COVID-19 is Not the Same Disease for Everyone

The summer spike in COVID-19 infections, triggered in part by a rise in new variants of the virus, was an unpleasant reminder that COVID-19 is here to stay. As we brace for an anticipated larger wave of COVID-19 cases during the fall and winter respiratory season, healthcare professionals want to remind the public that the virus does not affect everyone equally; some people, because of their age or overall health, may be at greater risk for severe illness.^1,2

Age and other risk factors for severe COVID-19

Age is a major risk factor for severe COVID-19.² As people get older their immune system weakens and they have a harder time fighting off infections, putting them at higher risk for severe outcomes from viruses like COVID-19.² People with severe outcomes from COVID-19 who are at higher risk may need to go to the hospital emergency room (ER) for care; some may need to be admitted to the hospital or even to the intensive care unit (ICU).³ Once admitted, it becomes important to treat them quickly according to COVID-19 treatment guidelines and avoid waiting to see if their symptoms worsen.⁴ Data show that in the U.S. from October 2023 to April 2024, more than 70% of COVID-19-related hospitalizations occurred in people aged 65 and older; this age group also represents more than 81% of COVID-19-related deaths.^2,5

Like the elderly, people who are immunocompromised or are taking medicines that weaken their immune system (such as some cancer treatments) have a higher risk of severe COVID-19 outcomes.² People with certain health conditions, such as chronic lung or heart disease, high blood pressure, obesity, diabetes, and kidney or liver disease, may also be more likely to get very sick from COVID-19.^4,6 In a recent study, 80% of adults hospitalized with COVID-19 from October 2023 to April 2024 had at least two other medical conditions.⁵

With this understanding of how COVID-19 risk factors might affect different people, a team at Gilead Sciences was keen to understand if there were other ways COVID-19 affects people differently. In partnership with The Harris Poll, the team conducted a survey in the U.S. among 3,000 non-Hispanic White, non-Hispanic Black, and Hispanic adults aged 18 years and older who were diagnosed with COVID-19 or long COVID in the past year.⁷

Survey uncovers racial and ethnic differences in COVID-19

Results of the Harris Poll survey, conducted from March 12 to April 1, 2024, suggest that COVID-19 is not just one disease.⁷

Black and Hispanic people who developed COVID-19 or long COVID (a condition in which symptoms can last for weeks, months, or years after a COVID-19 infection) were more likely to experience certain symptoms than White people, such as chronic chest pain or pressure, but less likely to have other associated symptoms, such as fever, fatigue, sore throat, and headache.⁷ The researchers also assessed the severity of symptoms and found that Hispanic people were more likely than White people to have reported either somewhat or very severe symptoms at the start of their illness.⁷

Gaps in access to healthcare

The survey highlighted disparities in accessing healthcare and its impact on both the severity of COVID-19 and long COVID and how it is treated by healthcare providers.^7,8,9 Hispanic people who developed COVID-19 or long COVID reported having more difficulty accessing care, and both Black and Hispanic people were more likely to receive special medications and early oxygen support, compared with White people.⁷

When asked what factors influenced their care, Black and Hispanic people were about five times and four times more likely, respectively, to report receiving different healthcare based on their race or ethnicity, and about three and two times more likely, respectively, to perceive racial or ethnic discrimination during their medical care, compared with White people.⁷

"Minorities often face cultural, economic, and geographical barriers that may make it harder to obtain healthcare for COVID-19 or long COVID. Delays in receiving needed medical care may worsen a person's existing condition and put them at higher risk of severe illness," said Dr. Anu Osinusi, Vice President, Clinical Research for Hepatitis, Respiratory and Emerging Viruses at Gilead. "Understanding the root causes of racial and ethnic disparities in COVID-19 is crucial for improving care and reducing the high burden of the disease among minority populations."

To address these inequities, it is important to continue working with communities and influential leaders within these communities to provide the most recent information about COVID-19 and how the disease impacts its members. Gilead's focus is to evaluate and communicate barriers to healthcare access and equity. The company works with organizations around the world to improve access to care, particularly in communities who are disproportionately impacted by COVID-19 and other diseases.

The bottom line

• Know your risk for getting very sick, and potentially hospitalized, from COVID-19 and consider testing if you are showing symptoms
• Do not delay — seek medical care immediately if your COVID-19 symptoms worsen. Treatments are available that can help reduce your risk of hospitalization and/or death from COVID-19.⁵

For more information, please visit Springer Nature.

References

1. "Covid-19 Can Surge throughout the Year." Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, www.cdc.gov/ncird/whats-new/covid-19-can-surge-throughout-the-year.html. Accessed 12 Nov. 2024.
2. "People with Certain Medical Conditions and COVID-19 Risk Factors." Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, www.cdc.gov/covid/risk-factors/index.html. Accessed 12 Nov. 2024.
3. "Covid-19 - Know When to Go to the ER." COVID-19 - Know When to Go to the ER, www.emergencyphysicians.org/article/covid19/covid-19-know-when-to-go. Accessed 12 Nov. 2024.
4. "Underlying Conditions and the Higher Risk for Severe COVID-19." Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, www.cdc.gov/covid/hcp/clinical-care/underlying-conditions.html?CDC_AAref_Val=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fhcp%2Fclinical-care%2Funderlyingconditions.html. Accessed 12 Nov. 2024.
5. "Covid-19–Associated Hospitalizations among U.S. Adults Aged ≥18 Years - Covid-Net, 12 States, October 2023–April 2024." Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 3 Oct. 2024, www.cdc.gov/mmwr/volumes/73/wr/mm7339a2.htm#:~:text=Among%20this%20sample%20of%20adults,and%206.9%25%20died%20during%20hospitalization.
6. "COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines." National Institutes of Health. Available at https://www.covid19treatmentguidelines.nih.gov/. Updated February 29, 2024.
7. Oppelt, T.F., Polsonetti, B., Caron, M.F. et al. Patient Perceptions of their COVID-19 Inpatient Hospital Experience: a Survey Exploring Inequities in Healthcare Delivery. J. Racial and Ethnic Health Disparities 10, 2775–2782 (2023). https://doi.org/10.1007/s40615-022-01454-9
8. Zhang, Jin-Jin et al. "Risk and Protective Factors for COVID-19 Morbidity, Severity, and Mortality." Clinical reviews in allergy & immunology vol. 64,1 (2023): 90-107. doi:10.1007/s12016-022-08921-5
9. "Long Covid Basics." Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, www.cdc.gov/covid/long-term-effects/index.html. Accessed 12 Nov. 2024.