Long-COVID in adults and Ontario's expected burden

By Dr. Priyom Bose, Ph.D.Reviewed by Benedette Cuffari, M.Sc.Sep 12 2022

Long COVID has been defined as the persistence of symptoms or sequelae at least four to twelve weeks after the initial diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Over one hundred symptoms have been reported in patients with long COVID, many of which have been associated with poor quality of life, high pressure on the healthcare system, and difficulty in taking self-care. However, coronavirus disease 2019 (COVID-19) vaccination has reduced the risk of developing long COVID symptoms by about 54%. 

Study: Understanding the post COVID-19 condition (long COVID) in adults and the expected burden for Ontario. Image Credit: fizkes / Shutterstock.com

Long COVID patients are not provided with high-quality care due to the lack of potential therapies, diagnostic tests, and support for this condition. In a recent Science Briefs of the Ontario COVID-19 Science Advisory Table study, scientists identify the basic healthcare requirements for adults with long COVID. They also highlight the different types of support that must be provided to these patients and their caregivers. 

About the study

In the current study, relevant literature was collected from PubMed, COVID-19 Rapid Evidence Reviews, Google Scholar, the Joanna Briggs Institute’s COVID-19 Special Collection, the World Health Organization’s Global Literature on Coronavirus Disease, and other COVID-19-specific resources. Researchers also analyzed data obtained from Evidence Synthesis Briefing Notes published by the COVID-19 Evidence Synthesis Network and Public Health Ontario. All evidence gathered up to August 20, 2022, was scanned for relevant information to be included in the final analysis.

The meta-analysis was conducted using a random-effects model to quantify risk factors. The Mantel-Haenszel fixed-effects model was used to analyze the effect of COVID-19 vaccination. The Quality in Prognostic Studies (QUIPS) tool was used to determine the risk of bias associated with the studies included in the meta-analysis.

Prevalence of post COVID-19 conditions

It has been challenging to precisely estimate post-COVID conditions due to the varying definition of long COVID used in the studies considered for the meta-analysis. These studies have also presented heterogeneity in important factors, such as the severity of initial infection, varied follow-up duration, bias in sampling strategy, sample size, and impact on emerging therapeutics and vaccines against SARS-CoV-2 variants, each of which affect the estimation of long COVID prevalence. 

Current estimates indicate that about 10% of vaccinated individuals infected with contemporary SARS-CoV-2 variants experience long COVID. More research is required to confirm this estimate.

Several studies have analyzed the incidence of long COVID based on the emergence of different SARS-CoV-2 variants of concern (VOC). These studies have indicated that 4.5% and 10.8% of patients infected with the Omicron and Delta variants, respectively, reported long COVID. This finding indicates that people infected with Omicron are at a lower risk of developing long COVID as compared to those infected with Delta.

No evidence on the identification of biological markers, clinical findings, or symptoms that could predict the development of post-COVID-19 conditions was available. According to a retrospective matched cohort study, female sex, ethnic minority, smoking, obesity, a wide range of comorbidities, and socioeconomic deprivation increased the risk of long COVID.

Treatments of long COVID and their limitations

To date, potential treatments for long COVID are not available. Nevertheless, several therapies have been recommended for the treatment of its common symptoms, such as shortness of breath, increased heart rate, and fatigue.

Several models have been proposed to provide better care for patients with post-COVID-19 conditions. The primary care provider (PCP) model is based on the direct assessment of individuals suspected of having long COVID by their PCP to identify the care requirements. Based on the assessment, the PCP may manage medications, provide self-management support, and/or refer the patient to specialists for ongoing assessment.

The clinical model involves a dedicated multidisciplinary team of healthcare providers who support patients and their multifactorial care needs. The hybrid care model is associated with both specialized clinics and PCP insights. It is difficult to determine which model is most effective for managing long COVID patients.

A high disparity in health human resources (HHR) prevails in rural and remote regions, despite the equivalent health burden in these areas. The lack of specific therapies to treat post-COVID-19 conditions, as well as limited access to care due to staff shortages and long wait times, are factors that pose difficulties in treating long COVID.

In Canada, the current average wait time to access multidisciplinary clinics, which provide long COVID treatments, is between three and six months. Factors that contribute to long wait times are limited numbers of clinics, increased healthcare demands, low staffing, and lengthy process from referral to therapy.

Even though the Ontario Health Insurance Plan (OHIP) supports many services, it is limited to physiotherapy and psychosocial counseling, which require private insurance. It is important that policymakers proactively develop comprehensive strategies to address the potential barriers to providing the best care to long COVID patients.