Links between Long COVID Rooted in Social and Health Inequalities

The Distilled Post Editorial Team

Studies published by the NHS and the US’s National Institute of Health show that patients from minority backgrounds are more likely to experience debilitating rates of long-COVID. 

Black and Asian patients were revealed to be more likely than their white counterparts to experience more serious symptoms. These include Additionally, some people who had covid early in the epidemic may have long covid but not be diagnosed as such because of coding changes.

Long-COVID: Three Years On

Long COVID is a phenomenon that has emerged in the wake of the COVID-19 pandemic. It refers to a range of symptoms that persist long after the initial infection has cleared. The symptoms can be severe and debilitating, affecting a person's physical, mental, and emotional health.

While long COVID is a relatively new concept, there is growing evidence to suggest that certain groups are more likely to develop it than others. In particular, there is concern that people from ethnic minority backgrounds may be at a higher risk of developing long COVID, and that racism may be a contributing factor. Mitchell Elkind, professor of neurology and epidemiology at Columbia University Medical Center in New York and chief clinical officer of the American Heart Association, said:

“New evidence suggests that there may be important differences in how long covid manifests in different racial and ethnic groups. Further research is needed to understand better the mechanisms for these differences in symptoms and access to care, and also if diagnostic codes assigned by clinicians may play a role.”

How is Race Related to Long-COVID?

There are several reasons why racism may be linked to long COVID. Firstly, people from ethnic minority backgrounds are more likely to have underlying health conditions that can make them more vulnerable to COVID-19 in the first place. For example, Black people are more likely to have high blood pressure, diabetes, and obesity than white people, all of which can increase the risk of severe COVID-19.

Secondly, people from ethnic minority backgrounds may be more likely to work in jobs that put them at greater risk of exposure to the virus. This includes roles in healthcare, public transport, and retail, which have been deemed essential during the pandemic.

Thirdly, racism can have a significant impact on a person's mental and emotional health. Studies have shown that experiences of racism can lead to increased levels of stress, anxiety, and depression. This can have a negative impact on a person's immune system, making them more susceptible to infection and less able to fight off illness.

Finally, there is concern that racism may impact the way that long COVID is diagnosed and treated. People from ethnic minority backgrounds may be less likely to seek medical help due to mistrust of healthcare providers, language barriers, or fear of discrimination. They may also be less likely to receive an accurate diagnosis or appropriate treatment due to unconscious bias or systemic racism within healthcare systems.

Effect on Care Pathways 

The diversity of symptoms means that long COVID patients may require multiple appointments and tests, which can create a significant burden on healthcare services. Patients may also require ongoing care and support, which can place additional demands on community healthcare services. For systems and organisations located in areas of high deprivation and low resource, this can be challenging. 

In particular, they are faced with overcoming the variability in how patients experience the condition. Some patients may recover relatively quickly, while others may experience symptoms for many months. This means that care pathways need to be flexible and responsive to individual patient needs, which can be difficult to achieve within existing healthcare structures. Indeed, when considering the breadth of how Long-COVID can present across minority populations, it is no surprise that organisations are finding it difficult to step up to the plate. 

The impact of long COVID on healthcare services is also reflected in the wider healthcare system. Long COVID is likely to increase the demand for healthcare services, which are already under pressure due to the backlog of routine and elective care caused by the pandemic. The condition may also impact the provision of other services, such as mental health and social care.

In response to these challenges, the NHS has developed a range of initiatives to support long COVID patients. These include the establishment of specialist long COVID clinics, the development of guidance for healthcare professionals, and the provision of ongoing support for patients through community services.


It is essential that we address the link between long COVID and racism if we are to tackle this issue effectively. This requires a multi-faceted approach that addresses the underlying social and economic inequalities that drive health disparities. We need to ensure that everyone has access to quality healthcare and that healthcare providers are trained to recognize and address the unique needs of diverse patient populations. We also need to tackle racism head-on, both within healthcare systems and in society as a whole.

In conclusion, long COVID is a complex issue that requires a nuanced understanding of the social, economic, and political factors that contribute to health disparities. Racism is just one of these factors, but it is an important one that must be addressed if we are to ensure that everyone has access to the care and support they need to recover from this debilitating condition.