Long COVID (GAO-22-105666)

Summary

A GAO Science & Tech Spotlight on long COVID, GAO-22-105666, dated March 2022, from GAO's Science, Technology Assessment, and Analytics team. It states that long COVID has potentially affected up to 23 million Americans, pushing an estimated 1 million people out of work. According to the Centers for Disease Control and Prevention, long COVID is the occurrence of new, returning or ongoing health problems 4 or more weeks after an initial infection with SARS-CoV-2. GAO notes that researchers do not yet fully understand the risk factors, causes and effects of the condition, which complicates diagnosis and treatment.

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Science, Technology Assessment,
MARCH 2022
and Analytics
WHY THIS MATTERS
Long COVID has potentially affected up to 23 million
Americans, pushing an estimated 1 million people out of
SCIENCE & TECH SPOTLIGHT: work. The full magnitude of health and economic effects

LONG COVID
is unknown but is expected to be significant. The causes
of long COVID are not fully understood, complicating
diagnosis and treatment. The condition raises policy
questions, such as how best to support patients.

/// THE SCIENCE symptoms such as anxiety, depression, post-traumatic stress disorder,
and psychosis.
What is it? Long COVID, according to the Centers for Disease Control
and Prevention (CDC), is the occurrence of new, returning, or ongoing What are the knowledge gaps? Researchers do not yet fully understand
health problems 4 or more weeks after an initial infection with SARS- the risk factors, causes, and effects of long COVID. Risk factors include
CoV-2, the virus that causes COVID-19. It is also known by other names, preexisting conditions, such as type 2 diabetes. Severity of COVID-19
including post-acute COVID, post-COVID conditions, and chronic COVID. may also be a predictor, although people with mild or asymptomatic
infections can also develop the syndrome. Whether vaccination for
Symptoms of long COVID vary from person to person. They may COVID-19 reduces an infected person’s risk of developing long COVID is
include fatigue, cognitive impairment (or “brain fog”), muscle or joint unclear. Some studies have suggested that vaccination reduces risk by up
pain, shortness of breath, heart palpitations, sleep difficulties, and mood to 50 percent, while others have found no reduction in risk.
changes (see fig. 1). Long COVID can affect multiple organ systems and
cause tissue damage. Researchers have identified several possible causes of long COVID and
have suggested that causes may vary from person to person (see fig. 2).
For some, COVID-19 may cause the body to produce an antibody that
mimics SARS-CoV-2 and triggers an autoimmune response in which the
immune system attacks its own antibodies. For others, SARS-CoV-2 virus
may persist in the body and cause symptoms. Another possible cause is
organ damage from COVID-19. Research also suggests that microclots
may form in blood vessels, blocking blood flow and causing tissue
damage. And COVID-19 may disrupt the immune system and reactivate
other previously contracted viruses, such as Epstein-Barr.

Figure 1. Some reported symptoms of long COVID.

Long COVID is a post-viral syndrome. Post-viral syndromes are well
documented for a range of infections. For example, one study found that
more than 27 percent of survivors from another coronavirus, severe acute
respiratory syndrome (SARS), had chronic fatigue syndrome 4 years after
their initial infection.

What is known? Long COVID can have serious impacts. Some
individuals have reported a need to adjust their work hours or stop
working altogether due to chronic fatigue or cognitive impairment. One
study of nearly 4,000 long COVID patients found that 45 percent reduced Figure 2. Some possible causes of long COVID as suggested by researchers.
their work hours. For some, the change in job status can affect health
insurance, which can further complicate treatment options. Individuals Researchers are working to develop methods to reliably diagnose and
have also said their symptoms interfere with childcare, exercise, and treat long COVID. Health care providers may use COVID-19 antibody
social activities. This disruption of their daily lives can cause mental health tests in an attempt to confirm previous infection, then rule out other
issues. Another study used the electronic health records of more than conditions that may cause similar symptoms. Treatment strategies
200,000 COVID-19 survivors and found that within 6 months following are based on patients’ specific symptoms and may include existing
initial infection, one-third experienced neurological or psychological therapeutics, such as steroids or anti-inflammatory medication. Trials are
underway to test new therapeutics for long COVID patients.

