Long COVID hits poor and middle income Americans harder than the rich
After COVID-19 left him gasping for breath in a hospital bed, after his kidneys failed and his lungs filled with fluid and his heart almost gave out, Rick Henline set what he believed were some realistic goals for his recovery.
First among them was walking again. He wanted to stand on his own and traverse the roughly 20 feet from the family room to the kitchen in his Fort Thomas apartment. In time, he hoped, he’d drive a car, go grocery shopping and do some traveling with his wife, Teda.
This is how Rick thought about life after COVID three years ago. Today, sitting in his medical lift chair in his apartment, braces on his legs and a walker at his side, he is less ambitious.
‘There’s a lot we don’t know.’At 400 million patients and counting, long COVID remains a mysterious affliction
He pointed to a cane leaning against the wall a few feet away.
“Now,” he said. “I’m hoping I can someday use that thing.”
Rick’s COVID journey has been more difficult than most, but he shares a bond with other working class and poor survivors who continue to struggle for months or years after their initial infection. Many suffer an array of symptoms, including fatigue, breathing problems and debilitating pain, that have come to be known as “long COVID.”
While the condition can afflict anyone and can be life-altering regardless of a person’s wealth, a growing body of evidence suggests that those in the low- and middle-income brackets are more likely to develop long COVID, to suffer longer with its symptoms and to endure job loss, eviction and other serious consequences because of it.
Before he got sick, Rick, 70, and Teda, 71, lived on about $60,000 a year from her Social Security check and his work at a truck parts factory. That’s roughly 300% above the federal poverty line – not poor, but on the edge of middle class for a two-person household.
They were comfortable, Rick said. They rented a nice house, enjoyed the occasional night out with friends and saved what they could in hopes he’d soon join his wife in retirement.
But the COVID-19 pandemic created risks for the Henlines that not all Americans faced.
The lower the income, the greater the risk
The Centers for Disease Control and Prevention last year found that people at the Henlines’ income level are about 25% more likely to develop long COVID than those who earn more.
A U.S. Census survey last year made a similar connection: The poorer the household, the greater the chance it was home to a long COVID sufferer.
The reason for the disparity is unclear. But physicians, activists and public health officials suspect lower income people suffer more from long COVID for the same reason they suffer more from heart disease, diabetes and other ailments. They have less access to all the things that contribute to good health, from quality medical care and insurance to healthy food and affordable housing.
“It makes sense,” said Sarah Mills, who has led nonprofits dedicated to expanding health care access in Cincinnati and Columbus. “They don’t have the resources that people in higher income groups have.”
When the pandemic began, many public health officials predicted those with less would suffer most. They’d seen it before, in pandemics throughout history, and saw no reason COVID would be different.
“That’s exactly the way it played out,” said Richard Becker, the physician who leads the University of Cincinnati’s long COVID clinic.
Long COVID, though, was an unexpected legacy of the pandemic. While COVID is caused by a virus, the cause of long COVID symptoms that linger after the virus is gone is more mysterious. The only certain connection is a previous COVID infection, but the severity and symptoms vary widely from patient to patient.
For the Henlines, long COVID changed everything. They now spend thousands of additional dollars a year on medical care and have taken on debt. They moved to a small apartment that’s more accessible for Rick. They rarely venture out together for anything other than church or appointments with doctors and physical therapists.
Like millions of Americans, the Henlines walked a fine line for years between doing well and struggling. COVID, and now long COVID, knocked them off balance.
They’re trying to get back what they lost, both financially and, in Rick’s case, physically. But long COVID is as unpredictable as it is destructive.
Every day brings new challenges.
“I’ve been dealt the cards,” Rick said. “I’m determined to play the cards as well as I can.”
Every movement, every task is harder than it was
Rick, an Army veteran, goes at least once a week to physical therapy sessions at the VA Medical Center in Fort Thomas. On a Wednesday in early October, he arrived with Teda to find his therapist, Lisa Tagariello, waiting for him at the parallel bars.
She rolled his chair between the bars and handed him a TV remote control. His mission on this day was to stand and alternate placing the remote on tables to his left and right, using the bars when necessary to steady himself.
“Take your time,” Lisa said.
Picking up and moving a TV remote is not something Rick would have thought twice about before he got sick. But these days, every movement, every task, requires careful planning and effort.
He pressed down on the arms of his chair and rose to his feet, shakily, and began turning left to right and back again. After about a half dozen times, he struggled to catch his breath.
“That was hard,” he said, chest heaving. “I need to sit.”
For Rick, this was progress. The goal, every week, is to do a little better than the week before. Stand a few seconds longer without holding the bars. Do one more lap around the room with his walker.
It may not seem like much, but it feels to Rick a world away from where he was when he returned home in 2021 after 297 days in a hospital and rehabilitation facility. Most people who got as sick from COVID as Rick didn’t survive.
Rick and Teda believe he caught the virus at work. Truck parts can’t be assembled remotely, so when millions of Americans began working from home early in the pandemic, Rick kept going to the factory.
The risk was greater than he realized. During the first year of the pandemic, according to a University of South Florida study, working-class Americans died at five times the rate of those with higher incomes, most likely because in-person work increased their risk of exposure and infection.
One of Rick’s jobs was to take the temperature of his fellow workers in the morning as they entered the building. In the absence of vaccines and reliable tests, this was how many employers tried to keep infected workers from infecting others.
