Ontario could see 'tsunami' of recovered COVID-19 patients with long-term symptoms: experts

There's a growing waiting list of patients who need treatment for long-term symptoms after recovery from COVID-19, according to physicians and researchers. 

Anywhere from 10 to 20 per cent of COVID-19 patients who are infected recover from the virus but suffer long-term symptoms, according to Dr. Alexandra Rendely, a staff physician at the University Health Network's Toronto Rehabilitation Institute.

With thousands of cases per day in March, April and May in Ontario — with a peak of more than 4,000 cases in April — Rendely expects that many of the people who recovered will experience long-term effects.

"Come September, we're going to have a tsunami of patients that are going to need ongoing rehab supports," she said.

"Currently, we don't have enough manpower, capacity or clinics available to treat all these patients."

Treatment can require physiological support

Rendely is part of a team at the University Health Network that launched a virtual COVID-19 rehabilitation program for post-COVID-19 patients in summer 2020. 

Long-term symptoms can affect anyone from those who were hospitalized in an ICU with COVID-19 to people who had mild symptoms at first, she said. 

"It's very hard to predict that the degree of disease leads to the degree of impairment. Anyone at any age can be affected long-term," she said.

Rendely said her team looks at patients' heart rates, muscles, breathing, mood and other indicators to create a tailored treatment plan for them. They especially hear about overwhelming fatigue and concentration difficulties, she said. 

"Are you not back to exercising? Does walking bring on fatigue and function limitations? "These are all things we ask patients," she said. 

Patients typically receive treatment from physiotherapists and occupational therapists for four to five sessions, with about a third of patients needing support from a social worker as well, Rendely said. She added that it can also be psychologically difficult to adjust to life with ongoing symptoms from COVID-19.

"We're seeing some depression, we're seeing anxiety, we're seeing some patients with post-traumatic stress disorder," she said. "We can't help the body function without also addressing the brain."

The Toronto Rehabilitation Institute is funding the treatment, which means that it's free for patients. Rendely says they're trying to increase their funding to serve more patients because most occupational therapy and physiotherapy is not covered by Ontario health insurance.

"For patients who don't have the financial resources, we can't always send them into 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 co-lead investigator for the Canadian COVID-19 Prospective Cohort Study (CANCOV), which is looking at one-year outcomes in more than 1,300 patients who had COVID-19.

"There are more than a hundred symptoms that patients who have long COVID can have," said Cheung, who's a professor of medicine at the University of Toronto. 

"The common ones are fatigue, brain fog, shortness of breath, feeling their heart racing and difficulty sleeping."

Cheung said patients affected by fatigue "will feel not quite up to their usual self" and may find that activities like climbing the stairs or cooking dinner leave them feeling totally exhausted. 

She said that there are still many things we don't know about the long-term symptoms of the virus, and that health professionals are learning along with patients. She said she hopes that governments across Canada will "think long and hard on some way to manage this post-pandemic pandemic."

Cheung and her collaborators plan to study the way that these symptoms affect certain groups more than others, such as racialized groups, Indigenous communities or people experiencing homeless, she said.

"It's going to be like HIV. At the beginning of the HIV [epidemic], there were lots of unknowns," she said.

"We're not afraid to say we don't know, but it would be helpful to do this systematically."