We've got to get on top of long COVID before it drowns us
As infections from the Omicron variant surge, many are concentrating on hospitalizations but ignoring the hidden landmine of long COVID.
“Long COVID will be the post-pandemic-pandemic,” says Dr. Angela M. Cheung, a physician, professor of medicine and co-lead of several national long-COVID studies.
“There are definitely people who get long-term symptoms past the acute phase of a COVID-19 infection,” says Dr. Cheung. “Estimates vary widely. The number is between 10% and 50% The problem is how you define it. Some people may have one or two symptoms, but it's not that bothersome to them and doesn’t affect their function. Some people have 10 symptoms and can’t go to work.”
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The potential severity of long COVID is crucial to recognize. In its most serious manifestations, it can be extremely debilitating, impacting many organs in our body, like our brain, lungs and heart.
“Some [with long COVID] have been in the ICU and their symptoms are similar to ‘Post ICU Syndrome” we have seen previously, with perhaps a bit more neurological issues.”
Dr. Cheung explains that even those with mild, asymptomatic infections who haven’t been in hospital can get long COVID. Along with symptoms like shortness of breath and fatigue, one of the most discussed symptoms is ‘brain fog’ with memory and concentration problems.
What brain abnormalities are they finding? Though there has been much discussion about micro-infarcts in the brain, Dr. Cheung says that, apart from these micro-infarcts sometimes presenting in the first three months, MRI and CT scans often don’t show brain abnormalities.
To find the brain abnormalities, a CVR protocol MRI is needed, measuring capillary venous resistance and, “With this we see a slowness of dilation of blood vessels and areas resembling a hypo-metabolic state.This has been shown not just in our group but in others.”
Since even those with mild COVID-19 infections can get long COVID, avoiding infection is the way we can prevent it. But how effective are our vaccines against getting infected with Omicron? To answer this, we should look at the U.K.., which is about a week or two ahead of Canada in dealing with this variant.
The U.K. has found that vaccines are effective against hospitalization, particularly booster doses but, “booster doses, are 75% effective at preventing infection two to four weeks after receiving them, but only about 40% to 50% effective after 10 weeks.
Since the vaccinated can get infected with Omicron, does being vaccinated prevent long COVID?
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“Vaccines reduce the risk of long COVID by lowering the chances of contracting COVID-19 in the first place. But for those who do experience a breakthrough infection, studies suggest that vaccination might only halve the risk of long COVID—or have no effect on it at all.”
This means long COVID will continue rising, even with Canada’s high rate of vaccination.
“We are trying to look at various treatments and what can help symptoms and resolve the issue,” says Dr. Cheung. “Long COVID is like any new disease in the early days, when people don’t understand the ins and outs of it.”
When asked what is needed to facilitate treatments, Dr. Cheung notes that, “First, we need interdisciplinary specialty clinics. Places that patients can go to seek help.”
She explains that, presently, a patient with Long COVID can go to their family doctor (if they have one) and get referred to a specialist like a neurologist for ‘brain fog’ and a respirologist for shortness of breath. These specialists may have seen some cases of long COVID, but they may not have seen the full spectrum of long COVID. The speciality clinics would connect specialists within and between specialties, as well as nationally. They would also allow specialists to get the latest research, such as from the studies Dr. Cheung is the co-leading: Recovering from COVID-19 Lingering Symptoms Adaptive Integrative Medicine Trial (RECLAIM) and Canadian COVID-19 Prospective Cohort Study (CANCOV), among others. CANCOV is a two-year study with 2,000 patients in the five hardest-hit provinces in Canada: Quebec, Ontario, Alberta, Manitoba and British Columbia. The researchers are in communication with researchers nationally and in other countries.
Developing specialty clinics in provinces and facilitating national and international connections between specialists would provide the best care for long COVID patients.
The second need is funding for more research. Initially, CANCOV was to be a one-year study but patients were still ill and the study was extended to two years, soon to be extended to three, because of the length of symptoms patients are experiencing.
Canada needs to invest in research for the coming surge of long COVID patients. Just like research gave us vaccines, we need research to give us treatments and hopefully a cure for long COVID.
Other countries have shown great foresight in dealing with long COVID. The U.S. National Institutes of Health are investing US$1.15 billion over four years to investigate and find treatments for long COVID. The U.K. National Institute for Health Research announced £18.5 million in similar funding.
As Dr. Cheung says, so beautifully and hopefully, “It’s an evolving science. Everyday there’s something different. We need to move as fast as the science is moving and turn knowledge to action—we need that to happen.”
Turning knowledge into action for patients demands careful planning, expertise and funding.
In Canada, the question is always: who funds this? The federal or provincial governments? Certainly, the research is national and can be funded federally. However, what about the specialty clinics? They’ll be located in provinces but communicating nationally, and created at a time when provincial health budgets are stretched, so perhaps federally directed funds would be the best.
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Some will argue that health is solely provincial jurisdiction, but this isn’t accurate since the federal government has directed funds to resolve national health problems. Since the 2005 federal funding to support research and services to reduce surgical wait times, the federal government has stepped in to resolve national health crises. More recently, the federal government directed $9 billion to shortfalls in Canada's long-term care sector revealed by the pandemic. Surely, a tsunami of long COVID that is coming is a national crisis and demands a national response by funding both research and clinics to care for patients.
One thing is for certain: long COVID cases will increase with the surge of Omicron infections. What are the actual number of COVID-19 infections in Canada from the start of the pandemic?
”Based on the average estimates of actual case numbers from the Imperial College London and U.S.-based Institute for Health Metrics and Evaluation, about 8.7 million or more Canadians may have been infected by the end of December, 2021,” says Dr. Tara Moriarty, associate professor and infectious disease researcher at the University of Toronto. “Nearly one third of these infections have occurred since November 15, 2021, when Omicron was first identified in Canada and Omicron cases are doubling somewhere between every three to seven days right now.”
These should be sobering numbers for all governments and a call to arms for funding long COVID clinics and research in Canada.
Dr. Mary Fernando is a physician in Ottawa. Find her on Twitter @MaryFernando_.