Long COVID Knowledge Hub

Explore internal and external resources on long-COVID's potential effects and implications.

Young doctor delivering results to two patients in his room.

About the Long COVID Knowledge Hub

The Long COVID Working Group was established in June 2023 to provide actuaries with insights about the potential impacts of Long COVID. This includes understanding the definition, changes to underlying insurance risks associated with persistent symptoms an/or changes originating from the post-pandemic “new normal” ways of working and living.

The Working Group also seeks to inform the broader actuarial community of the evolving societal impacts from Long COVID, including impacts on the health system, government agencies and organisation outside the financial services industry.  

The Actuaries Institute and the Working Group have launched this Knowledge Hub to support actuaries and others. Information has been sourced from external Australian and international sources.

Members are:

Chair 
Zhan Wang  

Members 
Shelley Agrawal 
Sally Galbraith 
Linda Kemp 
Daniel Langford 
Maggie Lee 
Han Li 
Chris Scheuber 
Xu Shi 
Darren Stevens 
Nicholas Stolk 
Kelly Yong 
Rui Zhou

Institute Liaison 
Clare Marshall

woman stands at lectern in front of group of people sitting.

The Long Haul: Insights on Long COVID

A summary of the Long COVID Working Group's discoveries and observations that could impact the life and private health insurance sectors in Australia.

Read the article

External resources list

Last updated: April 2024

Overview 

This section provides links to resources that have been externally developed. Long COVID is an evolving field of research, and not all resources have been peer-reviewed. Members are encouraged to critically review all external sources.

The Working Group notes that some information appearing in the literature is inconsistent and, at times, conflicting. For instance, there is a substantial degree of variation in the estimates of the scale of long-COVID. This is, in part, a result of differing definitions, dominant strains, degree of vaccination, sample size, study population, and study methodology/quality (e.g. self-reporting, testing methodology for underlying COVID-19 infections, use of a control group). Actuaries should think critically about the assumptions underlying the material they are reading and producing.

Public health bodies 

Long COVID is a medical condition recognised by major health bodies globally. Resources prepared by various reputable health bodies are linked below.

Australian-based overviews and literature reviews 

Two separate reports have been prepared that provide an overview of the research at the time of their publication with an emphasis on the Australian experience.

Members may find these to be a helpful first resource before doing subsequent research. Additional studies and papers can be found via the sidebar on this page.   

Sick and Tired: Casting a Long Shadow. Inquiry into Long COVID and Repeated COVID Infections (April 2023)

This report from the Australian Government's inquiry into long COVID provides a broad overview at the time of the inquiry; covering the definition, prevalence, prognosis and lived experience, with an emphasis on the Australian healthcare setting.

Long COVID in Australia – a Review of the Literature (December 2022)

Broad overview and literature review by the Australian Institute of Health and Welfare covers background, prevalence, determinants, co-morbidities and impact of long COVID, with a focus on the Australian experience.

Disclaimer 

Information from the Long COVID Working Group is intended for discussion purposes only and does not constitute consulting advice on which to base decisions. The members of the Working Group are not medical professionals, public health specialists or epidemiologists.

External resources have been provided for informational purposes only and have not been independently reviewed by the Working Group for their accuracy. The Working Group does not warrant the accuracy or completeness of the above information.

Information provided reflects the views of the authors and does not necessarily reflect the views of the Working Group or the Actuaries Institute.

Long COVID is an evolving field of research, and new research is being produced that may not yet be reflected on this page.

External papers and studies

To assist members with navigating external studies, the Working Group has tagged several keywords against each study. These include:

Overview: Provides an overview across various topics, e.g., definition, symptoms, prevalence, etc.
Australian focus: Places an emphasis on experience within/implications for Australia.
Symptoms: Describes the symptoms caused by long COVID.
Prevalence: Provides estimates of the prevalence of long COVID.
Severity: Considers the severity of long COVID symptoms.
Prognosis: Considers morbidity outcomes for individuals with long COVID over time (e.g., 1-2 years after initial infection).
Economic impact: Considers the costs of long COVID, either to an individual, an insurer, and/or the economy.
Lived experience: Describes the experience of individuals living with long COVID.
Study quality: Discuss difficulties in interpreting/applying study results.

View all external papers and studies

Browse external resources by year.

