We are in the midst of a 7th wave of COVID-19. We are seeing infections, hospitalizations and deaths rise. Our communities, services and economy are strained because of burnout and the number of people off sick.
But these early impacts are not the final story. We now know that a portion of people who are infected by the virus suffer from prolonged symptoms due to a condition known as “long COVID.” These symptoms range from extreme fatigue, “brain fog,” pain and anxiety, to breathing problems and heart palpitations.
While it’s unclear how many people have prolonged illness from COVID-19, conservative estimates from the fall of last year suggest that 150,000 people in Canada and between 56,000 and 78,000 people in Ontario were suffering with long COVID symptoms. More recent calculations based on a 10 per cent prevalence rate indicate that as many as 390,000 people in Canada could have the condition. Projections are emerging about the broader social implications of the condition, such as impacts on health systems, labour market shortages, and increased responsibilities for impacted families.
Over the last two years, we’ve seen COVID-19 disproportionately affect low-income and racialized communities, essential workers, and older Canadians. Long COVID is likely to hit vulnerable and marginalized groups hard.
Health is the cornerstone of competitive economies and strong communities. COVID is one of the top five causes of death in Canada, and the growing number of people disabled by long COVID has become a significant unaddressed social issue which could impact us all if not properly dealt with.
As governments continue to respond to the impacts of COVID-19, they must also respond to the needs of people with long COVID. They need to invest in services that address long COVID, provide supports for people with long COVID and their caregivers, and prioritize research that centres equity and groups disadvantaged by the pandemic.
Invest in and improve access to physical and mental health services that address long COVID
People with long COVID and healthcare providers across Canada have been vocal about the need for better access to health services to address the condition. The government should ensure that there is access to appropriate treatment services and supports for people with long COVID. Internationally, most models of care involve an integrated multidisciplinary team to help people manage their symptoms and regain quality of life.
When planning for public programs they should focus on equity to ensure that everyone can access services to help them recover and prevent continued disability. Access to programs should be universal and not require user fees or private insurance coverage. Decades of research has shown that universal publicly funded health programs are needed to provide equitable access to services.
People with long COVID should have access to medications, support for mental health and well-being, and other therapies. This might require locating funded clinics in areas where there has been a greater COVID-19 burden, eliminating additional financial barriers to access, and ensuring flexibility in program eligibility requirements. By making sure services are accessible to everyone, people from communities that have fared worse during the pandemic will be given the fair chance for recovery and to resume their usual roles and activities.
Provide economic and social support for people with long COVID and their caregivers
There are many unknowns about long COVID, but we know that low-paid essential workers, people with low income, and racialized groups have all disproportionately borne the burden of COVID-19 to-date. Inequities have been experienced in terms of rates and severity of the disease and protection through vaccination. We also know that the social determinants of health have been key for framing risk versus resilience. For example, housing and work conditions determine the degree to which people are able to socially distance or isolate if they become sick.
While emergency pandemic programs (e.g., CERB, CRCB) have temporarily filled an income gap for many, there is a need for longer-term planning for programs that provide adequate income support. Without this support, individuals who are already struggling financially will have difficulty making ends meet or fall into debt. An adequate income is required so that people can pay their rent and purchase food and other necessities to help with their recovery. Physical and mental health support services are only part of the equation; economic support will relieve some of the burdens many residents and caregivers feel while experiencing the affects of long COVID.
The course of long COVID is unpredictable, but our lack of data should not mean that we leave people destitute. People with long COVID need access to income support payments that are commensurate with the level of their disability for the length of their impairment. Our income support schemes need to pivot to ensure that people are not doubly impacted by long COVID and by our inability to adapt our social support systems.
Prioritize research that centres equity and the perspectives of groups disadvantaged by the pandemic
While funding research that helps us better understand the causes, outcomes and effective treatments for long COVID is clearly important, greater knowledge of the social and economic conditions that determine how people experience long COVID differently is needed. Much uncertainty surrounds long COVID, including questions about how many people are impacted, who is at greater risk of developing the condition, what the protective factors may be, and treatment options.
While research has shown gaps in knowledge about the link between long COVID and factors such as income and ethnicity, it has been established that the effects of the pandemic to-date have been highly inequitable. Data shows that 53 per cent of people who were hospitalized in Toronto as of July 2021 were living in households classified as “low income,” despite the fact that these households represent only 30 per cent of the city’s population. The same data shows that the rate of COVID-19 hospitalization is three times greater in Toronto’s Black populations than in White populations. Focusing research efforts on understanding how long COVID impacts these populations will allow us to address inequities in our response.
Looking toward the future
The pandemic is still unfolding, and the future remains uncertain, but we can and should act on what we already know as we move forward. Since early 2020, the pandemic has made it clear there are stark inequities in our society. Uncertainty with respect to long COVID and the ongoing effects of the virus on society does not justify inaction. People affected by long COVID have been vocal about the need for greater investment into programs to address their condition.
Building resilience in the face of future pandemic waves and other emergencies must include steps to address the conditions that made some people more vulnerable to COVID-19 in the first place—including work, income, housing, schools and other care environments. We need to develop a health and social infrastructure that adequately supports those with ongoing illness and disability resulting from this virus, adapting responses in a way that accounts for its unpredictability.