Long COVID Illness: Disparities in Understanding and Receipt of Care in Emergency Department Populations - 24/09/24

Doi : 10.1016/j.annemergmed.2024.07.009

Robert M. Rodriguez, MD ^a,^⁎ , Karen Reyes ^b, Vijaya Arun Kumar, MD, MPH ^c, Brian Chinnock, MD ^d, Stephanie A. Eucker, MD, PhD ^e, Kristin L. Rising, MD, MSHP ^f, Zubaid Rafique, MD ^g, Michael Gottlieb, MD ^h, Graham Nichol, MD, MPH ⁱ, Dana Morse, BSN ⁱ, Melanie Molina, MD, MAS ^a, Mireya I. Arreguin ^a, Lindsey Shughart ^f, Christopher Conn ^c, Svea Eckstrand ^j, Heba Mesbah, MD ^g, Lauren Chakraborty ^k, Robert D. Welch, MD ^c
^a Department of Emergency Medicine, University of California, San Francisco, CA
^b School of Medicine, University of California, San Francisco, CA
^c Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI
^d Department of Emergency Medicine, University of California, San Francisco, Fresno, CA
^e Department of Emergency Medicine, Duke University, Durham, NC
^f Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA
^g Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX
^h Department of Emergency Medicine, Rush University Medical Center, Chicago, IL
ⁱ University of Washington-Harborview Center for Prehospital Emergency Care, Seattle, WA
^j School of Medicine, Duke University, Durham, NC
^k School of Medicine, Rush University, Chicago, IL

^∗Corresponding Author.

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Abstract

Study objective

Most long coronavirus disease (long COVID) studies rely on traditional surveillance methods that miss underserved populations who use emergency departments (EDs) as their primary health care source. In medically underserved ED populations, we sought to determine (1) whether there are gaps in awareness and self-declared understanding about long COVID illness, and (2) the prevalence, impact on school/work attendance, and receipt of care for long COVID symptoms.

Methods

This study was a cross-sectional, convenience sample survey study of adult patients at 11 geographically representative US EDs from December 2022 to October 2023. Awareness and self-declared understanding about long COVID illness were measured. Prevalence, impact on school/work attendance, and receipt of care for long COVID symptoms were also assessed.

Results

Of 1,618 eligible patients, 1455 (89.9%) agreed to participate, including 33.4% African Americans and 30.9% Latino/a. Of the patients, 17.1% lacked primary care. In total, 33.2% had persistent COVID-19 symptoms lasting >1 month, and 20.3% had symptoms >3 months. Moreover, 49.8% with long COVID symptoms missed work/school because of symptoms; 30.3% of all participants and 33.5% of participants who had long COVID symptoms had prior awareness and self-declared understanding of long COVID. Characteristics associated with poor understanding of long COVID were African American race (adjusted odds ratio [aOR] 3.68, 95% confidence interval [CI] 2.66 to 5.09) and Latino/a ethnicity (aOR 3.16, 95% CI 2.15 to 4.64). Participants lacking primary care were less likely to have received long COVID care (24.6% versus 51.2%; difference 26.6%; 95% CI 13.7% to 36.9%).

Conclusions

Despite high prevalence and impact on school/work attendance of long COVID symptoms, most of this ED population had limited awareness and self-declared understanding of long COVID, and many had not received care. EDs should consider the development of protocols for diagnosis, education, and treatment of long COVID illness.

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Plan

Introduction

Background

Methods

Study Design and Setting

Survey Instrument Development

Screening and Participants

Survey Administration

Outcomes and Analysis

Sample Size and Per-Site Enrollment

Results

Limitations

Discussion

	Please see page XX for the Editor’s Capsule Summary of this article.
	Supervising editor: Gillian R. Schmitz, MD. Specific detailed information about possible conflict of interest for individual editors is available at editors.
	Author contributions: RR, KR, VK, BC, SE, KR, ZR, MM. and MG designed the study; all authors participated in data acquisition; RR, KR, and RW analyzed and vouch for the analysis; RR, KR, and RW wrote the primary draft with review and revision of other authors; and RR had the primary responsibility for manuscript submission decisions and takes responsibility for the paper as a whole.
	Data sharing statement: Partial or complete datasets and data dictionary are available year on request and to the discretion of Dr. Robert Rodriguez at email Robert.rodriguez@ucsf.edu.
	All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
	Funding and support: By Annals’ policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). This study was conducted without financial support. Drs. Rodriguez and Molina have received grants from the National Institute of Allergy and Infectious Diseases and Pfizer Inc. for other research on COVID-19 and influenza vaccine messaging. The authors have no conflict of interest relevant to this article to disclose.