Long COVID and Health Inequities: The Role of Primary Care

Berger, Zackary; Jesus, Vivian V. Altiery De; Assoumou, Sabrina A; Greenhalgh, Trisha

doi:10.1111/1468-0009.12505

Cited by 114 publications

(91 citation statements)

References 80 publications

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“…Multidisciplinary long COVID clinics are being increasingly introduced by academic medical centers around the country ( 188 , 189 , 190 , 191 , 192 , 193 , 194 ), building on models of cancer survivorship programs. In most areas of the country, however, such programs will not be available and primary care providers do and will continue to play a central role in the diagnosis and management of PASC and ensuring that all patients have equitable access to timely, evidence-based care ( 195 ). Because data on PASC is only beginning to emerge, we recommend all survivors of COVID-19 establish care with a primary care provider and seek timely consultation for any new or persistent symptoms.…”

Section: Discussionmentioning

confidence: 99%

Postacute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 Infection

Jiang

Roy

et al. 2021

JACC: Basic to Translational Science

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Section: Discussionmentioning

confidence: 99%

Postacute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 Infection

Jiang

Roy

et al. 2021

JACC: Basic to Translational Science

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“…Recent data from the Office for National Statistics demonstrated that self-reported long Covid was greatest in people aged 35-69 years, women, people living in the most deprived areas, those in health and social care occupations, and those with another activity-limiting health condition or disability [2]. As for the acute infection, long-term sequelae of Covid-19 infection are strongly impacted by socioeconomic determinants such as poverty and structural inequalities such as racism and discrimination [67], which may affect health beliefs, healthseeking behaviours, or the response of health services. Whilst not directly reported by participants in this study, further work to explore the impact of such determinants on long Covid epidemiology and interactions with health services will be crucial to mitigate the impact of associated disability.…”

Section: Comparison With Previous Empirical Studiesmentioning

confidence: 99%

“I can’t cope with multiple inputs”: Qualitative study of the lived experience of ‘brain fog’ after Covid-19

Callan

Ladds

Hussain

et al. 2021

Preprint

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Objective To explore the lived experience of brain fog i.e the wide variety of neurocognitive symptoms that can follow Covid-19. Design and setting UK wide longitudinal qualitative study comprising online interviews and focus groups with email follow-up. Method 50 participants were recruited from a previous qualitative study of the lived experience of long Covid (n = 23) and online support groups for people with persistent neurological problems following Covid-19 (n = 27). In remotely held focus groups, participants were invited to describe their cognitive symptoms and comment on others accounts. Individuals were followed up by email 4-6 months later. Data were audiotaped, transcribed, anonymised and coded in NVIVO. They were analysed by an interdisciplinary team with expertise in general practice, clinical neuroscience, the sociology of chronic illness and service delivery, and checked by three people with lived experience of brain fog. Results 84% of participants were female and 60% were White British ethnicity. Most had never been hospitalised for Covid-19. Qualitative analysis revealed the following themes: mixed views on the appropriateness of the term brain fog; rich descriptions of the experience of neurocognitive impairments (especially executive function, attention, memory and language), accounts of how the illness fluctuated, and in some but not all cases, resolved, over time; the profound psychosocial impact of the condition on relationships, personal and professional identity; self-perceptions of guilt, shame and stigma; strategies used for self-management; challenges accessing and navigating the healthcare system; and participants search for physical mechanisms to explain their symptoms. Conclusion These qualitative findings complement research into the epidemiology and underlying pathophysiological mechanisms for neurological symptoms after Covid-19. Services for such patients should include: an ongoing therapeutic relationship with a clinician who engages with the illness in its personal, social and occupational context as well as specialist services that are accessible, easily navigable, comprehensive, and interdisciplinary.

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“…Enrollees who were still participating in the program at the time of the data collection are excluded between Black patients and other patients that already exist due to structural injustices (e.g., housing discrimination, limited public transportation) that limit access to primary care, nutritious food, and exercise. [23][24][25][26] We did not ask patients why they chose one program arm over the other, so we do not know if limited access to smart devices, limited internet connectivity, data privacy concerns, 27,28 or other factors impacted their choices. Distrust in healthcare organizations that have mistreated Black patients in the past may contribute to the engagement gap.…”

Section: Discussionmentioning

confidence: 99%