A Breakdown of the Many Manifestations of Long-Haul COVID-19

Health Disparities in Long-Haul Patients

Elmhurst Hospital in Queens, New York, was one of the hardest-hit hospitals in the early days of the COVID-19 pandemic. The hospital is part of a diverse community, where 140 different languages are reportedly spoken. The community is also home to many of the frontline workers (including service people, transit workers, and healthcare workers) who were hit hardest at the beginning of the pandemic. Many of the patients who were served by Elmhurst Hospital did poorly because they had a variety of undiagnosed medical problems.

“We’re playing catch-up in addressing [the chronic health disparities] that have existed in these more diverse underserved communities,” noted Diana Kirke, MBBS, MPhil, who works at Elmhurst Hospital one day a week. It was being reported that many of the patients who died at Elmhurst hospital had no prior medical conditions, but that wasn’t true, said Dr. Kirke. “Many of these people had undiagnosed chronic conditions such as diabetes and cardiovascular disease, and they did not have the time to seek medical care for these conditions.” With the return of the pressure on the hospital systems, she noted, “we are again seeing treatment delays and an interruption in elective cases.”

In San Francisco, where José Gurrola II, MD, an associate professor in the department of otolaryngology–head and neck surgery at the University of California, San Francisco (UCSF), practices, there is a wide socioeconomic divide. “One aspect of the pandemic that our colleagues at UCSF discovered is the fact that there were larger numbers [of patients from underserved communities] who had COVID-19. There’s probably a large number of [underserved] people out there who are still not seeking treatment for long-haul COVID-19 issues, such as loss of smell and taste.”

Patricia Loftus, MD, an assistant professor in the rhinology and skull base surgery division in the department of otolaryngology–head and neck surgery at UCSF, also works at Zuckerberg Hospital, a San Mateo County clinic that caters to an underserved population. “I believe that I have seen more patients at the Zuckerberg clinic with COVID-19-related loss of smell, but they note this symptom as a sidebar and not as their primary reason for seeking ENT help. I think these patients aren’t as aware of the risk of smell loss with COVID-19 and that the earlier they seek treatment, the better,” she said.

“In contrast,” she continued, “I am seeing my faculty practice patients [earlier in their course of disease] because they are able to advocate for themselves. So there have definitely been disparities, not only regarding how many people have been infected, but also among those who seek out treatment and seek it out in a timely manner.”

Dr. Gurrola believes the role of the otolaryngologist is vital in reaching these patients. “It is on us to try and ensure that we continue to increase awareness amongst our patient population and our primary care providers about these significant, albeit less severe, sequelae that are best treated early,” he said.