Comment: Long Covid has quietly become a mainstream chronic illness, affecting 4.3 percent of adults. This is comparable to rates of other chronic health conditions such as ischaemic heart disease (4.5 percent), gout (4.8 percent), chronic obstructive pulmonary disease (4.4 percent), and rheumatoid arthritis (2.7 percent).
But here’s the paradox: Long Covid is mainstream, yet invisible, with sufferers expected to self-manage.
We argue New Zealand urgently needs a national strategy for Long Covid rather than its current ‘business as usual’ approach where care is absorbed into routine health services. This leaves those with Long Covid navigating a disabling condition within a health system that remains poorly equipped to recognise and manage it.
The case for change
A 2024 paper, published by the Organisation for Economic Co-operation and Development, examined the burden of Long Covid in OECD countries and identified priorities for improving care. One priority flagged by the paper’s authors was for countries to align responses to Long Covid with established responses to other chronic conditions.
As things stand, New Zealand’s manages chronic conditions distinctly differently to the way it manages Long Covid.
For example, heart disease is rightly treated as a national health priority, with dedicated funding, coordinated care, multidisciplinary teams, measurable outcomes, and public health campaigns. Nobody with heart disease is expected to become their own specialist, pharmacist, funder, and support team.
In contrast, Long Covid care is subsumed within the business as usual healthcare system. This puts the burden of care onto patients, leaves clinicians unsupported, increases risks of poorer outcomes and the use of unproven treatments, and potentially delays recovery.
Initially, our Long Covid response showed promise. In 2022, the Ministry of Health convened an expert advisory group and published a clinical rehabilitation guideline. However, the group was dissolved the same year. Little has followed from the ministry or Health New Zealand, apart from a review of international models of care in 2025, which emphasised the need for a national approach.
Instead, business as usual has become the default. This approach ignores Long Covid’s profound impacts, not only on people’s health but also the economy. For the year to March 2024, the estimated annual economic loss from Long Covid was $2 billion. The condition is estimated to affect the work productivity of 40,000 people.
A 2026 OECD report on Long Covid’s costs warned that impacts on workplace productivity will continue to affect countries’ GDP and urged the adoption of national strategies to manage the condition. Continued failure to address Long Covid is likely to carry substantial ongoing clinical, social, and economic costs.
The diagnosis problem
Long Covid is complex and often medically misunderstood. The importance of care has also frequently been dismissed, despite evidence Long Covid can cause substantial disability comparable to serious chronic illnesses such as multiple sclerosis and severe rheumatoid arthritis.
Many patients report clinician reluctance to recognise Long Covid, leaving people without appropriate investigation, diagnosis, or management. These unmet needs are more pronounced for Māori, Pacific communities, and disabled people, who already experience higher rates of Long Covid and disadvantage from longstanding inequities in healthcare access.
It’s true Long Covid diagnosis can be challenging. New Zealand uses the World Health Organisation diagnostic criteria, but the lack of a specific biomarker or medical test, and variability of symptoms – which can overlap with other conditions – potentially reduces clinician confidence, delaying diagnosis.
Long Covid also remains complex for clinicians to treat, although understanding is improving. Evidence-based guidance now exists, directing effective symptom management. But the ongoing uncertainty about diagnosis, combined with limited government action, contributes to a clinical culture of dismissal, stigma, and deprioritised care.
Delayed diagnosis can cause harm by delaying appropriate clinical care, which may potentially worsen symptoms, particularly if post-exertional malaise is present. This is an abnormal response to exertion, causing disproportionately worse symptoms lasting from days to months.
Conversely, early diagnosis facilitates timely management, optimising earlier improvement and a return to normal life. Preliminary results from our ongoing study of care at an allied health-led Long Covid clinic in Taranaki suggest early intervention successfully supports patients to remain in or return to full-time employment.
Unfortunately, the business as usual approach has already led to the closure of a Long Covid clinic in Christchurch and is placing pressure on the Taranaki clinic amid ongoing funding constraints.
It has also driven inequities in accessing support. With loss of income from reduced ability to work, and needing up to three times more GP visits than the general population, patients commonly face financial and support difficulties. Despite impairments meeting disability definitions, Long Covid is not classified as a disability by the Disability Support Services framework.
The burden of Long Covid will continue to cost us. Insistence on business as usual is difficult to justify, clinically or economically. From a health-system perspective, it urgently warrants a funded and systematic approach. This could help influence clinical practice by legitimising the condition, increasing clinical engagement, and improving clinical care.
We propose a national action plan, based on similar examples within the health system, that covers the following areas:
Prevention: strengthening commitments to infection prevention, as has previously been recommended. This could include returning to free RAT tests, paid Covid-related sick leave, and protections for high-risk populations.
Screening: establishing free post-Covid assessments for people with symptoms persisting beyond 12 weeks, to support timely recognition, use of safe management strategies, and reduce deterioration.
Guidance: national Long Covid resources for clinicians are available but should be regularly updated, and aligned with evolving international evidence, to support consistent identification and management.
Health education: providing access to accredited education modules. These should cover diagnosis, screening for post-exertional malaise, common associated conditions, and management strategies, including consideration of pharmacological options where appropriate.
Specialist support: establishing guidance on referral pathways to enable appropriate multidisciplinary specialist input where appropriate.
Monitoring: establishing national data collection and reporting to track prevalence outcomes and inform ongoing service planning.
Equity: ensuring equitable and targeted access to diagnosis, care, and support for disproportionately affected populations.