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Impact of Long COVID-19 on rural and American Indian-serving primary care practices and their patients in Washington state

Principal Investigator: Patrik Johansson, MD, MPH; Co-Investigators: Justin Denney, PhD and Dedra Buchwald, MD

Rural and American Indian communities experience serious health disparities. Long-standing systemic health and social inequities place many rural residents at increased risk of contracting COVID-19 infection, severe illness, and death. In comparison to their urban counterparts, rural Americans tend to have higher rates of cigarette smoking, high blood pressure, and obesity; less access to health care; and lower rates of insurance coverage, all of which can increase risks associated with COVID-19 infection. American Indians in particular have a higher overall risk for developing severe illness from the virus due in part to the large burden of underlying chronic health conditions such as diabetes, which heightens risk for severe illness from COVID-19. Long COVID-19, defined as persistent or new symptoms that develop at least 4 to 8 weeks after the initial infection, is thought to affect at least 10% of infected individuals. The few rigorous studies on long COVID-19 suggest it confers substantial morbidity and may even contribute to premature mortality months after a patient has recovered from the virus. Due to COVID-19 and access to care-related health disparities, rural and tribal communities may be disproportionately impacted by long-COVID-19. The Northwest Health Education and Research Outcomes Network (NW HERON) is Washington State University’s practice-based research network, comprising 200+ sites across the state. We will survey participating providers and long COVID-19 patients from 10 rural and American Indian-serving NW HERON clinics to examine barriers and facilitators to care for long-COVID-19 patients and the impact of long-COVID-19 on patients, practices, and health care use. Beyond solidifying partnerships with NW HERON practices in Washington, this study will help us expand partnerships with PBRNs in other parts of the country. This activity is the first step in building a multi-state consortium focused on long-COVID-19 in rural and American Indian-serving practices, a necessary step that will make future large-scale funding proposals compelling and competitive.