SEATTLE – The first time Dr. Anita Chopra had a long COVID patient, she cried.
It was two years after the pandemic, she said, when the once-healthy patient described symptoms of weakness, chronic fatigue and frequently forgetting daily activities.
“I still see him. He’s in his late 40s, but the amount of change he dealt with, the challenges he’s still struggling with are just overwhelming,” Chopra said.
Chopra is a lead physician at the University of Washington Medicine Long COVID clinic, based at the Harborview Medical Center, and a primary care provider at the university’s primary care center at Shoreline.
Since the pandemic, researchers and physicians, including Chopra, have been studying the long-term effects of COVID-19 and the complications that continue to interfere with daily life. These effects have disproportionately affected some groups of people, such as Latino farmworkers. Chopra said her observations also reflect a broader pattern in the agricultural community, where workers face higher rates of long COVID but often don’t receive a diagnosis.
Dr. Leo Morales, a UW medical school professor and lead researcher with the university’s Latino Center for Health, said a survey by the center shows 41.2% of agricultural workers experience long COVID – one of the highest rates among professions studied. Overall, 34% of Latinos report experiencing long COVID, the highest rate among the racial groups examined.
The study defines long COVID as an illness affecting people with a probable or confirmed COVID-19 infection, with symptoms appearing within three months and lasting at least two months.
Morales said both delayed access to vaccines early in the pandemic and vaccine hesitancy contributed to these disparities.
“The best way to prevent long COVID is to prevent COVID in the first place and vaccines are an important strategy,” Morales said.
A 2020 study by the University of California Berkeley School of Public Health found that many farmworkersinitially avoided vaccination due to concerns about side effects (65%), fears of contracting COVID-19 from the vaccine (12%), and distrust of the government (12%).
The 2022 California Farmworker Health Study also points to poor living conditions and high rates of underlying conditions, such as diabetes, as contributing factors.
“At this point, long COVID is one of many different conditions that we need to be concerned with,” he said. “Access to care is the biggest issue we have right now.”
The diagnosis gap
Dr. Kendl Sankary, a physician at the clinic, said one of the key components to a long COVID diagnosis is ruling out other conditions that are causing similar symptoms.
“There’s not like a blood test or an imaging test that can tell us someone has a long COVID. We really base the diagnosis upon the person’s symptoms and the timeline of their symptoms with respect to a COVID infection,” she said.
Common symptoms of long COVID include fatigue, shortness of breath, brain fog and chest pain.
However, the waitlist at the only long COVID clinic in Washington state is long and the diagnosis process depends on the person.
The clinic has seven providers, making it difficult to get an appointment quickly.
Sankary said she’s had multiple patients who have worked with a primary care doctor and gotten to the point of at least suspecting long COVID as the diagnosis within a couple of months.
“And then I have other patients where they’ve been dealing with these symptoms for four years and haven’t come to a clear diagnosis until they’re able to get into our clinic. So it really depends from person to person,” she said.
For farmworkers, the referral and waitlists aren’t the only issues. Geography also plays a role.
Most farmworkers reside in Yakima, Chelan, and Grant counties, according to 2025 data from the Washington State Employment Security Department – far from Seattle, where the clinic is based. For a long period, referrals were also limited to King County, further restricting access, Sankary said.
“Which is unfortunate, because I know the rates are higher in that group,” she said.
Beyond distance, a 2025 report from the Washington State Institute for Public Policy found that about 40% of farmworkers lacked health insurance.
Chopra said she dedicates one day a week to long COVID patients and sees about six people. Only about 6% of her patients have been Latino. Sankary, who sees about 16 patients a week, said few of hers are Latino as well.
Awareness and working conditions also contribute to the gap, Chopra said. In rural communities, patients may not recognize their symptoms as long COVID.
She added that many farmworkers delay seeking or accepting a diagnosis, in part because symptoms like fatigue, shortness of breath or chest pain often are normalized in physically demanding jobs, and because taking time off work to seek care is not always feasible.
“These patients are working and sometimes the only working member in the family, so they feel like they have to keep on working,” she said. “The advice that they hear from their family members, or co-workers or friends, is just ‘tough it out.’ And unfortunately, with long COVID, there is no such thing.”
Chopra describes these delays as a “social determinant of health,” shaped by working and living conditions that can both discourage care and worsen lingering symptoms after COVID.
“They work in Eastern Washington. It is very dry. They can manifest as asthma, shortness of breath. Sometimes they can have chest pain. Sometimes, some of them experience heart racing for no reason,” Chopra said. “That impact of COVID on their lungs makes them more susceptible to the dry condition and all the dust that they are inhaling.”
But Chopra said their working conditions also can expose them to other health risks, raising questions about whether symptoms stem from COVID, environmental factors or both.
Pesticides vs. COVID
We Are Ella, a Latina-led social justice organization based in the lower Yakima Valley, recently released a documentary highlighting farmworkers affected by air pollution and chemical exposures from sources such as pesticides and fertilizers.
Maricela Santana-Walle, environmental justice coordinator, said the group also conducted a survey alongside the documentary to better understand the effect in the region.
It found many farmworkers face illnesses like asthma, linked to years of pesticide exposure, Santana-Walle said.
But asthma is also the fifth most reported symptom for long COVID patients, according to research by UW Latino Center for Health.
Chopra said pesticide exposure and long COVID likely overlap.
“What we see in patients is some of them have pre-existing asthma and that can become exacerbated after long COVID. Or some patients who come in, they don’t have any history of asthma, but now they have symptoms,” she said.
“So is this pesticide exposure? If they have reactive airways or new onset of asthma, then pesticides can add to it, which is why we will get a chest X-ray and will refer them for lung function testing. But certainly pesticide exposure can superimpose on the already irritated lungs,” Chopra said.
Sankary also said that at the university’s occupational health clinic, they have seen patients with chemical exposures. She said that for farmworkers, it is important to conduct additional testing to determine whether symptoms align with a clinical diagnosis, like pesticide exposure, rather than a symptom-based one, which is how long COVID often is diagnosed.
“As long as we’ve ruled out kind of those other conditions that have other specific treatments, then I’ll often kind of put them through some of the same treatments that are symptom-based that I would someone with long COVID, even if we’re not 100% sure,” Sankary said.
Chopra said the long COVID clinic is working toward making sure it has partnerships across the state to ensure patients who are dealing with COVID symptoms can get faster referrals and treatment.
“I want to make sure that it’s a trickle down effect; empowering providers will improve patient care,” she said. “That is the bottom line.”
This story is part of a reporting fellowship sponsored by the Association of Health Care Journalists and supported by the Commonwealth Fund.
