Hammond, B; Dalidowicz, M; Miller L; Groot, G, Reeder B. Response to Long COVID: What are the Programs or accommodations to current frameworks? 2022 Jun 30. Document no.: EOC220303 RR Table. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2022. (CEST Table).
Telemedicine and other technologies are being adopted and tested to facilitate appointments over video/audio call, as well as to deliver various rehabilitation programs.
Telemedicine may be a solution that increases specialist and primary care providers’ capacity to serve more patients.
Many studies focusing on rehabilitation for certain post COVID-19 conditions, such as shortness of breath (dyspnea) and fatigue, emphasize physiotherapy as a key aspect in recovery efforts.
Most studies and reviews endorse adopting multi-disciplinary care pathways to address the broad range of post COVID-19 symptoms.
Alternate treatment methods, such as singing and vocal therapy, are being studied with preliminary data supporting these as potentially effective interventions.
Attentive rehabilitation programs with frequent follow-ups from facilitators addressing physical and psychological barriers to recovery often result in improved health related quality of life in patients.
Although many (?) care pathways have yet to be formally evaluated, many resources and guidance documents for care providers and patients are available online from reputable organizations, such as the WHO, and are frequently updated with new information.
Social media and other digital media sources have caused confusion amongst much of the general public and have greatly contributed to the sharing of misinformation about COVID-19 and post conditions, as well as vaccination safety and efficacy.
Hammond, B; Dalidowicz, M; Miller L; Groot, G; Reeder, B. Response to Long COVID: What are the Programs or accommodations to current frameworks? 2022 Jun 30. Document no.: EOC220303 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2022. 21 p. (CEST rapid review report).
Groot, G; Reeder, B; Hammond, B; Badea, A; Howell-Spooner, B; Ellsworth, C. What are long COVID's demands on the healthcare system, and its severity of the illness? 2022 Jun 20, Document no.: EPM210602v002 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2022. (CEST table).
A case definition for long COVID has yet to be adopted but is referred to by the WHO as “usually 3 months from the onset of COVID-19 with symptoms and that last for at least 2 months and cannot be explained by an alternative diagnosis”; the CDC considers persistent symptoms, or the onset of long-term symptoms, =4 weeks after acute COVID-19 infection.
Many studies and systematic reviews refer to COVID-related symptoms that persist or emerge beyond 4 weeks of infection as consisting of two subsequent phases: 1) Ongoing Symptomatic COVID-19 (OSC; signs and symptoms from 4 to 12 weeks from initial infection) and 2) Post-COVID-19 Syndrome (PCS; signs and symptoms beyond 12 weeks) with respect to symptomatology, abnormal functioning, psychological burden, and quality of life.
Post Acute Sequalae of COVID (PASC) is often referred to in studies and systematic reviews and is commonly understood as “the presence of at least 1 abnormality diagnosed by (1) laboratory investigation, (2) radiologic pathology, or (3) clinical signs and symptoms that were present at least 1 month after COVID-19 diagnosis or after discharge from the hospital”. It can be further classified as short-term PASC as 1 month; intermediate-term, 2 to 5 months; and long-term, as 6 or more months after COVID-19 diagnosis or hospital discharge.
In previous reviews, we have referred to “long COVID” synonymously to the above terms (ie. OSC, PCS, PASC) but for clarity, will move toward using these specific terms as they appear in the literature as well as simply using the time frames reported in each study/review. For example, where needed, we have replaced “long COVID” with the more concise “PASC” or “symptoms beyond 4 weeks of infection”.
Recommendations set out in our 2021 report can be relied upon with an important update to follow-up times (previously 2-3 months). Now, a 4-week follow-up is recommended for diagnosing and managing any PASC, especially for patients who suffered severe acute COVID-19 manifestation, where severe typically refers to those requiring medical attention, such as hospitalization for respiratory difficulty, to manage symptoms during the acute phase. In addition, these follow-ups should include mental health assessments in addition to any relevant clinical testing in response to each patient’s specific symptoms.
The clinical care burden of ongoing COVID-19 symptoms (OCS) is significant in the 3 months after infection and can place great demands on primary care services. Both OSC and PCS have consistently been shown to affect a large portion of the population with complex and persistent challenges that will also place strain on healthcare systems. This involves:
o Complications pertaining to multiple care specialties, with 20-75% of individuals reporting at least 1 persistent symptom 12 or more weeks following COVID-19 diagnosis.
o Neuropsychiatric manifestations (or “NeuroCOVID”) such as smell/taste disorder, memory complaints, anxiety, depression, post traumatic stress disorder (PTSD), concentration difficulties, and sleep disturbances are reported in 20-50% of individuals beyond 4 weeks from infection.