2024

Prevalence of mental health conditions and brain fog in people with long COVID: A systematic review and meta-analysis:Prevalence of mental health conditions and brain fog in people with long COVID: A systematic review and meta-analysis : Meta-analysis of 17 studies (covering 41,000 cases of long COVID) analysing the prevalence of mental health conditions. Key topics include: Symptoms.
Long COVID in Children, Adults, and Vulnerable Populations: A Comprehensive Overview for an Integrated Approach : Paper providing a narrative review discussing risk factors and prevalence of a range of symptoms of long COVID in different populations. Key topics include: Symptoms, Prevalence.
How to Understand the Overlap of Long COVID, Chronic Fatigue Syndrome/Myalgic Encephalomyelitis, Fibromyalgia and Irritable Bowel Syndromes : Paper discussing a range of symptoms and the overlap of these symptoms with other chronic health conditions. Key topics include: Overview, Definition, Symptoms.
Long COVID awareness and receipt of medical care: a survey among populations at risk for disparities: Study on the awareness of and medical treatment sought for long COVID in the US, and disparities that exist amongst different ethnic and socioeconomic groups in the US.
"People don’t have the answers”: A qualitative exploration of the experiences of young people with Long COVID: Paper exploring the lived experience of young people living with long COVID. Key topics include: Lived Experience.
Insights into early recovery from Long COVID—results from the German DigiHero Cohort: Study analysing recovery from long COVID between 4 and 12 weeks post infection considering various risk factors and symptoms. Key topics include: Prognosis.
Prevalence and Trajectories of Post-COVID-19 Neurological Manifestations: A Systematic Review and Meta-Analysis: Systematic review of 126 studies (covering 1,542,000 individuals) analysing the prevalence of various neurological conditions at 3, 6, 9 and 12 months after infection. Key topics include: Prevalence, Prognosis, Symptoms.
Long COVID in a highly vaccinated but largely unexposed Australian population following the 2022 SARS-CoV-2 Omicron wave: a cross-sectional surveyLong COVID in a highly vaccinated but largely unexposed Australian population following the 2022 SARS-CoV-2 Omicron wave: a cross-sectional survey: Study of long COVID prevalence and risk factors in Western Australia during 2022. Key topics include: Australian focus, Prevalence.
The importance of reporting accurate estimates of long COVID prevalence: Note on the difficulty of interpreting and correctly applying study results. Key topics include: Prevalence, Study quality.
Prevalence of long COVID in the general adult population according to different definitions and sociodemographic and infection characteristics: Study of the prevalence of long COVID based on several definitions and severity thresholds in the adult population in mainland France and examined variations according to sociodemographic and infection characteristics. Key topics include: Prevalence, Severity, Symptoms.
Post-recovery health domain scores among outpatients by SARS-CoV-2 testing status during the pre-Delta period: Study of self-reported disability up to 7 months following infection among SARS-CoV-2-positive and negative persons with mild to moderate COVID-19-like illness who presented for outpatient care before widespread COVID-19 vaccination. Key topics include: Prognosis.
The global prevalence of depression, anxiety, and sleep disorder among patients coping with Post COVID-19 syndrome (long COVID): a systematic review and meta-analysis: Meta-analysis of over 100 studies analysing the prevalence of mental health conditions amongst those with long COVID. Key topics include: Symptoms
Association of vaccine status, reinfections, and risk factors with Long COVID syndrome: Study analysing the prevalence of long COVID and various risk factors including age, gender, weight, reinfections, and vaccination status. Key topics include: Prevalence.
Prevalence and Factors Associated with Long COVID Symptoms among U.S. Adults, 2022: Study analysing the prevalence of long COVID within the US and the impact of a range of risk factors such as gender, age, ethnicity, socioeconomic status, etc. Key topics include: Prevalence.
Characteristics of long COVID and the impact of COVID-19 vaccination on long COVID 2 years following COVID-19 infection: prospective cohort study: Prospective cohort study aimed to identify characteristics of long COVID and any potential mitigating effects of COVID-19 vaccinations in patients 24 months following COVID-19 infection. Key topics include: Prognosis.

