COVID-19 Long-Haulers : Persistent Symptoms, Organ Damage

"[The clinics were established to learn more about the disease and to] create a platform for various researchers to study long-term outcomes of patients in comprehensive and collaborative ways."

"About half [of referred COVID patients] have significant abnormalities in patient-reported outcome measures."

"The frightening message really is that this one hit probably ended up reducing lung function by an average of 20 percent in these patients, which may be permanent based on what was seen with SARS and MERS."

Dr.Christopher Ryerson, respirologist, associate professor, University of British Columbia Centre for Heart Lung Innovation

"[The LHSC clinic monitors COVID patients and identifies long-term complications early], so we can intervene early and prevent consequences of the disease that have been seen in past pandemics, including H1N1 and SARS."

Dr.Erin Spicer, general internist, LHSC Clinic, London-Middlesex region

"The goal of the clinic is to help people who've been left with long-term consequences of COVID to get back to their normal life and to understand why they're having difficulty and not able to get back to their normal life."

"Even the patients that didn't have severe COVID were having difficulties. They were complaining of extreme fatigue, they were complaining of nerve pain, they were complaining of brain fog."

"Some were feeling anxiety, some were showing symptoms of PTSD and almost all were complaining of an inability to exercise."

"Whenever you start up a clinic that's a new population, you have to learn enough about the population before you figure out what's common enough that you want to bring it into your clinic."

"It seems to be somewhere between five to ten percent [of COVID survivors] who have persistent problems. Even at that proportion, the health system really will have trouble managing that magnitude of people."

Dr.Mark Bayley, medical program director, Toronto Rehabilitation Institute

COVID-19 modelling suggests we're in it for a long haul ... CBC

 

The medical community is now increasingly aware that many survivors of COVID struggle to return to their normal lives, suffering from what conceivably can be long-term health challenges. Doctors only now, experts in their field, are trying to fully understand what this signifies, having identified many long-term effects such as shortness of breath, nerve pain, fatigue and mental-health issues. Experts are in agreement that, as COVID cases continue to rise, many Canadians will face long-term health challenges.

This has resulted in clinics being established in an effort to become more knowledgeable about the disease and its after-effects. In Vancouver, when the pandemic first surfaced, every patient with COVID who was discharged from hospital was referred automatically to a respiratory clinic. During the early stage of the pandemic doctors used a standardized clinic research model designed for respiratory patients including breathing tests, heart ultrasounds, chest X-rays and questionnaire' the plan being that for every patient to be seen following, six, 12 and 24 months.

It soon became evident that COVID patients bore more complex issues beyond respiratory, so that an increasing number of specialists were required to be involved in their care. Staffed primarily by general internists the clinic can now refer their patients to 15 different medical specialists. Dr.Ryerson studied along with his colleagues, patients' quality of life, frailty, shortness of breath, mood and sleep patterns. A loss of lung function appears to be suggested; at three months post-infection, survivors show a 20 percent reduced lung ability to exchange gases.

Among the Vancouver clinic's patients, 88 percent were seen to have abnormal lung CT findings, twenty percent were seen with scarring in the lungs suggesting the likelihood of permanent lung damage from the disease, points out Dr.Ryerson. A study in Beijing followed 71 patients with SARS from 2003 to 2018 discovering that while lung injury improved following the first year of SARS diagnosis, the improvement plateaued and decreased lung function was experienced by patients throughout the remainder of the study.

And in London, Ontario, where the follow-up LHSC clinic was developed, everyone in the London-Middlesex region diagnosed with COVID is now offered a referral to the clinic which is currently following over 100 patients, some of whom require more frequent follow-up than others. What is seen, however, is that patients indicate persistent nerve symptoms, brain fog and confusion, and accordingly are referred to neurologists. 

Many others at the LHSC clinic complain of weakness months following their initial COVID diagnosis and a significant number of patients require referrals to ear, nose and threat specialists reflecting their prolonged inability to smell. Dr.Spicer at the London clinic states that up to 46 percent of patients complain of anxiety, mood changes, symptoms familiar with post-traumatic stress disorder, social isolation and bullying, as a result of their diagnosis.

The Canadian COVID-19 Prospective Cohort Study involves multiple studies across Canada, including sites in British Columbia, Alberta, Quebec and Ontario where the group operates research clinics and provides clinical care. Hospitalized and non-hospitalized COVID-positive patients are included in the studies, where patients can be physician-referred or self-referred. Assessments are done at one, three, six and 12 months post-COVID, and under the CANCOV umbrella, specialists are available to provide detailed testing depending on patient needs.

The goal of CANCOV is to raise the standard of care for patients with COVID, and it hopes to provide clinical guidelines for policy-makers and chart a full description of the various ways COVID can affect the body's organs, with over 100 investigators with clinical and research expertise involved. "We are trying to understand what it means to be a long-hauler", noted Dr.Angela Cheung, who along with Dr.Margaret Herridge co-leads the Canadian COVID-19 Prospective Cohort Study.

Back at the Toronto Rehabilitation Institute, Dr.Bayley explains that the institute's staff realized people who survive COVID may be similar to those who have had lung disease or long stays in intensive-care units where it is acknowledged that patients who have been intubated and ventilated for over a week are likely to emerge with long-term health problems. Along with physical symptoms, Dr.Bayley estimates that 30 to 50 percent of survivors experience some mental-health issues, leading the rehab centre to use social work services.

Over 315,000 cases of COVID have surged across Canada. Even so, Dr.Ryerson believes the country is less than halfway through the pandemic from an absolute numbers perspective, and the number of people who will bear long-term challenges is an unknown.

Lorraine Graves, a science journalist, contracted COVID-19 in March. She's pictured, right, receiving oxygen to help with her breathing. But months later, she says she's still sick. (Submitted by Lorraine Graves)