Long-term COVID-19 effects have potential to create additional health-care system pressure

Ontario could be facing significant additional mid-term and long-term health consequences due to the coronavirus, as health experts continue to see effects in a sizeable number of patients long after they are symptomatic.

While the long-term effects remain unknown — the virus has not been around long enough for a 'long-term' to be here yet — there are serious health complications for many patients who have had the coronavirus, including damaged lung tissue and other vital organs, seizures, the virus lining cells and subsequently causing blood clots, and neurological damage too.

These complications, health experts say, further underscore the importance of stopping the spread of the virus and thinking about long-term strategies to address how the province can respond to the effects of COVID-19.

"In another 20 or 30 years we could see an uptick in dementia cases," said University of Toronto epidemiologist Colin Furness, pointing to one possible consequence of the pandemic. "We should be tracking cases to see."

Furness said one good outcome is that as treatment of the coronavirus improves, the fatality rate of positive tests should get better. But there should also be a corresponding shift to addressing longer-term issues — fatalities should not be the only metric that people follow to understand the impact of COVID-19 on the population. "Think about the burdens not just in terms of how many people it kills, but the kinds of disabilities it creates," he said, adding that quality-adjusted life years is an important holistic measurement.

And there can also be a shift from a policy perspective towards more of a focus on adequate rehabilitation, Furness added.

Among other complications, the coronavirus has caused some neuropathy, damage to nerves that control the central nervous system, causing numbness or tingling in the extremities. Furness said that the coronavirus can do permanent damage there.

Another impact is inflammation markers on heart tissue. A late-July German study published in JAMA Cardiology found that in 100 45–53-year-olds who recovered from the coronavirus, 78 per cent had heart issues when they were later tested with an MRI. While such findings are alarming, Ontario Medical Association President Dr. Samantha Hill told QP Briefing that it's difficult to know how many of those issues are due to COVID-19 and how many were pre-existing.

Regardless, the best strategy is prevention by not spreading the coronavirus and abiding by public health measures, Hill said. "First and foremost it's going to be trying to minimize the number of cases," she said, adding that there are still many unknowns about long-term health effects due to COVID-19.

But there will be other downstream health effects, she stressed. That includes a "massive backlog" of other medical procedures that have not taken place during the pandemic, and she called for more funding for doctors and the health-care system as a whole to help address those issues.

Public Health Ontario (PHO) is currently collecting and analyzing the different potential subsequent effects of COVID-19 based on academic and media reports. But one theme of the report is that there is still much to be known, and the findings thus far are preliminary.

"At this stage of the COVID-19 pandemic, there are few peer-reviewed studies examining the occurrence or prevalence of long-term sequelae associated with COVID-19," the July 10 report states. The report goes on to list a range of possible effects that PHO is monitoring based on reports, including neurological, respiratory, olfactory disorders, as well as glucose issues, anxiety, PTSD and depression.

Through spokesperson David Jensen, the Ministry of Health stated it would continue to monitor the situation and act on evidence as it arises. "As this outbreak evolves, we will continue to review the scientific evidence to understand the most appropriate guidance for the health system and the people of Ontario and make updates as needed. This work will be done in continued collaboration with our health system partners and scientific and technical experts within the health system."