2023

Experiences of Canadians with long-term symptoms following COVID-19: Study analysing the results of the 2023 Canadian COVID-19 Antibody and Health Survey – Follow-up questionnaire. Key topics include: Prevalence, Prognosis.
True prevalence of long-COVID in a nationwide, population cohort study: Study of the prevalence of symptoms attributable to SARS-CoV-2 infection, taking account of background rates and confounding, in a nationwide population cohort study of 198,096 Scottish adults. Key topics include: Prevalence, Prognosis.
Long COVID in the United States: Study analysing data collected from nearly half a million Americans in the period June 2022-December 2022 in the US Census Bureau’s Household Pulse Survey. Key topics include: Prevalence, Severity.
The long-term health outcomes, pathophysiological mechanisms and multidisciplinary management of long COVID: Paper describing the epidemiology, prevalent manifestations, pathophysiological mechanisms, and potential diagnostic tools and therapeutic options of long COVID. Key topics include: Symptoms.
Long-term health impacts of COVID-19 among 242,712 adults in England: Study of self-reported health, quality of life and symptom profiles for people with ongoing symptoms following COVID-19 to those who have never tested positive for SARS-CoV-2 infection and those who have recovered from COVID-19. Key topics include: Prevalence, Prognosis.
An overview of long COVID support services in Australia and international clinical guidelines, with a proposed care model in a global context: Paper identifying gaps among Australian Long COVID support services and guidelines alongside recommendations for future health programs. Key topics include: Australian Focus, Health System.
How methodological pitfalls have created widespread misunderstanding about long COVID: Paper discussing the difficulty of interpreting study results due to implications of imprecise long COVID definitions and study design. Key topics include: Prevalence, Study Quality.
Postacute sequelae of COVID-19 at 2 years: Study of the relative risks of various conditions as a result of long COVID over 2 years. Key topics include: Prognosis.
Incidence of long COVID and associated psychosocial characteristics in a large U.S. city: Study of 3-month outcomes of sample of 3595 adults with lab-confirmed cases of COVID-19. Key topics include: Prognosis.
Long COVID and significant activity limitation among adults, by age — United States, June 1–13, 2022, to June 7–19, 2023: Study of the US Household Pulse Survey results over the year to June 2023. Key topics include: Prevalence, Severity.
Long COVID prevalence and impact on quality of life 2 years after acute COVID-19: Study of self-reported disability outcomes over two-years. Key topics include: Prognosis.
Systematic Review of the Prevalence of Long COVID: Meta-analysis of 120 studies analysing the prevalence of long COVID symptoms. Key topics include: Symptoms.
Impact of fatigue as the primary determinant of functional limitations among patients with post-COVID-19 syndrome - a cross-sectional observational study: Study describing self-reported characteristics and symptoms of treatment-seeking patients with post-COVID-19 syndrome, and assessing the impact of symptoms on health-related quality of life (HRQoL) and patients’ ability to work and undertake activities of daily living. Key topics include: Severity.
ME/CFS and Long COVID share similar symptoms and biological abnormalities: Study comparing the symptoms and pathophysiology of long COVID and ME/CFS. Key topics include: Symptoms.
A system review and meta-analysis of long COVID symptoms: Meta-analysis of 49 studies analysing the prevalence of various symptoms with long COVID. Key topics include: Symptoms.
Development of a definition of postacute sequelae of SARS-CoV-2 infection: This Paper attempts to develop a definition of long-COVID using self-reported symptoms and describe frequencies across cohorts, vaccination status, and number of infections. Key topics include: Symptoms.
Socioeconomic inequalities of Long COVID: a retrospective population-based cohort study in the United Kingdom : Study of the risk of Long COVID by socioeconomic status, sex and occupation. Key topics include: Prevalence.
The economic burden of the post-COVID-19 condition - Underestimated long-term consequences of neuropsychological deficits: Paper discussing considerations for estimating the economic of long COVID. Key topics include: Economic Impact.
Sick and tired - Casting a long shadow. Inquiry into long COVID and repeated COVID infections: Report from the Australian Government inquiry into Long Covid. Provides a broad overview at the time of the inquiry, covering the definition, prevalence, prognosis and lived experience, with an emphasis on the Australian healthcare setting. Key topics include: Overview, Australian focus, Prevalence, Prognosis, Symptoms, Lived Experience.
Quantifying long term effects of COVID-19 on health care costs: Study modelling US health insurance claim costs in an insured population. Key topics include: Economic Impact.
Risk Factors Associated with Post COVID-19 Condition: Meta-analysis of 41 studies covering 860,000 patients, analysing risk factors for long COVID such as gender, age, weight, and vaccination status. Key topics include: Prevalence.
Workshop on long COVID: Summary of presentations to European Parliament’s Special Committee on the COVID-19 pandemic. Key topics include: Overview.
One-year adverse outcomes among US adults with post–COVID-19 condition vs. those without COVID-19 in a large commercial insurance database: Case-controlled study of 1-year outcomes among individuals meeting a post–COVID-19 condition definition, based on an insured population. Key topics include: Prognosis.
Living with “long COVID”: A systematic review and meta-synthesis of qualitative evidence: Summary of the qualitative evidence on lived experiences of people living with long COVID that may inform health policymaking and practice. Key topics include: Lived Experience.
Impact of COVID-19 vaccination on the risk of developing long-COVID and on existing long-COVID symptoms: A systematic review: Study of the available evidence on the impact of vaccination on the development of long COVID. Key topics include: Prevalence.
New-onset, self-reported long COVID after coronavirus (COVID-19) reinfection in the UK: 23 February 2023: Statistics on long COVID prepared by the UK Office for National Statistics. Previous releases are also available on the website. Key topics include: Prevalence.