For Rick, it meant he’d be exposed to every person who walked in the door.
“You’re probably the person most likely to get it,” a coworker told him.
‘Your husband is very sick’
On Memorial Day weekend 2020, Rick came down with a fever. He stopped eating a few days later and, not long after, had trouble breathing. Teda called an ambulance, but the driver, who was wearing a protective suit, was so terrified of getting COVID he refused to help Rick down the steps.
Teda got Rick to the car herself and drove him to the emergency room. When they arrived, someone asked Rick if he was well enough to make his own medical decisions. Rick said yes and passed out.
“I don’t remember anything else,” he said.
The weeks and months that followed were a blur. Teda couldn’t see him in person for two months because of isolation rules, but she knew he was in bad shape. Rick entered Christ Hospital’s critical care unit and remained in a medically induced coma for almost a month.
“Your husband is very sick,” his respiratory therapist told Teda. “We’re doing everything we can.”
It almost wasn’t enough. Rick suffered a heart attack, organ failure, pneumonia in both lungs and chronic infections. Teda, who got COVID but never became seriously ill, talked to his nurses every morning and evening. She wrote down his vital statistics, like his temperature and oxygen saturation, and studied them for signs of trouble or glimmers of hope.
When she saw him in person for the first time, 52 days after she took him to the hospital, Rick looked like a stranger. He was on dialysis and, for reasons no one fully understood, he could barely move his arms and legs.
Coming in and out of consciousness, Rick couldn’t comprehend what was happening. At the time, he said, he thought he couldn’t move because the nurses and doctors had put him in restraints, not because his arms and legs weren’t working properly.
Almost as bad for Rick, who thrived on good company and conversation, was the tracheostomy tube that prevented him from speaking. Teda brought a pen and paper to his bedside, hoping that would help.
“He couldn’t even hold the pen,” she said.
A mounting physical and financial toll
The evidence of Rick’s long, slow recovery is scattered around his apartment. Empty pill bottles on the kitchen counter. Braces and walking devices next to his chair. His daily medications – almost a dozen – on a portable table.
Before COVID, Rick had been treated for some heart issues but otherwise was healthy. Now, he suffers from kidney disease, diabetes, worse heart problems and continuing difficulty with movement. All those conditions have been linked to long COVID, but Rick’s case is extreme. Rarely does someone suffer so many, so severely, for so long.
“I’ve been told I can’t donate my organs to anybody but ‘Ripley’s Believe it or Not,’” Rick said.
His sense of humor remains in excellent shape. But Rick and Teda both worry about the toll his illness has taken on him and on their plans for a life together in retirement.
They are not alone among long COVID sufferers. A National Institutes of Health study last year found people with long COVID were nearly twice as likely as those without to experience problems with household expenses and housing costs.
And according to the Center for Economic and Policy Research, people who earn less than $50,000 a year are twice as likely as those who earn $100,000 a year to suffer severe long COVID symptoms.
“I can’t tell you how many people are couch surfing or living in cars,” said Delainne Bond, a Florida nurse who created the COVID-19 Long Haulers support group on Facebook. “You worry about making ends meet. You worry about being homeless.”
The Henlines know this, which is why they consider themselves fortunate, despite everything they’ve gone through. They borrowed some money when they moved to the apartment and still have more debt than they’d like. They’ve spent about $40,000 out of pocket since Rick got sick and still spend about $4,000 a year on prescriptions.
They are grateful, though, to have the apartment, a car and Medicare. Rick’s employer insurance covered most of his hospital stay and the VA covers his physical therapy. They are doing OK, Teda said.
“We’ve had struggles,” she said. “But we’re right at a little below comfortable.”
Many long COVID questions, but few answers
The wall of the Henlines’ dining room is covered with photos and mementos from their more than three decades together. In some, they are with friends. In others, it’s just the two of them. In all, they seem to be having a great time.
One framed image looks like a comic book cover – “The Adventures of Rick Danger” – and features a computer-generated photo of Rick in a purple and gold superhero costume.
“This is our fun wall,” Teda said. “You can see we’re serious people.”
The wall no longer is just a way to remember good times. It is aspirational. Rick and Teda want this life back. They want to go out, to have fun, to live their lives the way they’d planned in their retirement.
Rick will tell anyone who asks that he is lucky. He could be dead, he said, and he might be if not for the doctors and nurses who kept him alive despite COVID’s best efforts to kill him. Yet he still wonders where all this is going. He still has questions.
Will he get better? What does better even look like?
Lisa Tagariello, his physical therapist, runs a long COVID clinic for veterans and hears those questions often. She has the same questions because so little is known about long COVID and its causes.
“We don’t know,” she said. “We don’t have all the answers.”
This is unsatisfying for Rick, but he has resolved to focus on what he can control. His rehab. His attitude. His appreciation for everyone who has helped him. This isn’t the life he expected, but it is his life. He intends to live it as best he can.
Near the end of his physical therapy session in early October, after moving the TV remote from side to side for several minutes, Lisa let him rest a bit before suggesting his next exercise.
“Are you ready for one walk?”
Rick stood and steadied himself again at the end of the parallel bars, looking warily at the other side, about 10 feet away.
“Let’s walk,” he said.
Then he took a deep breath and began to move forward.
This project was underwritten, in part, by Interact for Health. Underwriters do not determine, change or restrict content.
