September 12, 2022 – Since the early days of COVID-19 pandemicPeople of color are the hardest hit by the virus. Now, many clinicians and researchers are seeing huge disparities emerging in who gets care for the coronavirus for long periods of time.
Long-term Covid disease can affect patients from all walks of life. But many of the same problems that have made the virus particularly devastating in communities of color are also shaping who gets diagnosed and treated. COVID longSays Alba Miranda AzollaMD, co-director of the Post-Covid-19 team at Johns Hopkins University School of Medicine in Baltimore.
Non-white patients are more likely to lack access to primary care, face insurance barriers to seeing specialists, struggle to take time off from work or appointments, and have financial barriers to care as co-payments for treatment accumulate.
“We get very few very wealthy Caucasian populations who come to our clinic because they have access to care, they have good insurance, they are looking online and You find Azula says.
This combination of patients at Azola Clinic does not align with demographics In Baltimore, where the majority of the population is black, half earn less than $52,000 a year, and 1 in 5 lives in poverty. This is not unique to Hopkins. Experts say many of the dozens of long-running specialty COVID clinics that have sprung up across the country are also seeing a disproportionate proportion of wealthy white patients.
It’s also a mix of patients that likely doesn’t reflect who’s most likely to have been infected with COVID for the long haul.
During the pandemic, people who identified as black, Hispanic, American Indian, or Alaska Native were more likely to contract COVID than people who identified as white, according to the CDC. These people of color were also twice as likely to be hospitalized with severe infections, and at least 70% more likely to die.
Time and time again, data demonstrates the disproportionate impact of COVID-19 on racial and ethnic minorities, as well as other population groups such as people living in rural or border areas, people experiencing homelessness, essential workers and frontline workers, people with disabilities, people People with disabilities use disorders, incarcerated people, and people not born in the United States,” John BrooksMD, chief medical officer for COVID-19 response at the CDC, during certificate Before the US House Energy and Commerce Subcommittee on Health in April 2021.
“While we do not have clear data yet on the impact of post-COVID conditions on racial and ethnic minorities and other disadvantaged communities, we believe that they are likely to be disproportionately affected … and less likely to be able to access health care services,” Brooks said at the time.
An image of the long Covid virus indicates that the condition affects about 1 in 5 adults. It’s more common among Hispanic adults than among black, Asian, or white people. It is also more common among those who are considered to be other races or multiple races, accordingly Scan data Collected by the Center for Disease Control.
It’s hard to say how accurate this snapshot is because researchers need to do a better job of identifying and following people who have had COVID for a long time, he says Monica Verduzco GutierrezD., MD, chief of rehabilitation medicine and director of the COVID-19 Recovery Clinic at the University of Texas Health Science Center at San Antonio. A major limitation of surveys like those the CDC has conducted for long-term COVID surveillance is that only people who are aware they have the condition can be counted.
“Some people from historically marginalized groups may have less health knowledge to see the long-term effects of COVID,” she says.
A lack of awareness may prevent people with persistent symptoms from seeking medical attention, leaving many long-running COVID cases undiagnosed.
When some patients seek help, their complaint may not be acknowledged or understood. Azola says cultural bias or structural racism can often hinder diagnosis and treatment.
“I hate to say this, but there may be bias between providers,” she says. “For example, I am Puerto Rican, and the way we describe symptoms as Latinos may seem exaggerated or may be overlooked or lost in translation. I think we miss a lot of patients who are diagnosed or referred to specialists because the primary care provider they see probably tends to This cultural bias to think that this is just a sexy Latin universe.”
There is some evidence that prolonged COVID treatment may vary by ethnicity even when symptoms are similar. One study Of the more than 400,000 patients, for example, they found no ethnic differences in the proportion of people with six common prolonged symptoms of COVID: shortness of breath, fatigueweakness, pain, difficulty with thinking skills and difficulty with movement. Despite this, black patients were less likely to receive outpatient rehabilitation services to treat these symptoms.
Benjamin AbramovD., MD, who leads the long-acting COVID collaboration for the American Academy of Physical Medicine and Rehabilitation, compares what happens with prolonged COVID to another common health problem often treated among patients of color: pain. With both COVID and chronic painOne of the main barriers to care is “just taking caregivers seriously,” he says.
“There is significant evidence that racial bias has led to fewer prescriptions of pain medications for people of color,” Abramov says. “Just as it can be difficult to obtain objective measures of pain, it can also be difficult to objectively measure prolonged COVID symptoms and requires trust between provider and patient.”
He says geography can be another barrier to care Aaron FriedbergD., MD, clinical co-chair of the Post-COVID Recovery Program at The Ohio State University Wexner Medical Center. Many of the communities hardest hit by the coronavirus – particularly in high-poverty urban neighborhoods – have long had limited access to care. The pandemic has exacerbated staffing shortages in many hospitals and clinics in these communities, leaving patients with fewer options near their homes.
“I often have patients drive several hours to come to our clinic, and this can create significant challenges due to the financial burden and time required to coordinate this type of travel, but also because post-COVID symptoms can make this type of travel very difficult to sustain, Friedberg says.
Although the full picture of who has long had COVID — and who is receiving treatment and getting good results — is still emerging, it is very clear at this point in the pandemic that access is not equal for everyone and that many low-income, non-white patients say Friedberg They miss the necessary treatments.
“One thing is clear,” he says, “and there are a lot of people who suffer from these conditions alone.”