Canadian researchers have warned that governments should prepare for increased healthcare demand thanks to the global impact of long-COVID.
The study, published 17 October 2022 in the Canadian Medical Association Journal, found that a GP who had 20 outpatient encounters per day before the pandemic, and who had half of their patients recently infected, would have to accommodate an additional 100 clinical encounters per year to meet a 5% mean expected increase in outpatient encounters, along with the associated time and resources for communication, documentation, and staffing.
The greatest increase in healthcare use was seen in just 1% of people who had COVID, with these patients spending an extra week or more in hospital over the following year compared to people who were not infected.
The research team, led by Dr Candace McNaughton from Toronto’s Sunnybrook Research Institute, looked at the health records of more than 500,000 Canadians, almost half of whom had returned a positive PCR test for COVID in 2021, to compare healthcare use between those who had, and had not been infected.
Dr McNaughton explained that the analysis included clinic visits, emergency visits, days in hospital, home care visits and days in long-term care.
“Given the number of recent infections, our findings portend substantial health care use by people in Canada,” Dr McNaughton said.
“We found that mean days in hospital per-person-year increased 47% and 53%, respectively, 8 weeks or more after infection for test-positive females and males, after we accounted for sociodemographic factors, comorbidities, and pandemic wave.
“An estimated 45% of Canadians had COVID in early 2022 and in the next year alone, 1% of these people with recent infections will likely be admitted to hospital about 1 week longer than similar people without infection, consuming 6.6% of pre-pandemic hospital bed-days, when almost 20% of hospitals have already averaged more than 100% annual occupancy rates.”
The results showed that COVID positive women had about seven additional days in hospital per-person-year and COVID positive men had nearly nine more days in hospital than their test-negative counterparts at the 99th percentile.
“Such increases in health care use will occur in the context of greater need for long-term care (further compounding pressure for hospital beds), as well as substantial care backlogs, critical staffing shortages and a shrinking health care workforce,” she explained.
“Although most people with COVID will not need more health care, they will be competing for scarce health care resources with the subset of people whose use increases considerably, and such increased demand will require substantial population-level restructuring and investment of resources.”
Analysis of 10 prospective surveys and the medical records of 1.1 million patients with COVID diagnosis codes before the emergence of the Omicron variant showed similar findings: 7.8%–17% had symptoms 12 weeks after self-reported COVID, with 1.2%–4.8% reporting debilitating symptoms.
Co-author Dr Clare Atzema, an emergency physician at Sunnybrook Research Institute and Senior Scientist at ICES, Ontario, said that the impact of long-COVID had significant implications for health care delivery in the future, not just in Canada, but across the globe.
“We hope this information will help those in leadership and government prepare for health care demand caused by long-COVID,” Dr Atzema said.
“Health care funders, policymakers and clinicians need a clear understanding of the impact of long-COVID on use of health care resources to allocate resources equitably now and plan for future needs.”
According to the WHO, 10%–20% of those infected acquire long-COVID and though estimates of long-COVID vary by methodology (e.g., definitions of initial infection and timing of symptoms, timing of data collection), risk is thought to be influenced by infection severity, type of variant, patient characteristics, vaccination and, potentially, previous infection.
In the first pandemic wave, as many as 27% of people admitted to hospital died or were readmitted within 60 days, and as many as 70% of people who were not admitted to hospital reported at least one symptom four months after infection.
And because each new infection carries some risk of long-COVID, everyone remains at risk of developing the condition.