Disparities in Long-COVID

Written by Erik Andersen, MD. Last updated 4/2022

What are the unique challenges that patients with long COVID face?

• Lack of understanding of long COVID by the healthcare community

  • There are many unknowns and healthcare’s understanding of long COVID is still being elucidated.

  • Because of this lack of understanding, patients may face stigma and may find themselves having to convince provider that their symptoms are valid.

• High burden on mental health

  • Long COVID has a high mental health burden because of some of the issues mentioned in this post, and is associated with increased rates of mood disorders (1, 2).

• Unequal access to rehabilitation services

  • “A long hauler may have cognitive impairment, headache, and dizziness, and most definitely would benefit from this type of multidisciplinary program. More severe patients with acute cerebrovascular diseases, critical illness polyneuropathy and myopathy, and encephalopathy can get acute in-patient rehabilitation, but this is not an option for someone who was not hospitalized.”

    • Excerpt from article by Dr. Verduzco-Gutierrez (read her Representation in Rehab interview here)

• Loss of employment and employer’s insurance

  • In an international survey of patients with Long COVID, 45% reported requiring a reduced work schedule and 22% were not working due to their health condition (3)

• The same factors that contribute to racial disparities in acute COVID case numbers can be expected to carry downstream to long COVID

  • Cumulative data reported by the CDC as of April 29, 2022:

    • When adjusting for age, Black, Hispanic, American Indian, and Alaskan Native people have higher rates of COVID-19 infection and death (5)

  • Although we don’t have clear data on long COVID’s impact on all communities, we can expect that racial disparities in COVID translates into racial disparities in long COVID

What is part of the solution?

• Prioritizing data collection and inclusive research by reporting on racial disparities in acute and long COVID-19. This is important so we can identify and prevent further widening of disparities with long COVID. 

  • Urge lawmakers to update federal minimum standards for reporting race and ethnicity data which were last revised in 1997 (6).

  • Require reporting by states and entities not currently required to report race/ethnicity data. We need more complete data that isn’t possible under our currently outdated federal mandates. 

  • An effort must be made to include races that have been disproportionately affected by COVID-19. 

• Believe patients when they tell us their symptoms. Long COVID is real but many physicians are uncomfortable to acknowledge it because it’s new and largely unexplained. 

• Expansion of COVID recovery clinics with a goal of linking disadvantaged populations to care.