Long Covid….Race and Ethnicity Matter
First a brief update regarding where Cincinnati stands in this Covid-19 pandemic. According to the CDC, our Hamilton County is at a LOW community level, as are ALL the adjacent counties. In the USA Covid-19 deaths are trending slightly downward, yet 2,838 Americans succumbed to this virus last week. The daily average new hospital admissions are 3,571. Thus, the acute tangible effects of this disease remain a clear and present danger.
The manifestations of acute COVID-19 are cough, fever, difficulty breathing, fatigue, loss of sense of smell and/or taste, and other symptoms. It has become increasingly clear that when the acute ailment should have run its course, a variety of symptoms may still be around. Long Covid, aka post Covid-19 syndrome, is said to be present if these complex and alarming symptoms linger, recur, or occur more than four weeks after the initial diagnosis of COVID-19. Long COVID can last months and even years after one was thought to be “out of the woods” subsequent to an acute infection. The more severe your initial case, the more prone you are to long COVID, yet it does occur after mild or moderate acute cases of COVID-19.
Symptoms of long COVID can include fever, cough, fatigue, loss of physical stamina, shortness of breath or difficulty breathing. Nervous system problems can include persistent loss of smell and/or taste, inability to concentrate, calculate, remember, or problem solve. This is commonly referred to as “brain fog”. Problems with balance, headaches, sleep, dizziness, tingling, anxiety, and depression can also be present. Few, if any, of the body’s systems are immune to this long-term disease. The heart can be affected by palpitations, rapid heartbeats, and chest pains. Symptoms in the digestive system can include diarrhea and pain. The vascular system can be involved by blood clots in the legs which may travel to the lungs. Abnormalities in the menstrual cycle and skin rashes may be the indicator of reproductive and dermatologic system involvement. If you are experiencing any of these symptoms a month after your COVID-19 diagnosis, see your doctor to determine the relationship to COVID-19.
As COVID-19 diagnostics, vaccinations, and treatments have evolved, there is even a governmental diagnostic code (ICD-10) for long covid, “U09.9 Post COVID-19 condition-unspecified”. This code was introduced to the US healthcare system in October 2021. The diagnostic codes represent the alphanumeric designation by which physicians, researchers, and payors communicate about diseases and ailments. The availability of this long COVID code has allowed the National Institute of Health (NIH) to identify important racial and ethnic disparities in the long COVID symptoms and diagnostic experiences, in two different independent studies.
The first study, compiled from the medical records of patients at five different hospitals in NYC, between March 2020 and October 2021, showed a disproportionate number of the severe acute COVID-19 cases were people of color. Blacks and Hispanics compiled 25% each of the severe cases, whereas Whites were only 14%. Whites were more likely to have experienced long-term sleep disorders, cognitive issues, or fatigue compared to the other two ethnicities. Even in those adults with mild to moderate long term disease, Whites were more likely to have documented complaints of “brain fog” and fatigue. The researchers acknowledge that it is unclear why Whites had more recorded nervous system symptoms while people of color had more respiratory, cardiac, diabetes, and musculoskeletal symptoms.
In the second study from thirty-four US medical centers, two years of data was gleaned from the records of nearly 34,000 adults and children with the coded diagnosis for long COVID. Again, disparities were identified which demonstrated several patterns. Most striking was that the patients carrying this diagnosis were predominately White, female, non-Hispanic, and from” areas with low incidence of poverty” and areas “with better access to health care”. The researchers provided no explanation for the disparities even recognizing that a disproportionate number of acute cases had occurred in people of color.
These two studies show that if you are African American or Hispanic, you may not experience or may not had recorded the nervous system symptoms, or you may not be diagnosed with long COVID, compared to White citizens. Knowledge that these disparities exist is step one to explanations and eliminations of these inequities.
