Child Opportunity Index: Paradoxical Risk of Pediatric Long COVID Cases

Pediatric long COVID is a chronic, multisystem condition with potential physical, cognitive, and psychosocial effects. Although children in under-resourced communities experienced a disproportionate COVID-19 burden, access to post-COVID specialty care may be uneven. We conducted a retrospective cross-sectional study of 194 pediatric long COVID patients from Washington, DC, Maryland, and Virginia, who presented to a multidisciplinary tertiary care clinic between May 2021 and January 2024. Patients had a mean age of 12.8 years; 57% were female and 63% were non-Hispanic white. Most patients lived in very high-opportunity areas, while few lived in low-opportunity areas. Spatial hotspots were identified in urban and suburban census tracts, including parts of Maryland, Virginia, and Washington, DC; cold spots were identified in rural and exurban areas. These findings suggest that clinic-based pediatric long COVID presentation may reflect access to specialty evaluation as well as underlying disease burden. Broader screening and community-based approaches may help identify unmet need in under-resourced communities.