Post by Nadica (She/Her) on Sept 13, 2024 2:12:02 GMT
Is ‘Long Covid’ similar to ‘Long SARS’? - Published June 9, 2022
BACKGROUND
Severe acute respiratory syndrome
In 2002–03, a Severe Acute Respiratory Syndrome (SARS) coronavirus caused a pandemic. It was described as a novel virus, meaning that it seemed to be unrelated to other viruses directly. Worldwide there were approximately 8000 cases and over 800 deaths. Toronto (Ontario, Canada) had the largest outbreak outside of Asia, with 251 cases and 41 deaths, with health care workers making up 43% of the cases [1].
Covid
The World Health Organisation (WHO) has recorded about 500 million Covid-19 cases and 6 million deaths globally, up to mid-April 2022 [2]. How many people have suffered from Long Covid [also called post acute sequelae of COVID-19 (PASC)]? We have both too much evidence and insufficient evidence. There are many, many articles published. There is incomplete agreement as to criteria for inclusion, symptoms, severity of symptoms and length of time symptoms have persisted. There is the question of what proof of Covid is required (is a self-reported test adequate?) and whether the study setting is in the community or whether it is post hospitalization. In the UK, the official register provides a prevalence of ongoing post-Covid symptoms at about 8% of cases (1.8 million people [3] post 22.3 million cases [4]). A recent Lancet preprint [5] (i.e. preliminary, not yet accepted for publication and without peer review) systematic review and meta-analysis including 196 studies and 120,970 participants showed that long COVID may affect more than half of the patients, after a median of 6 months from the diagnosis. It is expected that with time, the exact numbers will become more clear. However, it is now already clear that the numbers are very significant. To deal with those staggering numbers of people with ongoing Long Covid symptoms, innumerable rehabilitation programs have sprung up. However, since Long Covid is new, there is no knowledge as to what:
Makes a good rehab program for this population;
What is cost-effective;
What services are needed and helpful;
What are the short-term and long-term outcomes with and without rehabilitation?
These questions cannot yet be answered. However, if as seems likely, Long Covid is similar to the long-term outcomes post SARS, then predictions can be made. Since the term ‘Long Covid’ seems to have taken hold, I will retrospectively refer to the collective symptoms post 2003 as ‘Long SARS’. It should be noted that all the Long SARS patients in my experience were ‘severe’, as all our patients were very sick, hospitalized and many went through the ICU. The literature on Long Covid includes all levels of severity from asymptomatic to fatal. Severity of illness has not yet been established as a risk for Long Covid but it remains as a possibility.
REHABILITATION
In 2004, our hospital [6] created an extensive interdisciplinary rehabilitation program for 50 severely impaired post-SARS patients. At the time I was the Medical Director and the Chief of Staff. The intensity and duration of the program, together with the number of service providers, is unlikely to be matched by any current program. Ours was the gold standard of rehab programs for post coronavirus symptomatology. It was funded by the Workplace Safety and Insurance Board (WSIB) of Ontario exclusively as a treatment program. There was no possibility of this being funded as a research program. The WSIB case coordinators were generally quite accustomed, as part of their job, to approve or deny treatments in general. They almost never denied any form of treatment to the patients in this particular program and in fact pushed to make treatment as extensive as possible.
The program initially was 3–5 h a day, 3 days a week. The participants ranged in age from the mid-20s to the mid-60s. There was extensive physical rehabilitation and an even larger component focused on cognition and psychological needs. The core treatment team members were the nurse practitioner, occupational therapist, physiotherapist, physiatrist (MD) and psychologist. Core members saw each and every patient. At the recommendation of any of the core team members, the patients could be seen and treated by consulting team members. On site, these included: acupuncturist, chiropractor, dietician, registered massage therapist and pharmacist. Off site, further consulting members included: neuropsychologist, respirologist, cardiologist, psychiatrist and sleep expert (also a psychologist). We had further consultant specialties available in infectious disease, neurology, rheumatology and urology, although they were rarely used. We measured function on a number of scales [Canadian Occupational Performance Measure, Six Minute Walk Test, St. George’s Respiratory Questionnaire, Exercise Testing Modified Bruce Treadmill, SF-36, Cognistat, Fatigue Severity Scale, McGill Pain Questionnaire, SJRH/TRI Outpatient Patient Satisfaction Survey, Beck’s Anxiety Inventory, Spirometry Measures, Pittsburgh Sleep Quality Index, HADS (the hospital anxiety and depression scale), Beck’s Depression inventory, Post Traumatic Stress Disorder Checklist, Civilian Version]. Other tests available to us included PFT (pulmonary function tesing), EMG (electromyography), X-rays, neuroimaging and sleep studies. The main program was phased out before 2007, but a follow-on program was started for the psychological components that required ongoing treatment. Our last publication on psychological outcomes was at the 7-year mark [7].
SYMPTOMS
The most prevalent Long Covid symptoms currently are reported as being functional mobility impairments, pulmonary abnormalities and mental health disorders but over 200 symptoms, involving 10 body systems have been listed [8]. In our Long SARS rehab program, there were multiple symptoms in multiple systems reported by every patient. There were overlapping commonalities. The most prevalent symptoms were in the areas of fatigue, respiratory system, cognition, mental health and sleep disturbance. Some symptoms were so common that I made a checklist for each patient visit, detailing the intensity of each symptom on a Likert scale (Appendix 1). The symptomatology for Long Covid and Long SARS is very similar, but not very specific.
