Sasheenie Moodley & Ebony Hilton //
Long Covid (also known as long-haul Covid, post-acute sequelae of SARS-CoV-2 infection, and chronic Covid) has been shown to include various long-term respiratory, cardiac, and brain complications1 (see Myalgic Encephalomyelitis/Chronic Fatigue Syndrome2) as well as body pain, insomnia, psychological challenges.3 Post-mortem examinations show irreversible inflammation (structural changes) in the brains4 of Covid-19 victims that resemble the brains of patients with Alzheimers, Parkinson’s, and other advanced neurodegenerative diseases.
Data show that, much to our dismay, America is facing a double-edged pandemic: COVID-19 and Long Covid.
Recent socio-health articles5 have called much-needed attention to Long Covid in an effort to encourage quality care across clinical disciplines and patient demographics. Researchers are focusing on primary prevention strategies (vaccination) and championing research that applies lessons learned from prior disease outbreaks. In addition, socio-health activists and clinicians alike are applauding multispecialty post-COVID clinics that prioritize and empathize with patients battling Long Covid symptoms.
These efforts are definitely a step in the right direction. Assuming we can achieve them over the next year, however, how will they benefit the members of our society most impacted by Covid-19?
Unsurprisingly, Latino and Black Americans bore the brunt of Covid-19 exposures6 in the US and went home to “communities disproportionately affected” by Covid-19.7 Increased Covid exposures coupled with chronic disease (and the influence of systemic racism such as environmental racism, hospital and food deserts) resulted in staggering disparities burdened to both the youth and elderly, making it clear that these individuals are not only vulnerable to morbidity and mortality due to innate weaknesses but are also targeted due to necro-politics. Among the Latino population, the risk for developing cancer, mental illness,8 asthma,9 and/or hypertension10 increases with increased time in the US.
Hispanic Americans have a higher risk of developing diabetes11 and are less likely to be on hypertension treatment12 compared to their Black and White peers. 1 in 7 Black children suffer from asthma.13 Black Americans14 also have higher death rates for breast, colon, prostate, and lung cancers15 at younger ages than their White counterparts. As individual insults, these factors lead to increased severity of Covid-19 infection, but collectively, these insults make for a deadly combination. National data show that Covid-19 death rates16 for Latino and Black Americans are at least double that of White Americans, respectively. Yet it might prove difficult to reach Latino and Black communities despite best-efforts. This is not necessarily the fault of those designing national health policies, but rather the legacy of an unequal and inequitable socio-health system across our nation. When it comes to primary prevention (such as federal-funded vaccination programs), there is a risk that minority communities lack trust in these programs. This has roots in historic (ethical) transgressions17 as well as implicit racial bias18 affecting patient experience in the healthcare system. Such a lack of trust could affect primary prevention strategies and research efforts to combat Covid-19.
Awareness campaigns that explain the utility and clinical efficacy of the Covid-19 vaccine might help leverage any distrust entrenched in Latino and Black communities. Public health campaigns – ideally involving key community leaders – could also promote ‘Long Covid’ education among minority communities. As far as multispecialty post-Covid clinics19 go, the University of North Carolina (UNC) recently opened one such clinic. This clinic was the first of its kind supporting the dense population between Atlanta and Washington DC. It might be worthwhile to examine and replicate UNC’s clinic model.
Indeed the whole country, not only Latino and Black communities, is facing a double-edged pandemic. However, there is a real concern that Latino and Black Americans are slipping through ever-expanding cracks in an inequitable health system. There is an urgent need to involve these communities in the way we engineer responses to Long Covid, because their deaths will be too many to mourn.
In the meantime, we might consider reinstating Covid-19 precautions. Wearing a mask, social distancing, and vaccinating are ways to protect ourselves but – perhaps more importantly – these are ways to protect our loved ones. It has been said that each of us are separated by only six degrees.20 If this is true, and we have good reason to believe it is, then it is only a matter of time before our actions in the workplace or playground ripple to the ones we love.