More post-COVID rehab programs needed in Ontario

The number of people with post-COVID symptoms, also known as long-COVID, is increasing, with over 200 reported symptoms and no specific test criteria.

The province has had over 1.3 million COVID cases since the pandemic began; a number that’s still growing as GPs see more patients with symptoms for more than two months.

dr Mary Jackson, a respirologist at St. Mary’s General Hospital, has been helping with various aspects of the pandemic, including post-COVID symptoms in local patients.

“People can have persistent symptoms in many different systems. They can have shortness of breath, they can have fatigue, they can have what they call “brain fog,” anxiety, depression, rashes. There are many things they have attributed to this syndrome that does not have a clear definition, which can make it difficult to study.”

Anyone with symptoms lasting more than two months is considered post-COVID, according to the World Health Organization.

GPs in the area attempt to treat and diagnose patients, sometimes sending the more serious cases to the nearest post-COVID rehabilitation clinic or rehabilitation program in Toronto.

“We do not have a specific long COVID program in our region. We have not received specific money as a region to set up long COVID clinics.”

The post-COVID condition can affect 1 in 3 people who have had COVID, said Dr. Ashley Verduyn, VP of Medical Affairs and Chief Medical Director of Houses of Providence.

She oversees one of the few post-COVID rehabilitation programs in the province, housed at Unity Health Toronto, which some Waterloo-area residents are referred to.

“We now have a long waiting list.”

“About 70 percent of our patients are under 65 years old. We don’t see the pediatric age range. We see kids as young as 20 and the average age in our program is 50.”

Her post-COVID rehab program started just over a year ago, said Verduyn, who works with the Ontario College of Family Physicians and speaks at events, educating GPs about post-COVID and how they can help patients with symptoms.

“We’re seeing more and more people with ongoing symptoms of COVID, and GPs are wondering what it is and how to help their patients.”

“It’s up to GPs to determine if this is post-COVID or if it’s something else, but treatment at this point is mostly about managing the symptoms. There is no specific treatment, there are rehab programs like the ones we offer – to help them get back to the things they were doing before they got sick.”

Verduyn mentioned that anyone who is not vaccinated is at a higher risk of getting post-COVID symptoms.

The most common persistent symptoms they see are fatigue, post-exercise discomfort, cognitive dysfunction, shortness of breath, and chest discomfort.

“It has a major impact on a patient’s quality of life.”

“Before, it was a bit stigmatized by the general public and doctors because we didn’t really know what was going on. But now we know it as an actual disorder and risk after COVID infection.”

The more severe the COVID infection, the greater the risk for patients of developing post-COVID symptoms.

The rehabilitation program helps patients achieve their goals, such as returning to work.

The first step is to educate them on how to manage fatigue, the next is a treatment that suits their specific needs.

Fatigue and post-exercise discomfort are some of the biggest factors affecting the ability of post-COVID patients to function in everyday life, as their bodies become exhausted from too much work or exercise, Verduyn said.

“We see that people are doing better. So little was known about this when we started the program and we see our patients improve fairly quickly with their functional abilities and then we have other patients that are more about learning to manage the symptoms , because the symptoms are still there and never go away completely. That can take up to a year.”

It can be a complicated process for patients seeking rehab programs in Ontario, as they often need to be referred by primary care physicians, some of whom may not be aware of the few programs like this in rural communities.

Some rehab programs only accept patients previously hospitalized with COVID, Verduyn said, noting that there is no coordinated post-COVID response in Ontario.

“The majority of patients who access our program have never been hospitalized for COVID and as a result some people may not have access to rehab that they really need.”

Alberta Health, on the other hand, has a holistic approach and a coordinated path for patients to access interdisciplinary post-COVID rehab.

“We don’t have that here in Ontario,” says Verduyn. “We do not have a coordinated rehab approach for patients with post-COVID conditions.”

Post-COVID clinics or programs are mostly limited to large provincial cities and many of them have very limited criteria for inclusion in the program.

“I’d like to see a more provincial approach to accessing clinics or programs when the need arises. It should apply to everyone, not just those who live in a big city.”

“Society benefits when they get jobs and are able to do the things they need to do. It is unfair in terms of access at the moment and that needs to be addressed.”

Waterloo Region Public Health and Ontario Health declined to comment.