Experts create Canada's first-ever guidelines for diagnosing, preventing, and treating long COVID

A team of experts from McMaster University has led the creation of Canada's first-ever comprehensive guidelines for diagnosing, managing, preventing, and treating post COVID-19 condition (PCC), more commonly known as long COVID.

The Canadian Guidelines for Post COVID-19 Condition (CAN-PCC) provide clear, evidence-based recommendations to educate and help patients, health-care professionals, and policymakers navigate the still relatively new condition. It's estimated that PCC affects more than one million Canadians.
In 2023, McMaster received a $9-million financial contribution from the Public Health Agency of Canada to develop the guidelines in collaboration with people with lived PCC experience, health-care professionals, policymakers, as well as international experts, together referred to as the CAN-PCC Collaborative.

"These guidelines are designed to provide and implement actionable recommendations that will help health-care professionals offer the best possible care to patients experiencing long COVID. They also empower patients with the information and tools they need to advocate for their health and ensure they receive the necessary support and treatment," says co-lead Robby Nieuwlaat, associate professor with McMaster's Department of Health Research Methods, Evidence, and Impact and director of the Michael G. DeGroote Cochrane Canada Centre.

The guidelines consist of approximately 100 recommendations related to PCC, broken down into six key categories:

• Prevention
• Testing, identification and diagnosis
• Clinical and non-clinical interventions
• Neurological and psychiatric topics
• Pediatric and adolescent topics
• Health systems and social support

The recommendations cover a broad range of important topics addressing prevention, identification, and management of PCC. For example, CAN-PCC suggests using indoor ventilation and air filtration to prevent COVID-19 and thereby PCC, metformin to treat people with PCC, and care navigators to support people with PCC. One of the main challenges faced by the CAN-PCC Collaborative was formulating recommendations based on currently available research evidence that was mostly of low certainty and the guidelines highlight key research priorities.

The creation of the Canadian Guidelines for Post COVID-19 Condition marks a significant milestone in our ongoing efforts to address the long-term impacts of COVID-19. These guidelines will serve as a crucial resource to support those living with this condition as well as the health professionals that provide the care that best fit their needs."

Theresa Tam, Canada's chief public health officer

The CAN-PCC Collaborative has also developed tools to make the guidelines easier to use, including plain-language summaries, decision aids and resource sheets, and infographics to help Canadians make informed decisions together with their health-care providers. The recommendations are available in English and French and accompanying tools in a variety of languages.

"The establishment of a multidisciplinary team of more than 150 Canadian and international collaborators, including persons with lived experience, who have created these guidelines is an achievement that puts McMaster and Canada at the forefront of long COVID care. With continued support we can update our recommendations as new evidence emerges, expand knowledge mobilization, and ensure that people in Canada have access to the best possible care," says Nieuwlaat.

PCC can affect anyone infected with the SARS-CoV-2 virus. According to the World Health Organization, PCC is defined as continued or new symptoms persisting for more than 12 weeks after COVID-19 infection.

Long COVID isn't a condition that is restricted to people who experienced severe outcomes from COVID-19 infection. People who experienced a mild case of COVID-19 or who were initially asymptomatic could still develop long COVID.

Symptoms can vary, with more than 200 having been reported in association with PCC, with some of the most common being fatigue, shortness of breath and brain fog, which can impact memory, concentration, and focus. Symptoms may be persistent or episodic and may worsen depending on circumstances.