What do plan sponsors need to know about long COVID, also known as “post-COVID-19 condition”? Take 5 for Health Benefits dived into the latest research, sussed out resources and got educated at a recent webinar by Sun Life Financial, a supplier partner of The Benefits Alliance Group.

Definition – The World Health Organization (WHO) released a definition of post-COVID-19 condition in adults in October 2021. It states that long COVID usually occurs about three months from the onset of the initial COVID infection. Symptoms last for at least two months, cannot be explained by an alternative diagnosis and “generally have an impact on everyday functioning.” The most common symptoms are fatigue, shortness of breath and cognitive dysfunction.

Incidence – WHO estimates that 10% to 20% of people who’ve survived COVID go on to experience its definition of long COVID. Other sources suggest a much higher incidence. A review of the observational studies (Reyes Domingo F et al.), funded by the Public Health Agency of Canada (PHAC) and last updated in November 2021, found that 53% of COVID survivors reported symptoms three months after the initial infection. And a 2020 retrospective analysis (Taquet M et al.) of electronic health records for 273,618 COVID survivors in the U.S. found that 37% had at least one symptom of long COVID three to six months after the initial infection.

If we take WHO’s more conservative estimate of 10% to 20% and do the math for Canada—with 3.8 million confirmed and probable cases of COVID infections as of May 5, according to PHAC—that translates into 380,000 to 760,000 Canadians who have or had long COVID. Even at the high end, that number is likely quite conservative, given the inability to capture all cases of the highly transmissible Omicron variant of the virus. Having said that, it’s too soon to know the incidence of long COVID triggered by Omicron versus other variants.

Who gets it – “Anyone with COVID-19 can get post-COVID-19 conditions, irrespective of the severity of [the initial] disease,” states WHO. In other words, people who had a mild case of COVID-19 or were even asymptomatic can develop long COVID, with symptoms that could be debilitating.

People who have been vaccinated can also get long COVID after experiencing a breakthrough infection, although a February 2022 article in Scientific American, reporting on preliminary results from unpublished studies, suggests they are less at risk than those who are unvaccinated.

More on symptoms – The symptoms of long COVID may be completely new or the return of symptoms experienced during the initial infection. WHO reports the most common symptoms are fatigue, shortness of breath/difficulty breathing, memory/concentration problems (“brain fog”), sleep problems, a persistent cough, chest pain, trouble speaking, muscle aches, loss of taste or smell, depression, anxiety, and fever.

A February 2022 study (Xie Y et al.) sounded the alarm on heart disease, stating that “the risk and 1-year burden of cardiovascular disease in survivors of acute COVID-19 are substantial.” This was evident “even among individuals who were not hospitalized.”

Researchers are also making the link between long COVID and dysautonomia, an umbrella term for disorders affecting the autonomic nervous system; that is, the “automatic” functions of the body such as heart rate, blood pressure, digestion and body temperature.

On the fatigue front, myalgic encephalomyelitis (ME), formerly known as chronic fatigue syndrome, appears to be gaining ground as a diagnosis linked to long COVID. ME is a chronic neuro-immune disease that limits productivity and is often triggered by an infection.

Long COVID can last for weeks, months or years. The symptoms can also relapse over time.

Treatment – Treatment for long COVID is still very much in its early days. Right now, the focus is on managing the wide range of symptoms. An April 2021 research paper (Al-Aly Z et al.) confirmed that people with long COVID use more health resources, including drugs to treat pain, depression, anxiety and diabetes.

WHO notes that “holistic care, including rehabilitation, can be helpful.” Physiotherapy appears to be a component of such care. Lifemark, a large provider of physiotherapy clinics in Canada, offers a post COVID rehabilitation and recovery program at many of its clinics.

Within the public healthcare system, hospitals across the country have opened long COVID clinics. In Ontario, there are at least 14 long COVID outpatient clinics, as listed on the website for the Ontario College of Family Physicians. Clinics in other provinces can be found on the Canadian page of the Survivor Corp website, or by searching online for long COVID clinics by province.

There appears to be some early anecdotal evidence that Paxlovid, the antiviral therapy authorized to treat COVID infection, may benefit those with long COVID. However, valid clinical research needs to be done.

Patient support – Two main support groups have emerged for Canadians with long COVID:

What plan sponsors can do – As with most health conditions, the earlier the intervention the better in order to minimize the impact on the workplace and reduce the risk of disability leaves. 

“The main thing right now is for employers to be proactive and communicate with employees about long COVID and the supports that are available to them,” stressed Rachel McNeill-Thompson, Assistant Vice-President Marketing Communications and Client Experience, Sun Life Financial, who presented an educational webinar on long COVID to benefits advisors at several events during the spring.

McNeill-Thompson suggested leadership education and the development of policy to guide accommodations. For example, “many people with brain fog can still work and want to work, but they may need more flexible schedules or the ability to work from home.”

It’s very important that plan sponsors highlight the resources available through health benefits plans. McNeill-Thompson noted that physiotherapy is often a component of treatment, as is occupational therapy and cognitive behavioural therapy.

McNeill-Thompson drew attention to “the high prevalence of mental health symptoms associated with long COVID and the importance of making mental health supports more accessible.” She recommended that plan sponsors expand the list of eligible providers (e.g., to include social workers and psychotherapists) and “look at increasing the annual maximum for coverage amounts so it is closer to the range recommended by the Canadian Psychological Association, which is between $3,500 and $5,000.” 

For small businesses that may find these amounts difficult to manage, she recommended “separating out mental health practitioners from other paramedical providers. That is a good place to start.”

Virtual care is also an important way to provide greater access to “high quality, affordable mental and physical health care,” said McNeill-Thompson. Research by the Canadian Medical Association showed that nine out of 10 Canadians are satisfied with virtual care services and almost half would prefer a virtual consultation as the first point of contact for their care.