed, compared to those without this condition (12% vs. 9%). In addition, the researchers found that individuals with long COVID were less likely to be working full-time, even after adjusting for sociodemographic factors, including age, sex, geographic region, and race and ethnicity. Using survey-weighted regression models that excluded retired respondents, Perlis and colleagues calculated that long COVID was associated with a reduced likelihood of working full time (adjusted odds ratio [aOR], 0.84) and a higher likelihood of unemployment (aOR, 1.23). More specifically, cognitive impairment (brain fog or memory impairment) was linked to a lower likelihood of working full time (aOR, 0.75).
Moving Forward
On January 30, 2023, the Biden Administration announced that it will end the COVID-19 public health emergency declarations on May 11, 2023. While this marks an important step in our recovery from the pandemic, many are concerned that our apparent shift away from the COVID-19 pandemic may neglect the needs of those experiencing persistent COVID symptoms.
The results of this study highlight the importance of developing strategies targeting the symptoms of long COVID, particularly the associated cognitive symptoms. Further research is urgently needed to determine whether such rehabilitation strategies can help to ameliorate the impact of long COVID symptoms and improve functioning.
We have yet to fully appreciate the impact of COVID-19 on our workforce. While many COVID-19 related economic relief efforts have focused on supporting businesses in industries most impacted by COVID-19, such efforts may not reach individuals who cannot work as a result of their long COVID symptoms or COVID-related disabilities. Extended unemployment benefits may help to fill this gap; however, unemployment benefits rarely last longer than six months, with some states providing as few as 12 weeks of benefits.
Co-Authors: Kristin Lunz Trujillo, PhD; Alauna Safarpour, PhD; Mauricio Santillana, PhD; Katherine Ognyanova, PhD; James Druckman, PhD; David Lazer, PhD
Read More
Perlis RH, Lunz Trujillo K, Safarpour A, Santillana M, Ognyanova K, Druckman J, Lazer D. Association of Post-COVID-19 Condition Symptoms and Employment Status. JAMA Netw Open. 2023 Feb 1; 6(2):e2256152.
Perlis RH, Santillana M, Ognyanova K, Safarpour A, Lunz Trujillo K, Simonson MD, Green J, Quintana A, Druckman J, Baum MA, Lazer D. Prevalence and Correlates of Long COVID Symptoms Among US Adults. JAMA Netw Open. 2022 Oct 3;5(10):e2238804.
In the News
Long COVID Linked With Unemployment in New Analysis (JAMA Network)
People With Long Covid Are More Likely To Be Unemployed (Forbes)
Long COVID Tied to Lower Likelihood of Employment (HealthDay)
Long COVID Linked with Unemployment (Fortune)
Roy Perlis, MD, MSc is the Director of the Center for Quantitative Health at MGH and Associate Chief for Research in the Department of Psychiatry. He is the Ronald I. Dozoretz, MD Endowed Professor of Psychiatry at Harvard Medical School and Associate Editor (Neuroscience) at JAMA's new open-access journal, JAMA Network - Open.
