USask researchers: COVID-19 will continue to impact health care

“COVID is talked about less now than it was before,” said Dr. Nazeem Muhajarine (PhD), professor of community health and epidemiology at the University of Saskatchewan (USask). “There are hardly any messages coming from our political leaders, and even from public health medical leaders. The threat of COVID putting people in large numbers in hospitals and dying of COVID is no longer present as it was before; one might assume that we don’t need to pay much attention to it now. The danger in this thinking is that COVID hasn’t disappeared, nor is it without any threat to individuals.”

He acknowledged that due to vaccines, immunity generated from having COVID-19, and treatment improvements, the threat of death and hospitalization have receded, but attention is still needed at the individual level.

“COVID continues to pose a threat to individual people, especially for older adults, those with severe and chronic pre-existing medical conditions, immunosuppressed or immunocompromised people, and those who are socially vulnerable,” Muhajarine said. “The impact of COVID on the medical system continues to be notable, especially if you consider the ongoing demand placed on it by long COVID patients as well.”

Muhajarine identifies long COVID, or Post-COVID Condition (PCC), as the least talked about topic that needs the most attention and action. According to the World Health Organization (WHO), long COVID is a condition that occurs in individuals who have either had a confirmed SARS-CoV-2 infection or the likelihood of that.

According to the WHO, “It is defined as the continuation or development of new symptoms three months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least two months with no other explanation.”   

Common symptoms include fatigue, shortness of breath, cognitive dysfunction, and others that negatively affect daily functioning. The symptoms may be new onset, following initial recovery from an acute COVID-19 episode, or may persist from the initial illness. Symptoms may also fluctuate or relapse over time.

“A survey developed by the Government of Canada showed that nearly 15 per cent of adults with a confirmed or suspected infection experienced longer-term COVID-19 symptoms and that just over 47 per cent of these people experienced symptoms for a year or longer,” said Dr. Gary Groot (MD, PhD), USask professor of surgery and community health and epidemiology. “The symptoms of long COVID limit daily activities in about 21 per cent of those affected. And while long COVID is less likely with the current Omicron variant and with vaccination, neither prevents individuals from developing the disease.”

Canada’s Chief Science Advisor recently issued a comprehensive report on PCC in which she noted that there is an urgent need for research to, “understand the biologic basis for the complex symptoms and conditions seen in PCC,” so that we can learn how to diagnose and treat this new disease entity.

“Given the ongoing nature of the COVID-19 pandemic, the impact of PCC will extend far beyond the health of individuals, affecting their families, labour markets, the workplace and social support programs,” Groot said.

Muhajarine agrees and offered the reminder that “people still get sick, lose work and income, study opportunities, and some lose their lives even. The conversation now, and the messaging, must be more nuanced, more targeted to people who are most vulnerable, like the unvaccinated or those who do not have their vaccines up to-date, elderly, or immunocompromised.”

Muhajarine was a member of the expert advisory panel on long COVID that informed the PCC report. He said the panel described long COVID this way: at a population level, acute COVID-19 illness is the “head” of the COVID-19 pandemic, while PCC represents a transition to its long tail, a stage characterized by chronic illness.

“The thing is that we do not know yet how long a tail this long COVID chronic illness is,” he said.

He points to the calls to action in the report that identify the need to accurately document the epidemiology of long COVID, including why some people transition to it and others don’t, how to treat long COVID patients and for how long, and how long COVID patients are supported to cope with their condition while living meaningful and fruitful lives.

“Canada has fallen behind other comparable nations—the U.K., the U.S., Israel, for example—in mounting a co-ordinated, well-publicized response to long COVID,” Muhajarine said.

The recent announcement of funding for a national network of researchers, called Long COVID Web, includes both Groot and Muhajarine, as well as several other USask researchers.

“It’s an important, positive development,” Muhajarine said, “but we have a lot to do on the long COVID front.” 

With estimates that about 65 per cent of Canadians have been infected with the virus that causes COVID, Muhajarine said that when that is applied to our province, we are looking at more than 115,000 people who potentially will need some type of care or support from the health care system three months after an initial COVID infection.

“That is a lot of people. For how long they would need care, we don’t know.”

He noted other lessons learned from the pandemic, including the damaging effect of the politicization of the pandemic and its use as a wedge issue by opposing government forces. He thinks Canada’s chief medical health officers, especially during a pandemic when the whole population is under threat, must be able to make independent decisions and communicate directly to Canadian people. Expanding the social safety net to better protect and support the socioeconomically disadvantaged and members of minority groups is necessary. He also recommends that public health be the go-to system in pandemics, and that these systems be strengthened.

“We need public health to be seen as critical infrastructure such that it can respond to not only a single public health emergency, but multiple ones at the same time. For example, this winter, and in coming winter seasons, we will contend with RSV, flu, COVID, measles, and even polio. It is a staggering and increasingly long list, and we need to make sure the infrastructure can handle it. By and large, we failed to do that with COVID.”

The online world we operate in now had a huge impact as well, creating huge problems in getting accurate information to people.

“We really need to figure out how to counter misinformation and disinformation,” Muhajarine said. “A rapidly changing virus, rapidly developed vaccines that were trying to keep up, and the virus striking with consequences at different intensity in different places, created a very challenging situation for messages to be communicated with clarity, consistency, and persuasion.”

In particular, he referenced the points where the virus and the response to it transitioned, and those key transition points needed to be better explained to people to help them understand why they needed to shift their own behaviours and actions.

Finally, he said, “One of the highest priorities in the coming year must be to get the COVID-19 pandemic treaty that WHO is leading sorted out. We should not blow this opportunity to put the lessons we have learned as a human collective to future use. There’s no scenario in the world that sees us controlling a pandemic by some countries doing well and other countries just letting the virus spread. To really control a pandemic, you have to treat it like a pandemic, a global threat. You’ve got to have the whole world working together.”