Read the full article or download the PDF at the link!
BACKGROUND
Severe acute respiratory syndrome
In 2002–03, a Severe Acute Respiratory Syndrome (SARS) coronavirus caused a pandemic. It was described as a novel virus, meaning that it seemed to be unrelated to other viruses directly. Worldwide there were approximately 8000 cases and over 800 deaths. Toronto (Ontario, Canada) had the largest outbreak outside of Asia, with 251 cases and 41 deaths, with health care workers making up 43% of the cases [1].
Covid
The World Health Organisation (WHO) has recorded about 500 million Covid-19 cases and 6 million deaths globally, up to mid-April 2022 [2]. How many people have suffered from Long Covid [also called post acute sequelae of COVID-19 (PASC)]? We have both too much evidence and insufficient evidence. There are many, many articles published. There is incomplete agreement as to criteria for inclusion, symptoms, severity of symptoms and length of time symptoms have persisted. There is the question of what proof of Covid is required (is a self-reported test adequate?) and whether the study setting is in the community or whether it is post hospitalization. In the UK, the official register provides a prevalence of ongoing post-Covid symptoms at about 8% of cases (1.8 million people [3] post 22.3 million cases [4]). A recent Lancet preprint [5] (i.e. preliminary, not yet accepted for publication and without peer review) systematic review and meta-analysis including 196 studies and 120,970 participants showed that long COVID may affect more than half of the patients, after a median of 6 months from the diagnosis. It is expected that with time, the exact numbers will become more clear. However, it is now already clear that the numbers are very significant. To deal with those staggering numbers of people with ongoing Long Covid symptoms, innumerable rehabilitation programs have sprung up. However, since Long Covid is new, there is no knowledge as to what:
Makes a good rehab program for this population;
What is cost-effective;
What services are needed and helpful;
What are the short-term and long-term outcomes with and without rehabilitation?
These questions cannot yet be answered. However, if as seems likely, Long Covid is similar to the long-term outcomes post SARS, then predictions can be made. Since the term ‘Long Covid’ seems to have taken hold, I will retrospectively refer to the collective symptoms post 2003 as ‘Long SARS’. It should be noted that all the Long SARS patients in my experience were ‘severe’, as all our patients were very sick, hospitalized and many went through the ICU. The literature on Long Covid includes all levels of severity from asymptomatic to fatal. Severity of illness has not yet been established as a risk for Long Covid but it remains as a possibility.
REHABILITATION
In 2004, our hospital [6] created an extensive interdisciplinary rehabilitation program for 50 severely impaired post-SARS patients. At the time I was the Medical Director and the Chief of Staff. The intensity and duration of the program, together with the number of service providers, is unlikely to be matched by any current program. Ours was the gold standard of rehab programs for post coronavirus symptomatology. It was funded by the Workplace Safety and Insurance Board (WSIB) of Ontario exclusively as a treatment program. There was no possibility of this being funded as a research program. The WSIB case coordinators were generally quite accustomed, as part of their job, to approve or deny treatments in general. They almost never denied any form of treatment to the patients in this particular program and in fact pushed to make treatment as extensive as possible.
The program initially was 3–5 h a day, 3 days a week. The participants ranged in age from the mid-20s to the mid-60s. There was extensive physical rehabilitation and an even larger component focused on cognition and psychological needs. The core treatment team members were the nurse practitioner, occupational therapist, physiotherapist, physiatrist (MD) and psychologist. Core members saw each and every patient. At the recommendation of any of the core team members, the patients could be seen and treated by consulting team members. On site, these included: acupuncturist, chiropractor, dietician, registered massage therapist and pharmacist. Off site, further consulting members included: neuropsychologist, respirologist, cardiologist, psychiatrist and sleep expert (also a psychologist). We had further consultant specialties available in infectious disease, neurology, rheumatology and urology, although they were rarely used. We measured function on a number of scales [Canadian Occupational Performance Measure, Six Minute Walk Test, St. George’s Respiratory Questionnaire, Exercise Testing Modified Bruce Treadmill, SF-36, Cognistat, Fatigue Severity Scale, McGill Pain Questionnaire, SJRH/TRI Outpatient Patient Satisfaction Survey, Beck’s Anxiety Inventory, Spirometry Measures, Pittsburgh Sleep Quality Index, HADS (the hospital anxiety and depression scale), Beck’s Depression inventory, Post Traumatic Stress Disorder Checklist, Civilian Version]. Other tests available to us included PFT (pulmonary function tesing), EMG (electromyography), X-rays, neuroimaging and sleep studies. The main program was phased out before 2007, but a follow-on program was started for the psychological components that required ongoing treatment. Our last publication on psychological outcomes was at the 7-year mark [7].
SYMPTOMS
The most prevalent Long Covid symptoms currently are reported as being functional mobility impairments, pulmonary abnormalities and mental health disorders but over 200 symptoms, involving 10 body systems have been listed [8]. In our Long SARS rehab program, there were multiple symptoms in multiple systems reported by every patient. There were overlapping commonalities. The most prevalent symptoms were in the areas of fatigue, respiratory system, cognition, mental health and sleep disturbance. Some symptoms were so common that I made a checklist for each patient visit, detailing the intensity of each symptom on a Likert scale (Appendix 1). The symptomatology for Long Covid and Long SARS is very similar, but not very specific.
Read the full article or download the PDF at the link!