Long COVID in Adults and Ontario’s Expected Burden

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.

More than 100 symptoms have been reported in long-term COVID patients, many of which have been associated with poor quality of life, high strain on the healthcare system, and difficulty in self-care. However, vaccination against coronavirus disease 2019 (COVID-19) reduced the risk of developing long-lasting COVID symptoms by about 54%.

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

Long-time COVID patients are not receiving high-quality care due to the lack of potential therapies, diagnostic tests, and support for this condition. In a recent Scientific briefs from the Ontario Science Advisory Table on COVID-19 study, scientists identify basic health care needs for adults with long COVID. They also highlight the different types of support that need to be provided to these patients and their caregivers.

About the study

In the present study, relevant literature was collected from PubMed, COVID-19 Rapid Evidence Reviews, Google Scholar, Joanna Briggs Institute COVID-19 Special Collection, World Health Organization Coronavirus Disease Global Literature health and other COVID-19 specific resources. . The researchers also analyzed data obtained from evidence synthesis briefing notes published by the COVID-19 Evidence Synthesis Network and Public Health Ontario. All evidence collected up to August 20, 2022 has been scanned for relevant information to be included in the final analysis.

Meta-analysis was performed using a random-effects model to quantify risk factors. The Mantel-Haenszel fixed-effects model was used to analyze the effect of vaccination against COVID-19. The QUIPS (Quality in Prognostic Studies) 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 was difficult to accurately estimate post-COVID conditions due to the variable definition of long COVID used in studies considered for meta-analysis. These studies also exhibited heterogeneity in important factors, such as severity of initial infection, varied duration of follow-up, bias in sampling strategy, sample size, and impact on therapies. and emerging vaccines against SARS-CoV-2 variants, each of which affect the long-term COVID prevalence estimate.

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

Several studies have analyzed the incidence of long COVID based on the emergence of different SARS-CoV-2 (VOC) variants of concern. These studies indicated that 4.5% and 10.8% of patients infected with 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 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 matched retrospective cohort study, female gender, ethnic minority, smoking, obesity, a wide range of comorbidities, and socioeconomic deprivation increased the risk of long COVID.

Treatments for long COVID and their limits

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, rapid heartbeat, and fatigue.

Several models have been proposed to provide better care for patients with post-COVID-19 illnesses. The Primary Care Provider (PCP) model is based on the direct assessment of people suspected of having long COVID by their PCP to identify care needs. 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 specialty clinics and PCP knowledge. It is difficult to determine which model is the most effective in managing long COVID patients.

A large disparity in health human resources (HHR) prevails in rural and remote areas, 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 understaffing and long waiting times, are factors that pose challenges in the treatment of long COVIDs. .

In Canada, the current average wait time to access multidisciplinary clinics, which offer long COVID treatments, is between three and six months. Factors that contribute to long wait times are the limited number of clinics, increased health care demands, understaffing, and the lengthy process from referral to therapy.

Although the Ontario Health Insurance Plan (OHIP) pays for many services, it is limited to physiotherapy and psychosocial counselling, which require private insurance. It is important that policy makers proactively develop comprehensive strategies to overcome potential barriers to providing the best care to long-standing COVID patients.

Journal reference:

  • Quinn, KL, Katz, GM, Bobos, P., et al. (2022) Understanding Post-COVID-19 (Long COVID) Condition in Adults and the Projected Burden for Ontario. Ontario COVID-19 Science Table. doi:10.47326/ocsat.2022.03.65.1.0

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