The Disparities of COVID-19
By: Caroline Sha
It’s no secret that the COVID-19 pandemic has disproportionately impacted marginalized groups, especially within the United States. Black, Hispanic, American Indian or Alaska Native, and Native Hawaiian or Other Pacific Islander groups had higher infection and death rates from COVID-19 as compared to White people. [1]
And such disparities exist not only in these rates but in other measures as well. For example, Latinas were most impacted by job losses caused by the pandemic- at the height of the pandemic-caused shutdown in April 2020, one in five Latinas were unemployed, a rate that was significantly higher than other demographic groups. [2] In addition, in one Pew survey, 47% of lower-income adults said someone in their family experienced pandemic-related job losses or pay cuts, compared to 42% of middle-income adults and 32% higher-income adults. [3] Clearly, vulnerable groups faced the greatest effects of the pandemic not only in mortality and infections, but economically and socially.
Unfortunately, such a disproportionate impact is also expected to carry over to post-acute sequelae SARS-CoV-2 infection, or long COVID. Long COVID is the persistence of certain symptoms after COVID-19 infection; these symptoms can range in severity, from joint and muscle pain to mental health problems like depression. [4] There is no consensus on what the cause of Long COVID is, but there are some leading theories, including an altered immune system, virus that lingers after acute infection, or small blood clots. [5] The exact prevalence of long COVID is also under study, with estimates ranging from five to fifty percent- some examples of factors that contribute to this large range are a lack of standard criteria for long COVID and the possible underreporting of long COVID symptoms. [6]
Though the effects of long COVID are lesser known among the general public, the condition can have devastating impacts. Two to four million people are out of the labor force due to long COVID, with a greater number facing reduced working hours due to their symptoms. Such effects can have devastating economic effects on workers and their families, especially considering the difficulty many long COVID patients face when attempting to receive Social Security Disability Insurance benefits. [7].
Researchers have also highlighted that these negative effects will most likely be more pronounced on vulnerable groups. Data from a Census Bureau and National Center for Health Statistics experimental survey (Household Pulse Survey) suggest that rates of self-reported long COVID among female, transgender, Hispanic and non-high school diploma holding adults are one fourth to one third higher than all adults. [8]
The causes for these long COVID disparities are very similar to the causes of the disparities in COVID-19 infection rate and mortality. One such cause is the fact that people of color often have to fight to be heard and believed in medical settings. Many patients have described experiences where the largely white male doctors they were seeing dismissed their concerns about long-term COVID symptoms, leading to delays in care. [9]
Moreover, marginalized racial groups have less access to primary and specialized medical care. People of color are more likely to live in medically underserved areas that do not have primary care physicians within geographic range; additionally, even when there may be a primary care physician, people of color are more likely to lack the transportation necessary to reach them. [10] Lack of access is especially pronounced regarding access to long COVID clinics, as they can be located hours away from some areas. Many marginalized racial groups, who are overrepresented among essential workers, may have difficulty receiving time off work to travel to these clinics to manage their symptoms.
Economic circumstances also have a hand in lack of accessibility to care. About twenty percent of Hispanic people and eleven percent of Black people within the United States are uninsured, while only eight percent of white people are uninsured. [11] This means that people of color face greater barriers when attempting to access care for long COVID, as receiving such care may mean placing great financial burden on themselves and their families. Treatment may also require some patients to take leave from their jobs, which may not be economically feasible, especially for workers in essential jobs. [10]
The higher incidence rate of COVID-19 among people of color also, logically, increases their risk of long COVID. People of color are more likely to work in occupations that carry high risk for COVID-19 transmission, such as in the service industry, as compared to their white counterparts. These jobs often require employees to interact with a large number of people within small distances and employers may not provide the necessary PPE to reduce infection. In addition, people of color are more likely to live in homes with more people than white people and live in high-density areas. [10]
The disparities seen in the COVID-19 pandemic are not isolated cases. They are symptoms of a larger inequity problem within society that will continue to generate disparities in everything from education to long COVID if the root causes are not solved. While policies geared towards long COVID disparities, like making it easier for those suffering from long COVID to get disability insurance benefits, are important, much more needs to be done on a larger scale. Housing affordability, worker rights, and access to insurance are all examples of things that need to be achieved if future medical disparities like the ones seen in long COVID are to be prevented. While much of the damage towards vulnerable communities from COVID has already been done, fundamental shifts in society can prevent such situations from repeating in the future.
[2] https://latino.ucla.edu/wp-content/uploads/2022/09/All-Work-and-No-Pay.pdf
[5]https://www.science.org/content/article/what-causes-long-covid-three-leading-theories
[6]https://www.nature.com/articles/d41586-022-01702-2
[11]https://www.technologyreview.com/2022/09/20/1059679/racial-disparities-of-long-covid/
Caroline Sha is a second year Biology major at UCLA and is a THINQ 2022 intern.
Visit our website at thinq.med.ucla.edu and follow us on Facebook and Instagram @uclathinq
