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Document Type
Table
Review Code
EOC021901v2 RR Table
Question Submitted
February 19, 2021
Date Completed
October 29, 2021
Status
5. Updated review
Research Team
EOC
Document Type
Table
Review Code
EOC021901v2 RR Table
Question Submitted
February 19, 2021
Date Completed
October 29, 2021
Status
5. Updated review
Research Team
EOC
Category
Healthcare Services
Clinical Presentation
Subject
Long Covid
Clinical Presentation
Health Planning
Symptoms
Population
All
Clinical Setting
Ambulatory
Long Term Care
Primary care
Priority Level
Level 5 Four weeks+ (28 days+)
Cite As
Williams-Roberts, H; Groot, G; Mueller, M; Dalidowicz, M. Long COVID: What does it mean for the healthcare system and programs? 2021 Oct 29. Document no.: EOC021901v2 RR Table. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. (CEST Table).
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EOC021901v2 RR Table

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Document Type
Rapid Review
Review Code
EOC021901v2 RR
Question Submitted
February 19, 2021
Date Completed
October 29, 2021
Status
5. Updated review
Research Team
EOC
Document Type
Rapid Review
Review Code
EOC021901v2 RR
Question Submitted
February 19, 2021
Date Completed
October 29, 2021
Status
5. Updated review
Research Team
EOC
Updated Key Findings
October 29, 2021
In October, WHO released a consensus definition of post COVID-19 condition that includes 12 domains. This development should lead to better standardization of reporting and contribute to more precise prevalence estimates and better understanding of associated risk factors.
The effects of Variants of Concern (VoC) and COVID vaccination on progression of Long COVID symptoms remains unclear.
Risk factors for developing Long COVID symptoms were similar but limited evidence suggests that pre-pandemic psychological distress and poor general health were associated with developing persistent symptoms. Evidence is too limited to determine whether vaccination reduces the risk of developing Long COVID among persons with breakthrough infections.
Given the protean manifestations of Long COVID symptoms, the underlying causes are likely multifactorial; however, strong evidence to substantiate the theories of causation remains limited.
Research related to longer-term consequences of SARS CoV-2 infections in pediatric populations is growing but remains limited.
Key Findings
March 15, 2021
There is a lack of consensus around the clinical definition of Long COVID which in turn causes challenges with understanding the incidence and prevalence as well as the potential impact for the health care system
Information about the natural history of Long COVID is incomplete but limited evidence suggests that the immune response trajectories differ for those with few or no symptoms compared to those with severe disease. Individuals with severe disease are more likely to exhibit immunological marker abnormalities but anyone can experience functional limitations.
The mechanisms underlying the development of persistent symptoms in Long COVID remain an enigma. Despite multiple theories, there is little empirical evidence for specific immunological and or biochemical abnormalities in samples of individuals with symptoms consistent with Long COVID.
Risk factors for Long COVID include female gender, older age, higher body mass index, pre-existing asthma and the number of symptoms.
Few studies explored the short-term impact of Long COVID on health care utilization patterns and found a higher impact for those with severe disease compared with mild disease.
Category
Healthcare Services
Clinical Presentation
Subject
Long Covid
Clinical Presentation
Health Planning
Symptoms
Population
All
Clinical Setting
Ambulatory
Long Term Care
Primary care
Priority Level
Level 5 Four weeks+ (28 days+)
Cite As
Williams-Roberts, H; Groot, G; Mueller, M; Dalidowicz, M. Long COVID: What does it mean for the healthcare system and programs? 2021 Oct 29. Document no.: EOC021901v2 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 14 p. (CEST rapid review report).
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Document Type
Table
Review Code
EPM210602 RR Table
Question Submitted
June 22, 2021
Date Completed
July 12, 2021
Status
3. Completed
Research Team
Epidemiology & Modelling
Document Type
Table
Review Code
EPM210602 RR Table
Question Submitted
June 22, 2021
Date Completed
July 12, 2021
Status
3. Completed
Research Team
Epidemiology & Modelling
Category
Clinical Presentation
Epidemiology
Subject
Long Covid
Health Planning
Clinical Presentation
Population
All
Clinical Setting
Ambulatory
Community
Emergency
ICU
Long Term Care
Medicine Unit
Primary care
Public Health
Priority Level
Level 1 2-3 days
Cite As
McLean, M; Williams-Roberts, H; Reeder, B; Howell-Spooner, B; Ellsworth, C. What are long COVID's demands on the healthcare system, and its severity of the illness? 2021 Jul 12, Document no.: EPM210602 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. (CEST table).
