The lockdown era of the COVID-19 pandemic is—hopefully—over for good, but even as the last of the mask mandates are dropped, many Canadians are still in it for the long haul. Long COVID, which occurs when symptoms of the virus persist four to 12 weeks after infection, has been linked to everything from brain fog to insomnia and even organ damage. Doctors are only now beginning to understand the full scope of the condition.
Dr. Angela Cheung, a senior physician scientist with Toronto’s University Health Network, recently helped to establish 18 long-COVID clinics across five provinces to provide care for Canada’s long haulers—and to map out what they’re in for. Here, she explains the extent of long COVID’s damage, how it’s burdening the already inundated health-care system and why it’s not all in your head.
What inspired you—and other physicians—to open Canada’s long-COVID clinics?
I’m a general internist, so I’ve been looking after COVID patients since March of 2020. In my group practice at Toronto Western Hospital, I was seeing more patients with lingering symptoms. I realized COVID wasn’t just an acute illness—some people weren’t returning to their usual activities after getting it. What we’ve seen with COVID reminds me of the early days of HIV, when people were struggling to understand the disease. At the beginning of the pandemic, I was reminded of a quote by the late tennis player Arthur Ashe, who was HIV-positive. He said, “Start where you are, use what you have, do what you can.”
How did the clinics get off the ground?
We got funding from the Canadian Institutes of Health Research for the Canadian COVID-19 Prospective Cohort Study, which is the first Canadian study to examine early outcomes for infected patients. Our first one joined the study in August of 2020. After people heard about the clinic we were running, we started getting referrals from physicians and colleagues, and we connected with folks across the country who were willing to help. We’ve had family doctors, general internists, infectious-disease doctors, respirologists and endocrinologists working with us, and we now have 18 sites across British Columbia, Alberta, Manitoba, Ontario and Quebec. We closed recruitment for the study back in March of 2022 after seeing more than 2100 patients, but we’re still treating people.
Are there any cases that stood out to you, in terms of their severity?
I’ve seen marathon runners—who had no other diseases prior to COVID—who now can’t walk a block without being short of breath. When I was working in the COVID ward, I saw 90-year-olds who were quite well and 40-year-olds who had to go to the intensive-care unit. A common idea is that it’s only people who are already unhealthy who will get sick and suffer from long COVID, but it’s not like that.
What kinds of mental health fallout have you seen?
We see anxiety and depression the most. Take the example of the marathon runner: they used to run without blinking an eye, and now they’re left wondering what the rest of their life will look like. Some patients have post-traumatic stress disorder from losing multiple loved ones during the pandemic.
There’s so much we still don’t know about long COVID. What do we know?
We know that the COVID-19 virus enters the cells through something called the ACE2 receptor, which is found throughout our bodies. That’s why we tend to see many different symptoms—in our gut, lungs, brain, heart and kidneys. We know that the more recent variants, like Omicron, may pose a lower risk of long COVID compared to previous strains. We also know that it affects women more, usually those between the ages of 35 and 65. Right now, we’re trying to understand why some people can’t get rid of their symptoms. Our group in Montreal has done genetic analyses that show there are two different types of variants that may predispose someone to long COVID. The science is moving forward pretty quickly, so every week, we learn something new.
What is the prognosis for long COVID?
We don’t currently have a cure, but we’re treating symptoms and seeing improvements. If a patient has fatigue, resting and pacing themselves is important. If a patient is coughing—and their chest X-ray is normal— we give them steroid inhalers. For congestion, we give nasal sprays. Long COVID isn’t something that goes away in a day or two.
Have any long-haul patients told you they’ve had trouble accessing care?
There is a lot of frustration. People sometimes have trouble getting doctors to believe that they still have physical symptoms of the virus. Some people make assumptions that these symptoms are due to anxiety, not from the virus. Our health-care system is also very overwhelmed—actually, it’s stretched for everything, not just long COVID. I do think that we need to start thinking more creatively in terms of how we can look after everyone. It’s not just physicians who are stretched.
Do you think governments are taking the effects of long COVID seriously enough?
I’m not a public health official; I work in a hospital. COVID still exists. My perspective is that we should still be wearing masks, and we don’t need a mandate to wear them. You don’t need someone to tell you to use an umbrella when it’s raining.
This interview has been edited for length and clarity.