It’s real and it’s still here: So what should doctors do about long COVID?

We may want to be finished COVID but COVID’s not finished with us. That was one of the messages delivered by speakers at an Ontario Medical Association briefing on the third anniversary of the World Health Organization's declaration of COVID-19 as a pandemic. “We’ve all had it with COVID,” said Dr. Allison McGeer, an infectious disease specialist and senior clinician scientist at the Lunenfeld-Tanenbaum Research Institute of the Sinai Health System in Toronto. “There are still more people dying of COVID than of influenza in a regular year. Even though we think it’s over, there’s still a very large number of hospitalizations and deaths.” While COVID is no longer a “hot topic,” it continues to affect many Canadians, said Dr. Angela Cheung, a senior physician scientist with Toronto’s University Health Network, who helped establish 18 long-COVID clinics across five provinces. “Many people are still suffering (from COVID), from not being able to work to getting divorced because of COVID,” she said. “We need to be vigilant against not only acute COVID but long COVID as well.”’ Read: Report says long COVID could impact economy and be ‘mass disabling event’ in Canada The latter is something that many people—including some doctors—fail to recognize as a real health problem, said Dr. Cheung. There are questions about “whether it’s real or not while others are wondering if it’s strictly a mental health issue, or if it’s a physical issue with some mental health consequences.” The reality for most patients is likely a combination of both. That’s why it’s important for doctors to address both physical and mental health symptoms. Dr. Cheung offered some suggestions for doctors looking to better support patients with long COVID. Listen and validate Don’t be too quick to dismiss a patient’s complaints as something “that will probably go away.” Doctors in doubt about a patient’s potential long COVID symptoms might want to check the federal government list of common post-COVID conditions. The recently launched Long Covid Web platform also houses a growing body of research into long COVID. Promote resting and pacing Scheduling adequate rest and spreading out activities can be an effective way for patients with long COVID to overcome symptom flare-ups “or what we call crashes—post-exertional exacerbation of symptoms,” said Dr. Cheung. Read: Ontario launches fee code for treating patients with long COVID Just breathe For patients still experiencing shortness of breath, it’s a good idea to encourage breathing exercises such as those used in chest physiotherapy, box or square breathing, pranayama or qi gong. The idea, said Dr. Cheung, is to help patients strengthen their respiratory muscles and, with some exercises, even modulate their autonomic system. She recommends directing patients to the Canadian COVID-19 Prospective Cohort Study website, which has videos on breathing exercises geared for long COVID. Clearing the air on brain fog While brain fog is a common long COVID symptom, it also occurs frequently among menopausal women, patients who have undergone chemotherapy, and those with anxiety and depression. What’s typical in COVID-related brain fog, said Dr. Cheung, is the notable impact on executive function, short-term memory and reaction times. “This is an areas where there’s currently not a lot we can do, other than treating other factors that may contribute to brain fog—such as anxiety or depression or not enough sleep—and asking people to have adequate rest,” she said. A number of oral therapies and other types of interventions—such as giving patients oxygen and carbon dioxide—are being tested at present, Dr. Cheung. Doctors looking for advice on how to treat their patient’s COVID-related brain fog can email reclaim@uhn.ca. A long road ahead of us Understanding long COVID and how to treat it is likely to be a long process, said Dr. Cheung. While researchers have learned a lot already—like long COVID’s dysautonomic and neurological symptoms—there’s still much to be uncovered. In Canada, researchers spanning across the various disciplines of science, continue to work together to learn more about long COVID. Organizations and governments are putting millions of dollars into long COVID research, said Dr. Cheung. “There are a lot of knowledge gaps—for example, we currently don’t have a comprehensive list of symptoms—and the federal government for one has recognized that long COVID is a serious problem and is providing funding and support so we can add to our current knowledge,” she said. “But without question, we know that long COVID exists. It’s real and we are looking for a cure for it.” Read: Top 10 takeaways from the latest Canadian data on long-COVID

It’s real and it’s still here: So what should doctors do about long COVID?

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