Researchers are now concerned that the same health inequalities that have made certain racial and ethnic groups experience higher infection and death rates also drive disparities in treatment for long Covid.
Covid “long haulers” are being taken more and more seriously in the medical communities today. About 60 clinics have now opened across the U.S. for COVID-19 patients whose symptoms go on for weeks or months past the average recovery period of 2 to 6 weeks. It’s now estimated that about 10% of COVID-19 cases become long haulers.
The long Covid effect has been seen across young and old age groups, healthy patients and those with underlying conditions, and those with mild cases versus those hospitalized with the virus. Yet researchers are now concerned that the same health inequalities that have made certain racial and ethnic groups experience higher infection and death rates also drive disparities in treatment for long Covid.
Compared to white, non-Hispanic persons, the CDC shows that cases of COVID-19 in Black persons are 1.1 times higher for cases with a 2.8 times higher hospitalization rate. Likewise, positive cases are two times higher in the Hispanic population with three times the hospitalization rate when compared to the white population.
Researchers look at the disparities of preexisting medical conditions and healthcare access to understand the disproportionate impact of COVID-19 on these minority populations. Other social factors include poverty rates and numerous minority workers in “essential industries” during the pandemic, unable to work from home.
The pandemic has also brought the lasting effects of a history of racism within the United States, and how that has affected the trust of the Black community in the healthcare system, where many have experienced neglect or unequal treatment.
“If you are from a community such as myself, it’s bad enough when you have to go to the doctor and you might have experienced discrimination or just unwillingness to be heard,” said Monica Lypson, a Black physician who is the co-director of the Covid-19 Recovery Clinic at George Washington University Medical Faculty Associates in Washington, D.C. “Now that you have these kind of nonspecific symptoms, it’s even harder to try to say, ‘OK, I’m a go and advocate for myself and be willing to browbeat the system to hear me.”
At this point, it’s unclear whether people of color are more likely to develop long Covid or not, but research to better understand those affected is underway. Researchers are diving into what causes these lingering problems to predict who is vulnerable and develop the best treatment plans accordingly.
“While we do not yet have clear data on the impact of post-Covid conditions on racial and ethnic minority populations and other disadvantaged communities, we do believe that they are likely to be disproportionately impacted by these conditions as they are more likely to acquire SARS-CoV-2 and less likely to be able to access health care services,” John Brooks, chief medical officer on the Covid-19 response at the Centers for Disease Control and Prevention, said at a congressional hearing last month. “While [post-acute Covid care] clinics are a critical resource for those suffering from post-Covid conditions, many people do not have access to them due to geographic location or insurance status.”
At the same hearing, Chimére Smith, a middle school English teacher in a low-income neighborhood in Baltimore, also spoke about her experience as a Covid long-hauler, losing her career, home, finances and mental acuity. In her words, long Covid turned her into “a Black woman in America who doesn’t know enough words to convince doctors and medical staff to take my bout with long Covid seriously.”
Physicians involved in the post-Covid clinics believe that access to care is essential in the outcomes for people with long Covid. Before long, Covid was truly recognized, people of all races and ethnicities were dismissed, their symptoms brushed aside, particularly when testing was available to back them up. This leaves patients hesitant to seek further care, unsure of what it will mean for their care and lives.
“A lot of people came into the hospital reluctant to interact with the health care system and have returned to the community, reluctant to interact more,” Fred Pelzman, an internist in New York who is associate medical director of Cornell Internal Medicine Associates, said. “We had an enormous number of people who didn’t want to come to care. They were scared to come to the hospital. They were worried they would lose their job. They would worry they couldn’t pay the bills. They were worried they couldn’t leave a family member at home and managed on their own and never even came to care.”
The main symptoms of Covid long haulers are typically extreme fatigue, lasting shortness of breath, limitations on the ability to work and brain fog.
Alex Truong, a pulmonologist and co-director of the Emory Executive Park post-Covid clinic, estimated that 1 in 5 of his long Covid patients score low enough on a cognitive assessment to qualify as having mild cognitive impairment.
For most, the brain fog lifts after about six months, but for some not entirely. Lingering effects include a struggle with concentration, word-finding and forgetfulness.
Truong urges communities to get vaccinated, which he realizes is not an easy sell in the Black community who have experienced a history of broken trust with the healthcare and governmental systems.
“I understand the hesitation. I totally understand it,” he said. “But I think that we need to do a much better job at outreaching to them.”
As of May 3, 2021, the CDC reported that race/ethnicity was known for just over half (55%) of those who had received at least one dose of the COVID-19 vaccine. Among this group, 63% were white, 13% Hispanic, 9% Black and 6% Asian with other or multiple reported for the rest. The racial breakdown in the U.S. is currently reported at 76% white, 18% Hispanic, 13% Black and 6% Asian.
