In late 2022, I had a sudden fever, sore throat and worsening fatigue. I scheduled an appointment with the first available provider, who skimmed my medical record and speculated that my symptoms may be caused or exacerbated by my testosterone shots. I had COVID-19.
As a transgender person with several chronic illnesses, I’ve had many doctors misattribute my symptoms to hormone therapy. This assumption that any condition can be traced to trans identity is so common that it has a name: “trans broken arm syndrome.” One-third of trans people have had their medical care derailed by such presumptions, according to a recent study.
Doctors often filter patient testimonies through the stories they’ve heard—about people of color, queer people, migrants, women, and other marginalized folks.
Unconscious bias—in which doctors import common stereotypes about a marginalized person into their clinical assessment—pervades cases of “medically unexplained symptoms” or other poorly-understood diseases. The majority of physicians feel unprepared to diagnose and treat long COVID, which disproportionately affects LGBTQ+ people, women and people of color. Without targeted interventions in prejudicial healthcare practices, our health care inequity crisis will only deepen.
I’m a professor at the University of Texas at Austin, where I study how cultural biases seep into health care settings. After centuries of entrenched mythologies about feminine hysteria, doctors are more likely to assume that a woman’s pain is caused by psychological distress. They’re also more likely to underestimate pain in women and people of color and to undertreat Black patients due to stereotypes about drug-seeking behavior.
In the absence of clinical guidance, doctors often filter patient testimonies through the stories they’ve heard—about people of color, queer people, migrants, women, and other marginalized folks—and they decide whether to trust what we say about our bodies. Most medical schools do not provide adequate training on treating trans patients. In fact, medical training that addresses the needs of vulnerable populations is rare—as is educational content that tackles implicit bias. Given all of this, it is unsurprising that long COVID is more severe in communities of color and significantly more common among transgender and bisexual people. (Clinics are also more difficult to access for these patients).
Long COVID is not without precedent. Many researchers and news outlets have turned their attention to myalgic encephalomyelitis (ME), an infection-related complex chronic disease that appears in roughly half of long COVID cases.
I am among the 1.5 million U.S. Americans who had ME prior to 2020. With the COVID-19 pandemic, the number of people with ME has exploded to an estimated 9 million. The same inequities researchers are finding in long COVID diagnosis and treatment have troubled ME communities for decades. Patients who receive ME diagnoses and treatment are disproportionately white and socioeconomically privileged. The majority of existing research on ME has focused on white patients, limiting the knowledge available for addressing ME and long COVID.
Organizations such as #MEAction and Body Politic have foregrounded the connections between these diseases and highlighted how long COVID responses can learn from ME history and avoid past mistakes. Policymakers need to fund targeted research on long COVID and ME that centers the needs of vulnerable communities. Focusing on those most severely affected can not only improve overall health outcomes but can lower healthcare spending across the country. Individual providers are also not helpless amid the gross inequities being exacerbated by long COVID. Research has identified specific strategies—such as community partnerships and emotional regulation– that show promise in addressing prejudice.
Although awareness and meaningful anti-bias interventions can help, health professions must diversify. Medical schools should actively recruit and mentor people from underrepresented communities, and they should incorporate curricula that directly confront health inequities. Health professions can also establish robust leadership pathways for people of color, LGBTQ+ people, disabled people and others who bring in much-needed perspectives.
Like many other people with ME, I found that my symptoms worsened dramatically after my COVID-19 infection. That was eight months ago, and I’m still working my way back toward my prior baseline. Because there are no effective treatments for ME or long COVID, I will likely continue experiencing this cycle of modest recovery and major setbacks.
In 1970, psychiatrists speculated that ME was actually hysteria because its patients were mostly women. And when long COVID first emerged, some psychiatrists and journalists tried to discredit patient advocacy groups because they were led by queer people and feminists. We do not have to repeat past mistakes; no one should be abandoned to preventable illness because of who they are.
This column was produced for Progressive Perspectives, a project of The Progressive magazine, and distributed by Tribune News Service.