Included in the American Rescue Plan of 2021, was a new $1.15 billion multi-site study into the effects of Long COVID by the National Institutes of Health. The Researching COVID to Enhance Recovery (RECOVER) study looked to identify how individuals recover from a COVID-19 infection and which populations are at higher risk for Long COVID.
Long COVID refers to the myriad symptoms stemming from COVID-19 that persist in the weeks and months following initial COVID infection.
One of the study’s principal investigators, Jerry Krishnan, MD, PhD, is a professor at University of Illinois Chicago, and an RHA board member. Dr. Krishnan notes that, “Long COVID is likely a result of the virus itself, the host response to the virus—our immune system’s ability to respond to the infection, clear the virus, and then turn off the response; which could be affected by age, underlying health conditions, medications that we are using—and the social determinants of health—all the factors that affect our ability to access and use healthcare effectively, including social supports through family and friends.”
An initial RECOVER study found that of 13,106 adults in New York who were hospitalized from COVID-19, 1 in 4 were Black, 1 in 4 were Hispanic, and only 1 in 7 were White adults. In general, Long COVID patients were more likely to have conditions affecting their nervous system, respiratory function, circulation, and have joint pain or fatigue. However, symptoms varied by race. In the months following infection, Black adults with severe comorbidities were more likely than Whites to be diagnosed with diabetes and experience headaches, chest pain and joint pain, but less likely than other racial groups to have sleep disorders, cognitive problems, or fatigue. Similarly, Hispanics were more likely to have headaches, shortness of breath, joint paint, and chest pain, but less likely to have sleep disorders, cognitive problems, or fatigue. Among patients who were not hospitalized, Black adults were more likely to have blood clots in their lungs, chest pain, joint pain, anemia, or be malnourished. Hispanic adults were more likely to have dementia, headaches, anemia, chest pain, and diabetes. White adults were most likely to have conditions such as cognitive impairment (i.e ‘brain fog’) and fatigue.
A second, RECOVER study, looked at data from 34 health systems in the US and found most Long COVID patients to be White, female, non-Hispanic, and likely to live in areas with low poverty and greater access to health care. This pattern suggests that not all patients who have Long COVID are being diagnosed, said Emily Pfaff, Ph.D., a study author, and professor at the University of North Carolina. In addition to long-documented health disparities, women are more likely than men to seek health care, and patients with the time and resources to access health care tend to be disproportionally represented in clinical data. Pfaff also found that patients could be grouped by age and symptoms. Patients with Long COVID had mild COVID-19 symptoms during infection. Gastrointestinal and upper respiratory problems were more likely among children and teenagers. Those aged 21-45 commonly experienced neurological problems, such as brain fog and fatigue. While adults ages 66 and older were more likely to have coexisting conditions. Study authors suspect this is likely due to age rather than COVID-19. However, additional studies are needed to confirm all trends.
“COVID-19 was the first pandemic. Long COVID is the second pandemic related to SARS-CoV-2,” said Krishnan. He points out, “although Long COVID is not infectious (unlike COVID-19), it can lead to disability (short-term, medium-term, or long-term) and prevent someone finishing school or going back to work. According to the CDC, about one in five Americans who had COVID-19 develop Long COVID. Many other infectious diseases (e.g., polio, chickenpox, Giardia) leave a tail of disability – Long COVID is another example of how infections not only lead to an acute illness but can leave some disabled.” While researchers are working with community stakeholders to identify strategies to prevent and treat the long-term effects of COVID-19, we do know that getting vaccinated and following CDC recommendations for boosters can help reduce the severity of COVID-19 and boost the host response.
One of RHA’s Next Generation Advocates, Mia Fritsch-Anderson
Dr. Kalhan additionally serves as director of the Alpha-1-Antitrypsin Deficiency Clinical Resource Center at Northwestern and medical director of the lung volume reduction surgery (LVRS) program. Dr. Kalhan’s clinical interests are in the care of patients with both asthma and COPD as well as alpha-1-antitrypsin deficiency. His research interests relate to respiratory epidemiology, in particular, identification of early risk factors that impact the vulnerability of certain cigarette smokers to develop COPD. He is also involved in clinical trials of new therapies for both asthma and COPD.