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EPM210602 RR Table

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Document Type
Rapid Review
Review Code
EPM210602 RR
Question Submitted
June 22, 2021
Date Completed
July 12, 2021
Status
3. Completed
Research Team
Epidemiology & Modelling
Document Type
Rapid Review
Review Code
EPM210602 RR
Question Submitted
June 22, 2021
Date Completed
July 12, 2021
Status
3. Completed
Research Team
Epidemiology & Modelling
Key Findings
Long COVID-19 is likely to increase healthcare demands across the health system, including emergency departments, hospital admissions, primary care visits, specialists appointments, and home care and rehabilitation services.
The clinical care burden of long COVID-19 is the greatest in the first 3 months after testing 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) on specialist care due to respiratory, circulatory, endocrine, metabolic, psychiatric and unspecified conditions.
Category
Clinical Presentation
Epidemiology
Subject
Long Covid
Health Planning
Clinical Presentation
Population
All
Clinical Setting
Ambulatory
Community
Emergency
ICU
Long Term Care
Medicine Unit
Primary care
Public Health
Priority Level
Level 1 2-3 days
Cite As
McLean, M; Williams-Roberts, H; Reeder, B; Howell-Spooner, B; Ellsworth, C. What are long COVID's demands on the healthcare system, and its severity of the illness? 2021 Jul 12, Document no.: EPM210602 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 23 p. (CEST rapid review report).
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Document Type
Rapid Review
Review Code
LTC090801 RR
Question Submitted
September 8, 2020
Date Completed
December 13, 2020
Status
3. Completed
Research Team
Long Term Care
Document Type
Rapid Review
Review Code
LTC090801 RR
Question Submitted
September 8, 2020
Date Completed
December 13, 2020
Status
3. Completed
Research Team
Long Term Care
Key Findings
No evidence was found as rationale for the 14-day isolation period on resident transition to LTC. This requirement likely arose from evidence that active monitoring for 14 days is sufficient to identify symptom onset in 99% of COVID-19+ cases (1).
No alternatives were found in Canada to a 14-day isolation period on transition of a resident into LTC. A rapid review of viral shedding and the need for isolation recommends a minimum 10-day isolation period, with additional consideration for high risk groups (36). The Centers for Disease Control and Prevention (2) in the US is considering decreasing the standard 14-day quarantine period to 7-10 days in recognition that the general two-week quarantine rule is onerous for many people and most of the benefit of quarantine to public health could be gained with a more flexible and contextual approach. Implications for changes in Public Health Agency of Canada’s (PHAC) policy on quarantine or duration of isolation for admission to LTC are not yet established.
The Canadian policies at the provincial government levels align with the PHAC’s recommendation of 14 days of isolation (14). Most jurisdictions across Canada follow guidelines requiring a resident to have a negative test on admission, and 14 days of self-isolation with contact and droplet precautions (4, 17).
However, a few jurisdictions stratify the level of precaution or need for isolation by community transmission (3, 5). For example, the Province of Alberta’s (5) Operational and Outbreak Standards for LTC recommends the following safety precaution: for residents with low or unknown risk of exposure, twice daily symptom checks for 14 days; for residents with medium risk, continuous use of a mask for 14 days while out of resident room; for residents with high risk, quarantine for 14 days. Best practices on transition to LTC to support residents’ well-being
Some Canadian policies state the importance of protecting resident well-being on transition to LTC but provide little guidance on how to ensure this is done. For residents who might find self-isolation challenging (e.g. those with cognitive challenges), Government of New Brunswick (18) recommends taking efforts to ensure adequate staffing level and support residents’ individualized care plan.
