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There is a growing waiting list of patients who need treatment for long-term symptoms after recovery from COVID-19, doctors and researchers say.
According to Dr. Alexandra Rendely, a staff physician at the University Health Network’s Toronto Rehabilitation Institute, between 10 and 20% of patients infected with COVID-19 recover from the virus but suffer from long-term symptoms.
With thousands of cases a day in March, April and May in Ontario – with a peak of more than 4,000 cases in April – Rendely expects many of those who have recovered will experience long-term effects.
“In September we are going to have a tsunami of patients who will need continued rehabilitation support,” she said.
“Currently, we don’t have enough manpower, capacity, or clinics available to treat all of these patients.”
Treatment may require physiological support
Rendely is part of a team from the University Health Network that launched a COVID-19 virtual rehabilitation program for post-COVID-19 patients in the summer of 2020.
Long-term symptoms can affect anyone, from people hospitalized in an intensive care unit with COVID-19 to people who had mild symptoms at first, she said.
“It is very difficult to predict whether the degree of disease leads to the degree of impairment. Anyone, at any age, can be affected in the long term,” she said.
Rendely said his team looks at patients’ heart rate, muscles, breathing, mood and other metrics to create a treatment plan tailored for them. They mostly hear about overwhelming fatigue and difficulty concentrating, she said.
“Are you not back to exercising?” Does walking cause fatigue and functional limitations? “These are all things we ask of patients,” she said.
Patients typically receive treatment from physiotherapists and occupational therapists for four to five sessions, with about a third of patients also needing support from a social worker, Rendely said. She added that it can also be psychologically difficult to adjust to life with persistent symptoms of COVID-19.
“We see some depression, we see anxiety, we see patients with post-traumatic stress disorder,” she said. “We cannot help the body to function without addressing the brain as well.”
The Toronto Rehabilitation Institute funds the treatment, which means it is free for patients. Rendely says they are trying to increase their funding to serve more patients because most occupational and physical therapy is not covered by Ontario Medicare.
“For patients who don’t have the financial resources, we can’t always send them to the community with a prescription for physiotherapy,” she said.
More than 100 symptoms can appear after COVID-19
Angela Cheung has seen hundreds of post-COVID-19 patients. She is the principal co-investigator of the Canadian COVID-19 Prospective Cohort Study (CANCOV), which examines one-year results in more than 1,300 patients with COVID-19.
“There are over a hundred symptoms that patients who have a long COVID can have,” said Cheung, professor of medicine at the University of Toronto.
“The most common are fatigue, brain fog, shortness of breath, a feeling of a heartbeat and difficulty sleeping.”
Cheung said patients suffering from fatigue “won’t feel quite up to their usual state” and may find that activities like climbing the stairs or cooking dinner leave them totally exhausted.
She said there is still a lot we don’t know about the long-term symptoms of the virus, and that healthcare professionals are learning from patients. She is sad to hope that governments across Canada “will think long and hard about a way to deal with this post-pandemic pandemic.”
Cheung and colleagues plan to study how these symptoms affect certain groups more than others, such as racialized groups, Indigenous communities or people experiencing homelessness, she said.
“It’s going to be like HIV. At the start of HIV [epidemic], there were a lot of unknowns, ”she said.
“We’re not afraid to say we don’t know, but it would help to do it consistently.”
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