Functional disabilities and incapacity to return to work has been reported in 5% to 90% of individuals, where some are unable to reach their pre-COVID employment level at 12 weeks or longer post-infection; this has the potential to impact all sectors, including various levels of healthcare.
A significant number of individuals suffer from severe clinical conditions, such as acute cardiac, lung, and kidney injury.
A key focus will be to support individuals and populations who experience other persistent yet less severe conditions and symptoms such as fatigue, dyspnea, and mental health challenges including depression, anxiety, and sleep disorders.
July 12, 2021
Long COVID-19 is likely to increase demands across the health system, including emergency departments, hospital admissions, primary care visits, specialist appointments, and home care and rehabilitation services.
The clinical care burden of long COVID-19 is the greatest in the first 3 months after infection (revised from ‘testing’ in the previous report) and is likely to place the greatest demand on primary care services.
Patients with severe COVID-19 illness are more likely to place longer-term demands (4-6 months after the infection) on specialist care due to respiratory, circulatory, endocrine, metabolic, psychiatric and unspecified conditions.
Groot, G; Reeder, B; Hammond, B; Badea, A; Howell-Spooner, B; Ellsworth, C. What are long COVID's demands on the healthcare system, and its severity of the illness? 2022 Jun 20, Document no.: EPM210602v002 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2022. 23 p. (CEST rapid review report).
Badea, A; Groot, G; Reeder, B; Miller, L; Young,C. What is the evidence on volume of surgery with hip and knee replacements and quality of care? 2022 Jun 17. Document no.: EOC220601 RR Table. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2022. (CEST table).
Badea, A; Miller, L; Young, C. What is the evidence on volume of surgery with hip and knee replacements and quality of care? 2022 Jun 17. Document no.: EOC220601 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2022. 8 p. (CEST rapid review report).
Dalidowicz, M; Miller, L. Response to Long COVID: programs or accommodations to current frameworks 2022 Jun 17, Document no.: EOC220303v2 ESR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2022. 33 p. (CEST evidence search report).
Miller, L; Young, C. What is the evidence on volume of surgery with hip and knee replacements and quality of care? 2022 Jun 07, Document no.: EOC220601 ESR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2022. 48 p. (CEST evidence search report).
ECDC & WHO have released statements indicating that while a 4th dose may be beneficial to populations at highest risk of severe outcomes, marginal benefits for other populations may be outweighed by the opportunity and financial cost
Extensive analysis of data from Israel’s 4th dose campaign indicates that while protection against severe disease and death remains high following 3rd dose, the administration of a 4th dose significantly increases protection against infection and symptomatic disease, though this protection appears short-lived, with protective effects waning by 10 weeks
Israeli healthcare workers demonstrate an increase in immunity markers following 4th dose, but protection against infection remains low
In immunocompromised individuals (such as solid organ transplant patients and dialysis patients), receipt of a 4th dose of COVID-19 vaccine increases immunity marker titers, but non-responders continue to have a low likelihood of de novo seroconversion
March 31, 2022
Data from Israel of adults 60 years and older who received a 4th dose of mRNA vaccine found that the rate of confirmed infection decreased ~2 fold following the 4th dose, and the rate of severe illness decreased by ~4-fold in those who received a 4th dose versus those with 3 doses, both results were found to be statistically significant
NACI recommends a 4th dose at least 6 months following a 3rd dose for severely immunocompromised individuals who are not only at higher risk of severe outcomes, but also at higher risk of decreased protection over time following vaccination – this recommendation has been echoed by Public Health Ontario, the Northwest Territories Health and Social Services
The FDA has also authorized the use of the Pfizer mRNA vaccine as a 4th dose for adults over 50 years and those over 12 years with compromised immune systems
A small study of Israeli healthcare workers compared the incidence of COVID-19 in those who had received a 4th dose of vaccine to those who had received only three doses. It found that protection from Omicron infection was only slightly higher in the four-dose vaccine group compared to the three-dose control group (31% for Pfizer as a 4th dose, 11% for Moderna as a 4th dose), and that neither result was statistically significant. Breakthrough infections were mild, yet with high viral loads
Small-scale studies of solid-organ transplant and hemodialysis patients found that while a 4th dose increased antibody titers in most participants, those with severe immune deficiencies such as those taking anti-rejection medication were still unable to mount an immune response to vaccination – in addition, these studies have not assessed the presence or strength of functional immunity in these populations
Badea, A; Dalidowicz, M; Howell-Spooner, B; Groot, G; Reeder. B. What is the efficacy of a 4th booster dose for COVID-19? 2022 Jun 07. Document no.: EOC220304v002 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2022. 12 p. (CEST rapid review report).