Residents in LTC who have cognitive impairments will have difficulties understanding the need for isolation and absence of families and friends, and complying with isolation procedures (31). There is little guidance for long-term care facilities on how to support safe isolation of those living with cognitive impairments, while maintaining the human dignity and personhood of the individual. Strategies need to be developed to have an isolation care planning that is effective, safe, and compassionate (31).
Maintaining connections between residents and their families should be supported under safety, socio-emotional, and ethical grounds (39). Several provinces and international jurisdictions designate Essential Family Caregivers (EFCs), who are present not for social visits but to provide services and brought into the facilities under the same specific protocols as staff (39, 49, 50, 51).
Category
Infection Prevention and Control
Administration
Subject
Facilities
Self-Isolation
Long Term Care
Health Planning
Elderly
Population
Aged (80+)
Clinical Setting
Long Term Care
Priority Level
Level 5 completed within 2 weeks
Cite As
Gao, Y; Ward, H; Tupper, S; Boden, C; Miller, L; Mueller, M. What is the evidence for 14-day isolation upon move-in to long-term care during COVID-19 pandemic? 2020 Dec 13; Document no.: LTC090801 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 33 p. (CEST rapid review report)
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Document Type
Rapid Review
Review Code
EOC071001 RR
Question Submitted
July 10, 2020
Date Completed
July 27, 2020
Status
3. Completed
Research Team
EOC
Document Type
Rapid Review
Review Code
EOC071001 RR
Question Submitted
July 10, 2020
Date Completed
July 27, 2020
Status
3. Completed
Research Team
EOC
Key Findings
· The terms cluster and outbreak both describe the occurrence of new disease cases within a particular location and time period. The number of cases within a cluster are not necessarily greater than what is expected, however in an outbreak the number of cases does exceed the usual norm. · In an outbreak the cases are confirmed to be epidemiologically linked while in a cluster an epidemiological connection is only suspected. · Not all clusters are outbreaks, however each cluster needs to be investigated
· Understanding how to characterize COVID-19 cases based on a suspected or proven epidemiological link can better guide prevention of disease spreading
Category
Administration
Epidemiology
Subject
Disease Outbreak
Public Health
Health Planning
Decision Making
Population
All
Clinical Setting
Community
Emergency
Long Term Care
Other
All acute care.
Priority Level
Level 5 completed within 2 weeks
Cite As
Radu, L; Badea, A; Groot, G; Ellsworth, C; Young, C. What is the definition of an outbreak versus a cluster for COVID-19 in different clinical and community settings in Canada, the US, and the UK? 2020 Jul 27; Document no.: EOC071001 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 11 p. (CEST rapid review report)
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Document Type
Rapid Review
Review Code
LTC042201 RR
Question Submitted
April 22, 2020
Date Completed
April 29, 2020
Status
3. Completed
Research Team
Long Term Care
Document Type
Rapid Review
Review Code
LTC042201 RR
Question Submitted
April 22, 2020
Date Completed
April 29, 2020
Status
3. Completed
Research Team
Long Term Care
Key Findings
· Overall, there is a lack of high quality evidence to support recommended pandemic preparedness strategies (checklist items) to prevent or mitigate respiratory infection outbreaks in LTC. · In the absence of high-quality or mixed evidence to support strategies for pandemic preparedness, it is advisable to follow clinical practice guideline recommendations that have been based on expert opinion (key sources are identified in red). This is particularly the case for infection control interventions that are likely to have no negative impacts on LTC residents (e.g. hand hygiene, cough etiquette). Strategies that have a potential negative impact on LTC residents (e.g. visitor restrictions) must be handled with more flexibility and individual assessment to determine how infection control can be preserved while minimizing negative consequences for residents and families. · Internationally recognized pandemic/outbreak preparedness checklists for LTC (e.g. CDC 2020, Buynder et al. 2017) share many similarities to the current SHA Annex R checklists. · Consideration should be given to converting the checklist into a planner with accountabilities to demonstrate how each item is being addressed (similar to CDC 2020). Links can be embedded in the planner/checklist to more detailed information, such as the PPE burn calculator (CDC 2020), education/training materials (WHO 2020), and communication materials for families (CDC 2020, WHO 2020, Buynder et al. 2017). · Consider the