October 12, 2022
Though much of the focus throughout the COVID-19 pandemic has been on the acute impacts of the disease, a growing body of evidence suggests that many who survive their initial infection continue to suffer ill effects, a phenomenon referred to as Long COVID. Commonly reported symptoms of Long COVID include difficulty concentrating or thinking (“brain fog”), difficulty breathing, fatigue that interferes with daily life, post-exertional malaise, and muscle and joint pain, among others. The impact of Long COVID on daily activities can range from mild to completely disabling. As noted in Understanding and Addressing Long COVID, a joint CEPR and Congressional Progressive Caucus Center (CPCC) report, the United States has lacked direct, nationally representative survey data on the extent to which Long COVID symptoms limit daily activities. To address this gap, the US Census Bureau, in collaboration with other federal agencies, added a question on Long COVID activity limitations to the Household Pulse Survey (HPS) beginning with the September 2022 wave of the survey. The question asks adults with Long COVID symptoms if these symptoms limit their daily activities “a little,” “a lot,” or “not at all.”
The first detailed tables from this wave of the survey were released in early October 2022 along with public use microdata files that contain anonymized versions of the individual responses to the survey questions. CEPR used these files to calculate four summary tables, Tables 1–4 below, and four detailed Appendix Tables 1–4, available for download. Tables 1 and 2 provide information on the percentage of all adults who have current Long COVID symptoms and related disabilities. Tables 3 and 4 provide information on the percentage of adults currently experiencing Long COVID who are disabled by their symptoms. Appendix Tables 1–4 provide more detailed information. They include these same metrics for additional groups, as well as population counts and the number and percentage of adults who report ever experiencing Long COVID.
Of the 119 million adults reported as having received a positive COVID-19 diagnosis as of late September 2022, 15 percent report current Long COVID symptoms (symptoms lasting longer than three months) and 29.6 percent have ever experienced Long COVID. This is consistent with findings in the US Government Accountability Office (US GAO) report which estimates that between 10 and 30 percent of COVID-19 survivors develop prolonged post-viral symptoms. In late September 2022, about 4.4 million adults reported current Long COVID symptoms that reduced their ability to carry out day-to-day activities by a lot. Another 9.9 million reported Long COVID-related impairments that slightly reduce their ability to participate in daily activities.
Long COVID Symptoms and Disabilities Among All Adults
While disability is a complex and evolving concept with multiple dimensions and varying definitions, a condition that limits a person’s ability to engage in daily activities is commonly considered to be disabling. Table 1 shows the percentage of all US adults currently experiencing Long COVID symptoms and whose activities are limited by these symptoms. About 7.1 percent of all US adults report currently experiencing Long COVID symptoms. About 5.8 percent of adults report that their Long COVID symptoms limit their activities to some extent. Nearly 2 percent of all adults report that their daily activities are limited by a lot. This translates into 17.6 million adults with current Long COVID symptoms, 14.3 million whose daily activities are limited, and 4.4 million whose daily activities are limited by a lot.
Women are more likely than men to have both Long COVID symptoms and related limitations. Hispanic/Latino adults are also more likely than either Black or white adults to report Long COVID symptoms and activity limitations. Among age groups, adults 40 to 54 are most likely to have Long COVID symptoms and limitations.
Table 2 shows the percentage of adults with current Long COVID symptoms and limitations by employment status, household income, and whether they have had a recent loss of employment income. About 7.6 percent of all employed adults report Long COVID symptoms compared to 6.6 percent of all not-employed adults. However, more not-employed than employed adults report having Long COVID symptoms that limit their daily activities by a lot (2.2 percent and 1.5 percent, respectively). Activity disruption due to Long COVID is also associated with recent loss of household employment income. Among adults who report a recent household income loss, about 1-in-20 (4.9 percent) have disabling Long COVID symptoms.
Majority of Adults with Current Long COVID Symptoms Report Activity Limitations
Table 3 shows the percentage of adults with Long COVID who report that their symptoms limit their daily activities. Among all adults with Long COVID, 81.4 percent report that their symptoms limit their ability to participate in daily activities. A quarter of adults with Long COVID report that their symptoms limit their daily activities by a lot. The likelihood that symptoms limit daily activities a lot generally increases with age and decreases with educational attainment, and is higher for Black and Hispanic/Latino adults than for white adults.
Table 4 shows the share of adults with Long COVID who have symptom-related activity limitations by employment status, household income, and whether they have experienced a recent loss of household employment income. Adults with Long COVID who are not currently employed are almost 80 percent more likely to have symptoms that limit their daily activities by a lot than employed adults with Long COVID. Long COVID sufferers with household incomes under $50,000 are almost twice as likely as those with household incomes of $100,000 or more to report symptoms that limit their daily activities by a lot. Among adults with Long COVID who have experienced a recent household employment income loss, four-in-10 have symptoms that limited their daily activities by a lot.
Conclusion
The HPS is an experimental survey with limitations, and the body of research on the economic and labor market repercussions of Long COVID is still growing. However, alongside evidence from other surveys, the HPS results provide insight into the nature and extent of Long COVID’s impact on the health and well-being of US adults.
Understanding the effects of Long COVID and the risk for disability is essential to ensure that policy interventions address the needs of people debilitated by or at risk of developing Long COVID. Our analysis suggests that Long COVID affects a sizable portion of the population, and that it disproportionately burdens certain groups. Equitable policy must reflect and address these disparities. The US must invest more seriously in preventing Long COVID and providing treatment for those currently experiencing its effects. It must also do more to mitigate the economic impacts of Long COVID on sufferers and their families.
Preventing Long COVID requires both improved understanding of who is most at risk, and a more general commitment to curbing transmission of COVID-19. As noted in the joint CEPR-CPCC report, an effective prevention strategy requires significant investment to modernize the US’ public health information system, expand global COVID-19 vaccine efforts, and raise indoor air quality standards. It must also include increased access to social insurance, including paid leave, unemployment insurance, universal health insurance, and housing assistance.
To better care for those currently experiencing debilitating effects of Long COVID and other complex chronic conditions, the US should establish a dedicated new National Institute within the National Institutes of Health. Given sufficient funding, this new Institute would facilitate research to improve our understanding of a variety of complex chronic conditions, including but not limited to Long COVID, Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), Post-Treatment Lyme Disease Syndrome, dysautonomia, Mast Cell Activation Syndrome (MCAS), fibromyalgia, and Ehlers-Danlos Syndrome. The US must also ensure equitable access to medical treatment, workplace accommodations, and other services for those experiencing Long COVID and other chronic conditions.
Appendix Tables and Methodological Notes
The Long COVID estimates in this article are drawn from HPS questions asking:
- Of all adults, whether they have tested positive for COVID-19 (using a rapid point-of-care test, self-test, or laboratory test) or been told by a doctor or other health care provider that they have or have had COVID-19
- Of adults who have ever had COVID, whether they have ever had any Long COVID symptoms that lasted three months or longer
- Of adults who have ever had COVID, whether they currently have Long COVID conditions
- Of adults currently experiencing Long COVID, whether their day-to-day activities have been limited: a lot, a little, or not all)
Shares omit non-responses. Gender categories include both transgender and cisgender individuals. LGBT includes those who identified as gay, lesbian, or bisexual; those who explicitly identified as transgender; and those who identified as male or female and whose gender identity differed from the gender they were assigned at birth. The appendix tables include more detailed breakdowns for LGBT individuals. Racial/ethnic categories are mutually exclusive. White and Black refer respectively to those who identified as non-Hispanic white alone and Black alone. The appendix tables include non-Hispanic adults who identified as other or multiple races.
