1 in 8 patients with long COVID also deal with unemployment

Sara Berg, MS , News Editor

For some individuals, symptoms of COVID-19 can persist beyond two months after initial infection. Yet even though long COVID has become prevalent, still little is known about this condition. But recent research has shown long COVID can impact an individual’s ability to work, leading to higher rates of unemployment and financial hardship. Knowing how to help patients who are unemployed and struggling with long COVID symptoms is key.

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Published in JAMA Network Open, the study “Association of Post–COVID-19 Condition Symptoms and Employment Status” used data from eight waves of a 50-state U.S. nonprobability internet and population-based survey of respondents between the ages of 18 and 69 conducted from February 2021 to July 2022. Out of 15,308 survey respondents with test-confirmed COVID-19 at least two months prior, 14.6% reported long COVID symptoms. This included 45.9% reporting either brain fog or impaired memory.

Of those with long COVID, 12.3% reported being unemployed compared to 8.7% without symptoms. Among those with long COVID symptoms, 45.5% worked full-time compared to 55.2% who did not report having this condition. This shows that long COVID was associated with a lower likelihood of working full-time and a higher likelihood of being unemployed. 

“Unfortunately, we are so eager as a country to move on from COVID that we tend to forget how many people still have persistent symptoms. And even if you acknowledge that people may still be ill, there’s a tendency to minimize these symptoms,” said Roy H. Perlis, MD, MSc, the study’s lead author and director of the Center for Quantitative Health at Massachusetts General Hospital in Boston. Dr. Perlis is also a professor of psychiatry at Harvard Medical School and associate editor of JAMA Network Open.

“Even when you account for sociodemographic differences, if you have long COVID, you’re substantially less likely to be working full-time, you are substantially more likely to be unemployed. Those are important numbers to get out there,” Dr. Perlis said. Also, “we looked specifically at the effect of having cognitive symptoms—either brain fog or memory impairment—and found that if you have long COVID, that was associated with a greater risk of functional impairment.”

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“We just can’t lose sight of how many people are out there who are still impacted by COVID,” Dr. Perlis added.

Here is what physicians should keep in mind.

Physicians are “very good at characterizing symptoms … but in the end it’s this aggregate burden of those symptoms that is what patients care about, so physicians should ask about functioning,” Dr. Perlis said. “It’s not just asking if a patient has brain fog, but asking if it is keeping them from doing things.”

That can help “make that link between the symptom and the function,” he said. “Physicians do learn to do this, but this paper to me is a reminder of the importance of linking symptoms to functioning.”

“The other thing is that people may not volunteer these symptoms because they may not recognize that these are long COVID symptoms,” Dr. Perlis said, noting “I’m still struck in my clinical practice by how many people don’t necessarily make a connection between having had that illness and persistent fatigue, brain fog and problems with balance or dizziness.”

“To those of us in health care, we might make that connection very quickly. Not everyone does,” he said. “So just making sure that when we see people with these kinds of symptoms, we ask about prior COVID and whether those symptoms might have persisted is still important.”

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“Sometimes in primary care settings, it’s easy to focus more on things like shortness of breath or fatigue,” Dr. Perlis said. But “it’s really important to ask about both cognitive and psychiatric symptoms.”

“We know that for a lot of people with long COVID, depression and anxiety can be prominent,” which is why it is important to ensure “physicians don’t forget to ask about brain symptoms in long COVID,” he said. “Long COVID absolutely can involve the brain and what this paper suggests is that some of those brain symptoms have real impact on functioning.”