How will long COVID affect our health system? Major Canadian study offers a glimpse of its reach

According to the World Health Organization, between 10 and 20 per cent of those infected will have symptoms of long COVID, which include fatigue, breathlessness and cognitive impacts, such as ‘brain fog.’

People who test positive for COVID-19 use health-care services more frequently in the months following their infection compared to those not infected with the virus, according to a large new Canadian study on long COVID.

The findings, published Monday in CMAJ (Canadian Medical Association Journal), highlight the impact long COVID has on the health-care system, and have “important health policy implications,” the authors write.

The study of more than 500,000 Ontarians found health-care use — including hospital stays, the need for home care and trips to a clinic or the emergency department — is more frequent among those who had COVID.

Researchers analyzed how people used the health-care system starting ateight weeks after a COVID infection and compared that to similar groups of people who tested negative. Researchers say their findings show the burden of long COVID is “substantial” and should prompt policymakers to plan — and provide further resources — for the condition.

“We hope the appropriate people in government and in leadership take the findings from this study … to inform decisions about how to allocate resources in a fair and equitable way, and that it encourages them to plan ahead, so that we can have some hope of providing the care that patients are going to need,” said Dr. Candace McNaughton, the study’s lead author and emergency physician at Sunnybrook Health Sciences Centre.

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Current estimates suggest about 60 per cent of Canadians have been infected with the SARS-CoV-2 virus, the majority testing positive in the first five months after Omicron became the dominant variant.

According to the World Health Organization, between 10 and 20 per cent of those infected will have symptoms of long COVID, which include fatigue, breathlessness and cognitive impacts, such as “brain fog.”

However, as research into the syndrome is ongoing, and depending on how the condition is defined, estimates vary for the number of people who suffer from the virus’s long-term effects.

A Scottish study of nearly 100,000 participants published this month reported that among individuals with a symptomatic infection, six per cent had not recovered and 42 per cent had only partially recovered between six and 18 months after testing positive.

Dr. Kieran Quinn, a clinician scientist at Sinai Health Systems and an assistant professor at the University of Toronto, called the CMAJ study “important” for health system planning in Ontario and other provinces, given the recent estimates suggesting about six per cent of those infected will develop long COVID.

“That’s a lot of people in Canada who are suffering with persistent symptoms,” said Quinn, who was not involved in the CMAJ study but was the lead author on a recent long COVID report published by the now-disbanded Ontario COVID-19 Science Advisory Table.

“Those symptoms negatively affect people’s health, their ability to function, their ability to work, whole aspects of their life. And many of those effects … lead to an increased need for health care.

“This kind of study helps give us a picture on how much more health care we might need to provide to our citizens who are suffering with long COVID. We need to appropriately resource our system to be able to meet this increasing demand.”

In a statement to the Star, a spokesperson for Ontario’s Ministry of Health called long COVID an emerging health problem and that “evidence and best practices for this condition continue to evolve, with ongoing research efforts being made to fully understand the scope, scale and impacts of the disease.”

“The Ministry of Health and Ontario Health continue to consider options for best supporting Ontarians with post COVID-19 condition or long COVID,” spokesperson Bill Campbell said.

Some Ontario hospitals have opened outpatient clinics for long COVID patients, Campbell said. He added that hospitals, in collaboration with Ontario Health, “have the flexibility to determine how to use their global budgets for operational and service needs,” including for long COVID care and clinics.

Dr. Clare Atzema, the senior author of the CMAJ study and an emergency physician at Sunnybrook Health Sciences Centre, said the goal of the analysis was to determine how the effects of long COVID will affect the health-care system, which is already struggling under pandemic strain.

“(Long COVID) has tremendous health-care usage ramifications,” said Atzema. Both Atzema and McNaughton are researchers at the Sunnybrook Research Institute and scientists at the non-profit ICES in Toronto.

The study, which analyzed ICES data on health-care usage between Jan. 1, 2020, and March 31, 2021, found females who tested positive had higher rates of health care use than males eight weeks after infection.

The researchers also found a gradient in health-care use for those who had COVID. In addition to calculating average rates between those who tested positive and tested negative, they also looked at the differences in rates in the one per cent of the population that uses the health-care system the most.

That’s where the researchers found the greatest increase in health-care use in those who tested positive.

“Although most of the people with SARS-CoV-2 infection had little-to-no change in health care use, a small but important subset of people experienced large increases in their rate of health care use,” the authors write, noting, “these findings indicate that a subset of people experience substantial burden of morbidity well after a SARS-CoV-2 infection.”

While the study took place before the Omicron variant swept the country, and prior to most people receiving two COVID vaccines, McNaughton said the findings are still relevant. Though Omicron causes a milder infection, and vaccines appear to lower the risk of long COVID, the number of infections has exponentially increased, she said.

Quinn said it was helpful that the researchers looked at different health-care encounters, such as whether individuals stayed in hospital or required home care, to inform health system planning. As an example, he said, the study showed that 10 people who had COVID had three more home care visits overall in one year compared to 10 people who didn’t have COVID.

Scaling that up to Ontario, with a population of 14 million people, “That’s a lot of additional health care use we need to plan for,” Quinn said.

Atzema noted that the additional burden from long COVID comes at a time when the health-care system is already stretched, with thousands more primary care doctors needed in the province and hospitals facing dire staffing shortages and record-long ER waits.

While most people who get COVID aren’t going to need to go to hospital or see their family doctor more frequently, they will still be affected by the pressures long COVID has on the health system, she said.

“They are going to be competing for scarce health care resources” with long COVID patients, Atzema said.

“More COVID is coming. And with that, more long COVID. What we’re really hoping is that government looks at (the findings) and takes some aggressive action.”

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