Long COVID Costs Portugal and OECD €115 Billion Yearly—Here's What Workers Need to Know

The Organisation for Economic Co-operation and Development (OECD) has issued a stark warning: long COVID will drain up to €115B annually from member economies over the next decade, a figure comparable to the entire annual health budget of Spain or the Netherlands. The projection, published on 8 April 2026, underscores that the pandemic's economic burden is far from over, five years after the virus first emerged.

Why This Matters

• Workplace impact: Roughly 1 in 5 workers with long COVID leave employment entirely, with productivity losses ranging from 5% to 10% per affected individual in the first year.

• GDP drag: The condition is expected to shave 0.1% to 0.2% off annual GDP across OECD and EU countries through 2035.

• Healthcare costs: Direct medical expenses alone will hover around €10B per year globally, even under conservative assumptions.

• Portugal-specific concern: The country lacks centralized epidemiological data and specialized reference centers, leaving many cases invisible and unsupported.

The Hidden Toll on Workforce Participation

The OECD report, titled "Addressing the Costs and Care for Long COVID: The Long Shadow of the Pandemic," emphasizes that the heaviest blow comes not from hospital bills but from lost working hours and reduced productivity. Long COVID forces patients into extended sick leave or outright exit from the labor market, a particularly dangerous scenario for aging European workforces already grappling with low growth and demographic contraction.

At the pandemic's height in 2021, an estimated 75M people—more than 5% of the OECD population—were living with long COVID. Direct healthcare spending that year reached approximately €50B. While prevalence has since declined, the OECD projects that between 0.6% and 1.0% of the population will continue to suffer symptoms through 2035, assuming low to moderate viral transmission. Even this reduced rate translates into a persistent economic headwind: indirect costs from absenteeism and diminished output will far exceed medical expenses from 2025 onward.

For Portugal specifically, the situation remains murky. The Aliança Millions Missing advocacy group warned in March 2026 that long COVID is "invisible and underdiagnosed" nationwide, with no centralized data registry, no specialized treatment hubs, and insufficient clinical training. A study by the NOVA Medical School published the same month found that Portuguese women with long COVID experience more disabling symptoms than men, driven by distinct immune system alterations that worsen with age and disease duration.

Treatment Landscape Remains Fragmented

No single, universally effective therapy exists for long COVID as of early 2026. Clinical practice leans heavily on symptomatic management and multidisciplinary rehabilitation, with promising but still-unproven interventions under investigation.

Sipavibart, a long-acting monoclonal antibody developed by AstraZeneca, is currently being tested in a 100-patient trial led by Nova Southeastern University and funded by the Schmidt Initiative for Long Covid. Early-stage research has also identified several repurposed medications that offer symptom relief: low-dose naltrexone for brain fog and pain, selective serotonin reuptake inhibitors (SSRIs) for cognitive and sensory overload, low-dose aripiprazole for cognitive deficits, modafinil for fatigue, and antihistamines for inflammatory flare-ups. A study published in The Lancet Infectious Diseases in October 2023 showed that metformin reduced the incidence of long COVID when taken during acute infection, though it appears less effective once the condition is established.

Emerging European clinical guidelines published in the European Respiratory Journal in April 2026 offer a conditional recommendation for multi-species probiotics (moderate certainty) but remain cautious on antivirals, immunomodulators, and monoclonal antibodies, citing insufficient evidence.

What This Means for Employers and Residents in Portugal

Portugal's healthcare response to long COVID remains fragmented. Centro de Reabilitação Profissional de Gaia (CRPG) in Gaia and Lisbon's Hospital do Mar offer multidisciplinary rehabilitation programs, but these are geographically limited and lack coordinated referral pathways. Portuguese residents seeking long COVID care typically enter through their local health center (centro de saúde) within the Serviço Nacional de Saúde (SNS), though many report long waiting lists and limited specialist availability.

The Autoridade para as Condições do Trabalho (ACT), Portugal's labor inspectorate, has emphasized the need for phased return-to-work plans and workplace accommodations—flexible schedules, reduced hours, and ergonomic adjustments—but enforcement and uptake vary widely. Workers have the right to request workplace accommodation under Portuguese labor law (Lei nº 99/2003), though many remain unaware of this protection.

For those seeking help, contact your SNS health center for an initial referral, or reach out directly to Hospital do Mar (Lisbon) or CRPG (Gaia) if you have a doctor's recommendation. The ACT can mediate disputes over workplace accommodations; contact details are available through the organization's website.

Across Europe, comparatively advanced systems exist: Germany's "Hamburg Model" allows employees to gradually resume duties while officially remaining on sick leave, with employers required to offer integration management after six weeks of incapacity. Switzerland's Invalidenversicherung (IV) provides reintegration measures including retraining and job placement. The EU-OSHA has published guides urging managers to adopt individualized re-entry strategies that account for the fluctuating, multisystem nature of symptoms. By contrast, Portugal's approach remains ad hoc, underscoring the need for a coordinated national strategy.

The OECD's analysis highlights a policy gap: many European healthcare systems, including Portugal's, remain unprepared for the chronic, relapsing trajectory of long COVID. Strengthening diagnostic capacity, clinical training, and social support is essential not only to ease patient suffering but also to contain economic fallout and prepare for future pandemics.

The Road Ahead for Portugal and the OECD

The report's authors stress that the economic impact of long COVID stems chiefly from indirect costs: reduced labor force participation, absenteeism, and impaired cognitive function in previously healthy working-age adults. In a context of modest growth and aging populations, this represents a compounding drag on productivity that governments can ill afford to ignore.

Portugal's challenge is compounded by a lack of centralized data. While a study by the ENSP-NOVA's LOCUS project (October 2024) found that 60% of infected individuals showed symptoms nine months post-infection, dropping to over 40% at 12 months, there is no systematic national surveillance. This data vacuum hampers both clinical care and evidence-based policymaking.

The OECD emphasizes that a coordinated, person-centered response—spanning prevention, harmonized clinical protocols, and integrated health and labor policies—is crucial. Without it, long COVID will continue to cast a shadow over economic recovery, eroding the gains made since the acute phase of the pandemic.

For policymakers in Portugal, the message is clear: the virus is no longer an acute crisis, but its legacy demands sustained investment in rehabilitation infrastructure, workplace accommodation, and social protection. Failure to act now will lock in years of preventable productivity loss and deepen inequalities for those—disproportionately women and older workers—already struggling with the condition's debilitating effects.