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As the world heads into another COVID-19 fall and winter, new data from the Brookings Institution sheds some insight on the effects of long COVID. According to the Centers for Disease Control and Prevention (CDC), long COVID covers a wide range of symptoms that persist for weeks to even years after initial COVID infection, such as headaches, “brain fog,” chest pain, and more.  The World Health Organization (WHO) defines long COVID as a condition in those who had a probable or confirmed COVID-19 diagnosis within three months, symptoms that last at least two months, and can’t be explained by another diagnosis.

An estimated 10 to 50 percent of those infected with COVID-19 will experience long COVID. A new Brookings report released on August 24 finds that anywhere between two and four million Americans are currently not working due to the effects of the mysterious disease. The new report builds on one from January that estimated long COVID is contributing to the country’s labor shortage by 15 percent. 

Brookings used new data from The United States Census Bureau’s Household Pulse Survey (HPS), a survey that is designed to gather and implement data quickly and efficiently. In June, the bureau added four questions about long COVID to the questionnaire, which gave researchers up to date date on the condition’s prevalence. A recent study from the Federal Reserve Bank of Minneapolis also corroborates numbers gathered by the HPS.

[Related: Long COVID can manifest in dozens of ways. Here’s what we know so far.]

“Critically, this number does not represent the full economic burden of long COVID, because it does not include impacts such as the lower productivity of people working while ill, the significant health care costs patients incur, or the lost productivity of caretakers,” wrote Brookings senior fellow Katie Bach. Including those factors, long COVID could cost an additional $544 billion annually, according to calculations from Harvard University economist David Cutler who reviewed to the report.

Brookings also finds that this experience is consistent with those of comparable economies. They cite a speech in May from a former Bank of England representative who stated that labor force participation has dropped by around 1.3 percent across the entire 16 to 64 year-old population and that long-term illness is causing the greatest impact.

[Related: The long road back to fitness after COVID.]

“If long COVID patients don’t begin recovering at greater rates, the economic burden will continue to rise,” added Bach. They estimate that if the number of Americans infected long COVID increases by just 10 percent each year, the annual cost of lost wages will amount to half a trillion dollars in 10 years. “These impacts stand to worsen over time if the US does not take the necessary policy actions,” the Brookings authors said.

At the end of the report, it highlights the five “critical interventions” that should be taken to best mitigate the macro and microeconomic effects of long COVID, including: better prevention and treatment, expanding paid sick leave, improving workplace accommodations, widening access to disability insurance, and enhancing data collection.