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Document Type
Rapid Review
Review Code
EPM210602v002 RR
Question Submitted
June 22, 2021
Date Completed
June 20, 2022
Status
5. Updated review
Research Team
Epidemiology & Modelling
Document Type
Rapid Review
Review Code
EPM210602v002 RR
Question Submitted
June 22, 2021
Date Completed
June 20, 2022
Status
5. Updated review
Research Team
Epidemiology & Modelling
Updated Key Findings
June 17, 2022 Case Definition
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”. General
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.
Key Findings
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.
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
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).
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Document Type
Rapid Review
Review Code
INF031801v019 RR
Question Submitted
March 18, 2021
Date Completed
December 26, 2021
Status
5. Updated review
Research Team
Infectious Disease
Document Type
Rapid Review
Review Code
INF031801v019 RR
Question Submitted
March 18, 2021
Date Completed
December 26, 2021
Status
5. Updated review
Research Team
Infectious Disease
Updated Key Findings
December 14, 2021
Ontario Immunization Advisory Committee recommended that if an 11 and 12-year-old child is inadvertently given a second dose of the Pfizer-BioNTech vaccine that is not authorized for their age, the dose should be considered valid and the series complete.
National Advisory Committee on Immunization (NACI) recommends that a booster dose of an authorized mRNA COVID-19 vaccine should be offered to vulnerable population and > 50 years old, =6 months after completion of a primary COVID-19 vaccine series.
Australian Technical Advisory Group on Immunization (ATAGI) recommends COVID-19 booster vaccination with either Pfizer (Comirnaty) or Moderna (Spikevax), which are considered equally acceptable, for anyone aged 18 and older who completed their primary course of COVID-19 vaccination 5 or more months ago.
On December 8th, 2021 in a press release by Pfizer-BioNTech said that preliminary laboratory studies demonstrate that three doses of the Pfizer-BioNTech COVID-19 vaccine neutralize the Omicron variant while two doses show significantly reduced neutralization titers. Data indicate that a third dose of BNT162b2 increases the neutralizing antibody titers by 25-fold compared to two doses.
Key Findings
December 3, 2021
The Therapeutic Goods Administration (TGA) has granted provisional approval to Moderna for the use of its vaccine in children (two 10µg doses) and as booster shot for adults (one 30µg dose) in preparation for the recent emergence of the Omicron variant. This is in addition to Pfizer, which was also recently approved.
The National Advisory Committee on Immunization (NACI) recommends that a complete series with the Pfizer-BioNTech COVID-19 vaccine (10 mcg) may be offered to children 5-11 years of age who do not have contraindications to the vaccine, with a dosing interval of at least 8 weeks between the first and second dose.
NNACI also recommends that children aged 5-11 years with a history of previous SARS-CoV-2 infection should be considered no longer infectious and symptoms of an acute illness should be completely resolved prior to vaccination.
Health Canada has authorized Moderna's COVID-19 vaccine (also known as Spikevax) to be used as a booster shot, using a half-dose of the vaccine.
Category
Epidemiology
Infection Prevention and Control
Subject
Vaccines
Immunity
Infection Prevention and Control
Clinical Presentation
Population
All
Clinical Setting
Community
ICU
Medicine Unit
Primary care
Public Health
Priority Level
Level 3 Two weeks (14 days)
Cite As
Jagwani, M; Lee, S; Shumilak, G; Reeder, B; Groot, G; Hernandez, L; Howell-Spooner, B; Miller, L. How effective are COVID-19 vaccines? 2021 Dec 26. Document no.: INF031801v019 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 93 p. (CEST rapid review report)
Review History
INF031801v17 RR: November 23, 2021
INF031801v16 RR: November 12, 2021
INF031801v15 RR: October 28, 2021
INF031801v014 RR: October 16, 2021
INF031801v013 RR: September 24, 2021
INF031801v012 RR: September 10, 2021
INF031801v010 RR: August 25, 2021
INF031801v9 RR: August 23, 2021
INF031801v8 RR: August 9, 2021
INF031801v7 RR: July 20, 2021
INF031801v6 RR: July 2, 2021
INF031801v5 RR: June 22, 2021
INF031801v4 RR: June 3, 2021
INF031801v3 RR: May 24, 2021
INF031801v2 RR: May 14, 2021
INF031801 RR: March 31, 2021
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