The study addresses the significant public health concern of long-term symptoms (Long COVID/PASC) following COVID-19 infection. While initial research focused on fatigue and anosmia, cognitive and psychiatric symptoms are now recognized as important components of Long COVID/PASC. Evidence suggests that SARS-CoV-2 can directly infect the central nervous system (CNS) or indirectly cause neurological complications through immune response or other mechanisms. The study emphasizes the importance of considering individual differences, especially social determinants of health like perceived discrimination and economic stress, as factors influencing the risk and severity of Long COVID/PASC. Discrimination acts as a barrier to healthcare, increases chronic stress (allostatic load), and elevates susceptibility to negative health outcomes. The study aimed to investigate the prevalence, impact, and social determinants of lasting symptoms in a large sample of COVID-19 patients months after recovery, comparing early and late infection cases, and testing the hypothesis that discrimination contributes to illness severity and lingering symptoms.

Existing research highlights the prevalence and variety of long-term COVID-19 symptoms, including fatigue, post-exertional malaise, cognitive dysfunction, and neurological complaints. Studies have shown lasting symptoms even in mild cases, with impacts on respiratory, gastrointestinal, pulmonary, and neurological systems. International studies and analyses of electronic health records confirm the widespread nature of these long-term effects. Neurological changes, including reduced brain volume and neurocognitive decline, have been observed in post-COVID-19 individuals. Studies have explored potential mechanisms, including direct CNS infection by SARS-CoV-2 and indirect effects via inflammation and immune responses. However, prior research has largely neglected the role of social determinants of health, especially perceived discrimination and economic stress, in influencing Long COVID/PASC outcomes. The need to address these factors is underscored by the disproportionate impact of COVID-19 on minority groups.

This study employed a cross-sectional design using data from 1,584 recovered COVID-19 patients (from an initial pool of 236,237) recruited via email from the NYU Langone Health system. Participants completed a 15-minute survey between February 23, 2021, and April 4, 2021, receiving a $25 gift card as compensation. The survey collected detailed medical and psychosocial information including sociodemographic characteristics, illness severity, lasting symptoms, perceived discrimination, stress levels, and perceived quality of medical care. The study compared patients infected early versus late in the pandemic (using April 8, 2020, and January 7, 2021, as dividing points). Path analyses were used to examine associations between discrimination, illness severity, and lasting symptoms, controlling for sociodemographic factors and health comorbidities. Secondary analyses explored sex differences, timing of infection, prior mental health problems, and the role of perceived quality of medical care. Post-hoc logistic regressions examined the predictive value of social determinants for neurological, cognitive, or mood symptoms. Measures of objective and perceived socioeconomic status (SES) were created using composite variables. All analyses controlled for potential confounders. Statistical analyses were performed using Mplus v8, employing full information maximum likelihood (FIML) to handle missing data. Bootstrap methods were used for mediation analyses.

70.6% of participants reported one or more lasting symptoms after recovery from COVID-19. 19.4% reported lasting mood problems, and 25.1% reported cognitive/memory problems. Perceived discrimination was a significant predictor of increased illness severity and a higher number of lasting symptoms, even after controlling for sociodemographic factors and comorbidities. This effect was specific to stress from discrimination, not general stress. Perceived quality of medical care significantly modified the association between discrimination and illness outcomes, with many paths becoming nonsignificant in the high-quality care group. Early infection was associated with more severe illness and more frequent lasting complaints. Post-hoc analyses showed that discrimination frequency predicted lasting neurological symptoms, and perceived (but not objective) SES predicted lasting cognitive complaints. The study highlights the importance of both objective measures of illness severity and subjective patient reports. The prevalence of Long COVID/PASC in this study was slightly lower than that reported elsewhere, potentially due to the inclusion of patients with mild to severe illness and the use of direct patient reporting. Individuals reporting lower perceived socioeconomic status were significantly more likely to report lower care quality.

The findings demonstrate a strong association between perceived discrimination and worse COVID-19 outcomes, highlighting the importance of considering social determinants of health when addressing Long COVID/PASC. The specific role of stress related to discrimination, as opposed to general stress, underscores the need for targeted interventions. The moderating effect of perceived quality of medical care suggests that improving healthcare access and quality may mitigate the negative impact of discrimination. The study's limitations include its cross-sectional design, which prevents causal inference, and reliance on self-reported data. Future research should explore longitudinal designs, biological mechanisms, and culturally-sensitive interventions to address the disparities in Long COVID/PASC outcomes.

This study confirms the high prevalence of lasting symptoms after COVID-19 and identifies perceived discrimination and socioeconomic status as significant risk factors. The findings underscore the need for equitable access to quality healthcare and culturally sensitive interventions to address the health disparities associated with Long COVID/PASC. Future research should focus on longitudinal studies to establish causality and explore effective interventions. The importance of acknowledging patient perspectives and experiences is crucial in addressing the challenges associated with Long COVID/PASC.

The cross-sectional design limits causal inferences. Self-reported data may be subject to recall bias and response bias. The sample, while large, may not be fully representative of all populations affected by COVID-19. The study's focus on perceived discrimination and SES, rather than objective measures, may introduce subjectivity into the analysis.