GAO-22-105666 Long COVID
Science, Technology Assessment,
and Analytics

The broader public health, social, and economic effects of long COVID are ■ Diagnosis and treatment. Some patients report difficulty obtaining
unclear. Studies in the U.S. estimate that 10 to 30 percent of COVID-19 a long COVID diagnosis, which complicates efforts to get support,
survivors develop long COVID. If so, 7.7 million to 23 million people in the such as disability assistance and clinical care. Patients experiencing
U.S. may have developed long COVID as of February 2022. In January several symptoms may need to consult with multiple specialists.
2022, the Brookings Institution conducted a meta-analysis to suggest that In addition, without consistent diagnoses, national data will not be
long COVID may be responsible for over 1 million workers being out of the adequate to track and respond to the condition.
labor force at any given time.
■ Economic effects. People with long COVID might leave the
What is being done? The federal government is taking steps to fund workforce, causing them to lose wages and employer-based health
additional long COVID research. For example, the National Institutes insurance. This could affect the broader U.S. economy through
of Health launched the $1.15 billion Researching COVID to Enhance decreased labor participation and an increased need for use of SSDI
Recovery (RECOVER) Initiative, which combines data across more than or other publically subsidized insurance.
200 research sites. The initiative is using electronic health records to
group common characteristics of tens of thousands of volunteers to better /// POLICY CONTEXT AND QUESTIONS
identify risk factors and causes of long COVID. Similarly, the CDC has
contracted for a study in which patients voluntarily share their health data ■ How can policymakers support research initiatives and improve data
through a cloud-based personal health platform. collection on long COVID, including to identify trends?

The federal government has also taken steps to support long COVID ■ What programs can policymakers leverage or develop to provide
patients. For example, the Departments of Justice and Health and support to those with long COVID?
Human Services (HHS) issued guidance stating that the condition can ■ How can policymakers guide health care workers and inform the public
be a disability under the Americans with Disabilities Act of 1990. Some about long COVID?
long COVID patients may qualify for Social Security Disability Insurance
(SSDI) if they meet certain requirements. The CDC has developed long ■ What steps can policymakers take to address potential economic
COVID guidance for health care providers and the public. Another HHS effects of long COVID?
agency, the Administration for Community Living, published a guide to
community-based resources to help connect affected people to services /// SELECTED GAO WORK
like transportation and personal care attendants. GAO has previously issued the following related products:
Non-governmental experts and organizations are also addressing long
■ Science & Tech Spotlight: Coronaviruses, GAO-20-472SP.
COVID. For example, the National Academies of Sciences, Engineering,
and Medicine will hold a public workshop in March 2022 to discuss several ■ Science & Tech Spotlight: Vaccine Safety, GAO-21-342SP.
long COVID topics, including effects on children, mental health, and labor,
■ See GAO’s “Coronavirus Oversight” webpage for additional
as well as the effects of vaccines. In addition, researchers are applying
products, Washington, D.C. 2022.
machine learning to patient data to identify symptoms, and many hospital
systems are forming specialized clinics to treat and support patients. /// SELECTED REFERENCES
/// CHALLENGES Administration for Community Living, “Resources for People with Long COVID.” Accessed
January 27, 2022, https://acl.gov/covid19/resources-people-experiencing-long-covid.
■ Research. Researchers have struggled to identify some causes of
other post-viral and bacterial syndromes, such as chronic fatigue Centers for Disease Control and Prevention, “Post-COVID Conditions.” Accessed January
syndrome and post-treatment Lyme disease syndrome. They may 10, 2022, https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html.
face similar challenges with long COVID.
Amy D. Proal and Michael B. VanElzakker, “Long COVID or Post-acute Sequelae of
COVID-19 (PASC): An Overview of Biological Factors That May Contribute to Persistent
Symptoms,” Frontiers in Microbiology 12, (2021), https://doi.org/10.3389/fmicb.2021.698169.

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GAO-22-105666 Long COVID

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