Commercial
Supported by
Guest essay
Send a story to any friend.
As a subscriber, you have 10 gift pieces to offer per month. Everyone can read what you share.
By Daniela J. Lamas
Dr. Lamas, an opinion writer, is a pulmonary and care physician at Brigham and Women’s Hospital in Boston.
Two years ago, at the height of the Covid pandemic, my colleagues and I told what now turns out to be a naïve story.
As a result of this virus, we would expand a physically powerful formula of follow-up care for patients who had been sickest in our hospital, many of whom came from medically underserved communities. We knew that survivors of serious illness and prolonged hospitalizations were most likely affected by the involuntary legacy of extensive care, called post-extensive care syndrome: anxiety, depression, post-traumatic stress and cognitive dysfunction. Not to mention scarring in the lungs and deep weakness that can arise from weeks of ventilation.
With this in mind, we have developed the Covid Recovery Center, a clinic, like many others across the country, committed to the care of patients with Covid-19 and its aftermath. The maximums affected by this disease would really gain advantages from compromised detection. and follow-up that could not be given otherwise.
And yet, when it opened, the clinic was flooded with self-referrals from patients who had not been hospitalized. Instead, they were experiencing what we now call “long covid”: a constellation of debilitating fatigue, shortness of breath, neurological symptoms, and more. That can happen even after a mild infection.
Many came to the clinic desperate. Their symptoms — heartbeat and brain fog so devastating they couldn’t work — needed treatment. English-speaking patients who had been transferred to us from hospitals in outlying communities.
“You have to be very intentional in making efforts to succeed in certain patient populations, barriers like language and transportation,” said Dr. Brown. Elizabeth Gay, who runs the center. To that end, she and her team partnered with network organizations to spread the word.
However, of the more than 1200 patients seen at our clinic between April 2021 and April 2022, nearly 80% were white and just over 70% were women. On the contrary, it seemed that those we treated in the hospital, namely the first pandemic wave, were disproportionately black and Hispanic men. “Looking at the data, we know we don’t see patients who have gone through the bulk of covid hospitalizations,” Dr. Gay told me.
My experience at the hospital is far from unique. I’ve heard stories of doctors concerned about post-covid patients across the country, from New York to California. Those who have been severely affected by this virus in acute conditions are very underrepresented. in specialized Covid follow-up care.
Here are two separate but similar disorders. One is how it is more effective to care for those who were in poor enough health to undergo long hospitalizations but, for unclear reasons, seem less likely to live long with Covid (or at least are not among the long-term covid patients who get appointments). The other question is whether the long-term burden of covid is felt, but not addressed, in minority populations. How can we ensure that those who have borne the brunt of this disease have a better productive chance of thriving in the future?
At the University of California, Los Angeles, Dr. Nisha Viswanathan finds that she disproportionately cares for long-term Covid patients in her post-Covid clinic who are thriving and can navigate the healthcare formula and, in some cases, may even make staffing arrangements. jets to fly from their homes in Ángeles. Si Los Covid-19 was a disease of the vulnerable, tracking Covid has become a luxury for the well-off. These are patients who may call the clinic repeatedly, waiting for an area to be available, who can take days off for pulmonary rehabilitation and other appointments. “How do you provide care to the neediest people when you have this competitive crowd?”Dr. Viswanathan asked.
This is troubling given the knowledge of his own institution, which interviewed covid patients after they were discharged from the hospital, which found that black and Hispanic patients had persistent symptoms such as fatigue and shortness of breath at a rate similar to that of their white peers. While expectations Although the formula for health care and disease differ across cultures, inequalities in access to health care could have an effect on patients’ seeking care. The suffering is there.
In fact, at Montefiore Medical Center’s Covid-19 Recovery Clinic in New York, covid has long been a disease of privilege. At the Bronx clinic, the population reflects the diversity of the surrounding community: a portion of patients are Hispanic. , a black quarter and about 15% white. Thanks to doctors who know the demanding situations of navigating Medicaid, those patients are referred to physical therapy and subspecialists who can access.
But even then, it remains a challenge to bring back to the clinic others threatened by extensive aftercare syndrome. “What happened to all the critically ill patients who needed to come to our clinic?” asked Dr. Brown. Marjan Islam, an extensive care physician who co-runs the Covid-19 recovery clinic. “They have to have suppliers somewhere. But where are they now?
While investment in studies by the National Institutes of Health has partly led hospitals to build clinics for those who have long suffered from Covid, there haven’t been the same incentives to care for patients with subsequent intensive care syndrome. As a result, even clinics established after intensive care, such as the one run by Dr. Anna S. Dr. Carla Sevin at Vanderbilt in Nashville, continues to fight for patients to be seen in a timely manner.
“These patients are young and incredibly weakened, and they come to me six months late, because we don’t have the resources to track and schedule them, so they go unnoticed,” Dr. Sevin said. “Yes, we have a new problem, the long Covid, but we also have an old problem, post-intensive care syndrome, which still does not attract attention, although many other people are suffering from it now. And it’s a parody. “
In a way, none of this applies to Covid-19. Unfortunately, chronic disease care has long been the goal of the wealthy. The same goes for physical therapy, psychiatry, and subspecialists who can make the difference between surviving a catastrophic illness and thriving.
But there is another layer of complexity that is unique to the sequelae of this virus, and that is that, whether for subsequent intensive care syndrome and prolonged Covid, more studies on remedies are needed. A lot of what we’re offering now is education. and tranquility. Determining whether and how we can help can only be done through efforts of considered studies with a diversity of participants whose demographics actually reflect the burden of this disease.
In each and every case, Covid-19 has exposed the flaws in our healthcare formula and in society. Not surprisingly, post-virus care threatens to further entrench pre-existing disparities.
But that’s not the case. The narrative of this pandemic and what happens afterwards is still ongoing. And if it is not enough to recognize and recognize these inequalities, it is an obligatory start.
Daniela J. Lamas (@danielalamasmd), editor, is a pulmonary and care physician at Brigham and Women’s Hospital in Boston.
The Times is committed to publishing a series of letters to the editor. We’d love to hear what you think of this article or any of our articles. Here are some tips. And here’s our email: lettres@nytimes. com.
Follow the New York Times Opinion segment on Facebook, Twitter (@NYTopinion) and Instagram.
Commercial