addition of specific detail to the SHA pandemic preparedness checklists on the date of the next pandemic plan/checklist review, contact names for local resource acquisition or assistance with staffing, tracking forms for dates of education/training with staff and residents, tracking of audits/observation of infection control practices, surge capacity planning items, and expanded items for communication (see attached recommendations from family caregivers of the Saskatchewan LTC Network). · Discrepancies exist between reported (77-100%) and observed (25-63%) adherence to infection control practices, indicating a need for independent audits. Adherence rates improve with direct observation, frequent education reminders and prompts. · Even when there is not an outbreak in a home, the pandemic response results in increased workload demands on staff due to infection control practices (e.g. PPE and hand hygiene), loss of family caregiver assistance with resident care, enhanced care needs of residents due to anxiety, increased communication with family caregivers and other members of the care team, monitoring and restricting resident movement in the home, enhanced cleaning, staff absenteeism, and education/training. Consideration is needed for a provincial process for evaluation of needs within individual homes, and allocation of additional human resources, disposable supplies, equipment, or funding to ensure that both infection control and usual care needs of residents are consistently met. · Maintaining public confidence through communication is a defined infection control strategy. Communication strategies include individual communication between family members and staff, public communication strategies by individual facilities and provincially through dedicated pandemic information pertaining to LTC (e.g. dedicated LTC section on provincial websites).
Category
Administration
Infection Prevention and Control
Subject
Facilities
Health Planning
Long Term Care
Elderly
Population
Aged (80+)
Other
Clinical Setting
Long Term Care
Priority Level
Level 3 completed within 2-3 days
Cite As
Tupper, S; Ward, H; Dalidowicz, M; Boden, C; Ellsworth, C; How can LTC facilities prepare for a pandemic? 2020 Apr 29; Document no.: LTC042201 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 27 p. (CEST rapid review report)
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Document Type
Rapid Review
Review Code
LTC041501 RR
Question Submitted
April 15, 2020
Date Completed
April 16, 2020
Status
3. Completed
Research Team
Long Term Care
Document Type
Rapid Review
Review Code
LTC041501 RR
Question Submitted
April 15, 2020
Date Completed
April 16, 2020
Status
3. Completed
Research Team
Long Term Care
Key Findings
There is limited information on transferring infected LTC residents to an off-site cohort location such as a purpose-built field hospital. Lessons learned from SARS suggest that transfers to dedicated facilities for cohorting may increase spread.
A greater number of recommendations support on-site cohorting of residents infected with droplet/contact transmitted illnesses. Health Canada’s COVID-19 Interim Guidance for LTC Homes report states that transfers within and between facilities should be avoided except for medically indicated procedures that cannot be provided by the long-term care home e.g. respiratory failure requiring ventilation or hemodynamic compromise.
Family members encourage cohorting a resident in the LTC home if possible. They also recommend following residents’ advanced care directives to determine whether life-sustaining measures are preferred, robust healthcare and psychosocial support for residents who are cohorted, and clear communication with residents and family members.
Cohorting on site includes isolation of residents to their rooms (preferably single occupancy) or dedicated units in the home. Staff and equipment cohorting should also be implemented if possible (i.e.dedicated staff that do not provide care to residents in non-infected units, and resident specific equipment).
Consider cohorting in day program spaces, recreation rooms, palliative care rooms, chapels, or dining rooms in the home that are no longer being used as common spacesas long as call bells or other appropriate communication measures are in place.
Category
Healthcare Services
Infection Prevention and Control
Subject
Facilities
Decision Making
Health Planning
Transmission
Population
Aged (80+)
Clinical Setting
Long Term Care
Priority Level
Level 3 completed within 2-3 days
Cite As
Tupper, S; Ward, H; Ellsworth, C; Dalidowicz, M; Boden, C. What are the best practices for cohorting long-term care residents to reduce transmision of COVID-19? 2020 Apr 16; Document no.: LTC041501 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 10 p. (CEST rapid review report)
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8 records – page 1 of 1.