Before Daniela Alves caught COVID-19 in March, the 31-year-old Londoner regularly worked overtime to accelerate her career as a mobile app designer. Now, she struggles with client meetings, and says persistent fatigue has halved her productivity.

“I was a beast before, but now things are different,” Alves says over Zoom, pausing frequently to catch her breath or cough. “I can’t physically do it, and I’m approaching life differently.”

Alves said she needed three months off work even after experiencing a “mild” infection that didn’t require hospitalization. COVID-19’s lingering effects count her among an expanding population of so-called long-haulers — survivors left with debilitating conditions who represent another insidious dimension of the pandemic.

It’s now known that SARS-CoV-2 will leave a portion of the more than 23 million people it’s infected with a litany of physical, cognitive and psychological impairments, like scarred lungs, post-viral fatigue and chronic heart damage. What’s still emerging is the extent to which the enduring disability will weigh on health systems and the labor force. That burden may continue the pandemic’s economic legacy for generations, adding to its unprecedented global cost — predicted by Australian National University scholars to reach as much $35.3 trillion through 2025 as countries try to stop the virus’s spread.

“The bottom line is that the physical, long-term health consequences are very serious for people’s welfare, and in economic terms,” said Hannes Schwandt, an assistant professor of education and social policy who studies well-being and economic outcomes at Northwestern University in Evanston, Illinois. “But, we don’t know enough about it yet.”

While it’s unclear how many survivors become long-haulers, a COVID-19 symptom study in the U.K. with more than 4 million participants found 1 in 10 people are sick for a least three weeks. People with mild cases of the disease are more likely to have a variety of “strange” symptoms that come and go over a longer period, according to Tim Spector, professor of genetic epidemiology at King’s College London, who is leading the study.

‘Weirder it gets’

“The more we learn about coronavirus, the weirder it gets,” he said.

The still-evolving clinical picture, dearth of patient follow-up, and incomplete data on the number of people afflicted by COVID-19 make it difficult to predict the pandemic’s long-term health and economic consequences, according to Christopher J. Murray, director of the Institute for Health Metrics and Evaluation at the University of Washington in Seattle.

“There’s enough out there to suggest it’s appreciable, and this is something we’re becoming interested in trying to measure,” said Murray, who has studied the global burden of disease for almost 30 years.

That information will be critical for anticipating and funding future health care needs, said Thomas File, president of the Infectious Diseases Society of America.

‘Significant burden’

“If you look at the intermediate-term consequences right now, we’re already seeing it” on the lungs, heart, neurological and psychological systems, said File, who is also chair of infectious diseases at Summa Health, a hospital system in Akron, Ohio. “This is going to have a significant burden on our health care system for years to come.”

The economic impact will be much greater if younger survivors endure decades of coronavirus-related disability, said Olga Jonas, a former economic adviser at the World Bank who studies the impact of contagions at Harvard University in Boston. Polio, a paralyzing disease, would have led to an estimated $215 billion in treatment costs in the U.S. from 1955 to 2015 had vaccines not become widely available, a 2006 study found.

There has been little recognition so far of COVID-19’s ill-effects on younger adults, said Hannah Wei, a 30-year-old long-hauler in Canada, who helps other sufferers through survivor support group Body Politic. An analysis of responses from 640 patients collected by the group in April and May found “recovery is volatile, includes relapses, and can take six or more weeks.”

Although all respondents experienced symptoms consistent with COVID-19, 48 percent were either denied testing or not tested for another reason. That can makes obtaining financial assistance for rehabilitation and disability services more difficult, Wei said.

‘Especially neglected’

“In the beginning of the pandemic, a lot of my age cohort weren’t the ones being tested, so we’ve been especially neglected from the system and not recorded on official numbers,” said Wei, who caught COVID-19 in March. “Now we’re seeing a lot of these people become long-haulers.”

Even if such cases are identified, there’s still no guarantee the economic consequences will be adequately quantified, said Janet Currie, an economics professor at Princeton University. For example, employment surveys favored by economists don’t routinely ask if people have disabilities, she said.

Also, the long-term economic effects of COVID-19 will ripple well beyond those who caught the coronavirus, Currie said. Mental health problems emanating from lockdowns will sap work performance and productivity, health care disruptions may exacerbate other medical conditions, and people needing to provide care for others will have less time for paid work.

In limbo

There are also those like Kyle Merryman, who is in limbo over his own classification.

The 39-year-old U.S. Iraq War veteran developed coronavirus-like symptoms in January. By the end of April he’d visited the emergency room eight times with symptoms including shortness of breath and blurry vision. Due to the timing of his illness, Merryman wasn’t tested for COVID-19, and an antibody test in June came back negative. Still, he has no other explanation for how he went from being completely healthy to unable to work.

He was recently diagnosed with postural orthostatic tachycardia syndrome — a problem with the automatic nervous system. The condition, which may develop after a viral illness, often causes heart palpitations, chest pain and brain fog, according to the Cleveland Clinic.

“I’m really not sure what my future holds,” said Merryman, who had to take leave from a technology job in Florida and move in with his mother in Texas. “My illness has already put a big financial strain on my family and me.”

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