Post-acute neurological consequences of COVID-19: an unequal burden

Appropriate healthcare insurance coverage will eliminate an important barrier to access to neurological services^16,17. In the United States alone, most of the 31 million uninsured adults forego diagnostic and treatment opportunities because of financial concerns. Universal healthcare has been proposed by the World Health Organization to allow people to have access to the health services that they need without financial hardship, and should be supported by the neurology community, whose members can learn about and engage in efforts that define a path to universal healthcare^17,18,19.

In countries without universal healthcare, there is an urgent need for medical care and support services for patients with COVID-19, many of whom face financial barriers to healthcare. The US government has allocated government funds toward COVID-19 testing and vaccination efforts, but there is a gap in funding for post-acute COVID-19 clinical services, including physical rehabilitation, mental health, home health, long-term care and other health services often not covered by health insurance. A successful example of a comprehensive model of care is the United States’ Ryan White HIV/AIDS Program, a discretionary measure created three decades ago in the face of another public health crisis²⁰. The Ryan White Program collaborates with a broad array of stakeholders at the federal, state and local levels, including community-based organizations, working together to implement public health interventions that aim to prevent and reduce transmission of HIV, improve clinical care and achieve positive health outcomes, while addressing the disproportionate impact of HIV on the Black, Latino, Indigenous and uninsured communities.

Black, Latino and Indigenous people are overrepresented as essential workers, with low-paying jobs, lack of adequate benefits such as paid leave and limited access to personal protective equipment, all of which contribute to a disproportionate impact from COVID-19, including its neurological sequelae. Research to understand the acute and post-acute neurological consequences of COVID-19 should be centered in the experiences and lives of people. Patient-centered research will require a commitment to dismantling the systemic forms of oppression that have led to disparate suffering among marginalized communities well before this pandemic. This starts with naming racism and engaging in anti-racist solutions to achieve health justice in and beyond neurology, including increasing access to quality neurological evaluations, treatments and research options. Prioritizing equity today will improve the delivery of neurological care far beyond this pandemic.