Long COVID and other considerations

Long COVID

The Ontario Science Table released a science brief on understanding the post COVID-19 condition (long COVID) in adults and the expected burden for Ontario. The most common symptoms of long COVID are fatigue, memory deficits, shortness of breath, sleep problems and joint pain, which are associated with reduced function, impairments in people’s ability to work and care for themselves, poor quality of life and high health-care use.

Long COVID may be less frequent following emerging variants of SARS-CoV-2 than with earlier variants that tended to cause more severe disease. Vaccination against COVID-19 with one or two doses prior to infection was associated with an approximately 50 per cent reduction in the risk of developing lingering symptoms. Vaccination also appeared to show benefits in reducing the development of long COVID in people who were vaccinated after SARS-CoV-2 infection.

There are no routine tests for long COVID. Tests should be ordered as indicated by symptoms and clinical judgment, including:

Complete blood count
C-reactive protein, erythrocyte sedimentation rate, ferritin
Thyroid-stimulating hormone
Chest X-ray

Diagnostic code

A diagnostic code (081) for long COVID is in effect. The use of this code will help the ministry to better understand this condition and the associated health-care services provided to individuals with long COVID. You are encouraged to use this code when submitting claims to OHIP for services provided relating to long COVID assessment and management.

Practice supports

The Centre for Effective Practice has information on long COVID, including symptoms, patient evaluation, symptom management, guidance for how to help patients recover and what to do if patients aren’t getting better.

A digital tool that captures the progression of symptoms associated with post-COVID-19 condition is available in TELUS PS Suite and OSCAR. This tool promotes supported self-management, allowing for a comprehensive plan to be built based on presenting symptoms. A patient handout with symptom-specific links to available resources can also be printed directly from the tool, which was developed by the eHealth Centre of Excellence in collaboration with Ontario Health.

The Canadian Guidelines for Post COVID-19 Condition include evidence-based recommendations and good practice statements on post-COVID-19 condition. These national guidelines are led by Cochrane Canada and the MacGRADE Centre, with scientific and financial support from the Public Health Agency of Canada.

COVID-19-related eConsult Service

The COVID-19 and Post-COVID condition eConsult Service is available for you to ask COVID and Post-COVID condition-related clinical questions and request advice from specialists. There are 11 different COVID-19-related specialty groups available, including five on post-COVID conditions:

Post-COVID Condition – Chronic Fatigue Syndrome, Environmental Health Group
Post-COVID Condition – Internal Medicine
Post-COVID Condition – Neurology
Post-COVID Condition – Physical Medicine & Rehabilitation
Post-Covid Condition – Respiratory Recovery Group

The Ontario eConsult service is available on the secure, web-based OTNhub platform and offers timely access to specialist advice to clinician senders.

For more information or to sign up, fill out the intake form or contact eConsultCOE@toh.ca.

Rehabilitative programs

Patients with ongoing symptoms of COVID-19 may benefit from outpatient rehabilitation programs. To support primary care providers in determining which patients they should consider referring to an interprofessional rehabilitation team, Ontario Health has developed a post-COVID-19 condition: guidance for primary care tool. This tool is aimed at assessing patients who have had persistent COVID-19 symptoms for four weeks or longer.

Access a list of COVID-19 rehabilitation programs. Check the criteria for each site to find out if they accept outside referrals. Access a referral form and standardized intake and communication pathway for COVID-19 outpatient rehabilitation.

Income supports

Accessing income supports can be important for some individuals with long COVID.

Resources for physicians completing income support applications include:

Resources for patients on income support include:

I think I have long COVID. Can I get ODSP? (CLEO)
Disability benefits in Ontario: who can get them and how to apply (CLEO)
How do I start an ODSP application? (CLEO)
Submitting COVID-19 claim information (WSIB)

Other considerations

Palliative care

The Ontario Palliative Care Network recently updated its Palliative Care Resources to Support Frontline Providers during the COVID-19 Pandemic document. It summarizes readily available tools and resources to support palliative care delivery for patients with COVID-19.

Areas covered include support for compassionate communication and difficult decisions, symptom management, end-of-life care for COVID-19, leveraging virtual care to support palliative care, support for health-care professionals and palliative care education.

Long-term and residential care

The MOH’s plan for addressing COVID-19 in long-term care homes and retirement homes includes guidance on outbreak prevention and control.

Resources:

Completing death certificates

On Jan. 26, 2022, the Ministry of Health sent out a memo regarding medical certificates of death. In the context of decreased COVID-19 testing in the province, hospitalization and death data is increasingly important to understand COVID-19 trends in Ontario. When completing medical certificates of death, it is important to distinguish clearly between deaths directly caused by COVID-19 and deaths where the person may have tested positive for COVID-19, but died from another primary cause.

If COVID-19 was the underlying cause of death, then COVID-19 should be provided in part one of the cause of death section of the medical certificate of death. If there was a clear alternative cause of death, then COVID-19 should not be provided as the cause of death. Deaths from COVID-19 must be reported to the local public health unit, ideally within 12 hours.