2022

Long COVID in Australia – a review of the literature: Broad overview and literature review by the Australian Institute of Health and Welfare, covering background, prevalence, determinants, co-morbidities, and impact of long-COVID, with a focus on Australian experience. Key topics include: Overview, Australian focus, Prevalence, Prognosis.
Comparison of Long COVID-19 caused by different SARS-CoV-2 Strains - A systematic review and meta-analysis: Study of international data sets to understand whether Long Covid symptoms are more prevalent with certain Covid-19 strains/variants. Key topics include: Prevalence.
Exploring new insights and strategies for long COVID - EU-US Conference on long COVID : Report from the EU-US Conference on long COVID. Key topics include: Overview.
The prevalence and long-term health effects of Long Covid among hospitalised and non-hospitalised populations: a systematic review and meta-analysis: Meta-analysis covering 194 studies and 700,000 patients analysing the prevalence of various long COVID symptoms. Key topics include: Prevalence, Symptoms.
Estimating the Current Scale and Impact of Long COVID in Australia: Study modelling the prevalence and severity of Long Covid in Australia using a stock and flow model. Key topics include: Prevalence, Severity, Australian focus.
Acute and postacute sequelae associated with SARS-CoV-2 reinfection: Study analysing the impact of multiple COVID-19 infections on the risk of long COVID. Key topics include: Prognosis.
Long COVID and its management: Qualitative review providing a summary of the general background of long COVID, risk factors, diagnostic indicators and management strategies. Key topics include: Prognosis.
Long-term cardiovascular outcomes of COVID-19 : Study focussed on the impact of long COVID on various cardiovascular conditions. Key topics include: Prognosis, Symptoms.

2021

Whole of population-based cohort study of recovery time from COVID-19 in New South Wales Australia: Study of the prevalence of long COVID in Australia during the early stages of the pandemic when COVID-19 cases were relatively contained and accurately tracked. Key topics include: Prevalence, Australian focus.
Assessment of the frequency and variety of persistent symptoms among patients with COVID-19 - A systematic review: Review of studies estimating the prevalence of persistent symptoms 30-60 days after an initial COVID-19 infection. Key topics include: Prevalence, Symptoms, Study quality.
Long COVID: An overview: Overview of available evidence including pathophysiology, symptoms and management, prepared in 2021. Key topics include: Overview.

Articles

This section provides links to various articles related to the topic. Actuaries are encouraged to think critically about the assumptions underlying the material they are reading and producing.

2024

Health systems and employers count economic cost of long Covid

Griffith University researchers to trial naltrexone on long COVID patients

Long COVID, ME/CFS and the Importance of Studying Infection-Associated Illnesses

About 2m people have long Covid in England and Scotland, figures show

Experts call for more research into long COVID, as study reveals high prevalence in WA

Study shows long COVID symptoms resolve for most

Long-COVID study reveals immunological improvement two years after infection

An Update on Long COVID

Long COVID: Teachers, healthcare workers most vulnerable occupations, report finds

Public Health advocates decry CDC’s weakened pandemic guidelines

Study: Long COVID affects 8% of those with COVID-19, is more common in women