What is long covid? Current understanding about risks, symptoms and recovery.

One major concern about contracting the coronavirus is the possibility of developing long covid, or persistent symptoms that can range from mild to debilitating and last for weeks, months or longer. (Michael S. Williamson/The Washington Post)

By Allyson Chiu February 28, 2020

[Excerpt] The condition known as long covid continues to frustrate its sufferers, baffle scientists and alarm people who are concerned about being infected by the coronavirus. The term, a widely used catchall phrase for persistent symptoms that can range from mild to debilitating and last for weeks, months or longer, is technically known as Post-Acute Sequelae of SARS-CoV-2 infection, or PASC. But scientists say much remains unknown about long covid, which is also referred to colloquially as “long-haul covid,” “long-term covid,” “post-covid conditions” and “post-covid syndrome,” among other names.

“This is a condition that we don’t even have an agreed upon name for yet, and we don’t have any understanding really of what’s going on down at a chemical level,” said Greg Vanichkachorn, medical director of Mayo Clinic’s COVID-19 Activity Rehabilitation Program. “So, until we have that kind of understanding, it’s really important that we not make quick decisions about what long covid can or can’t be.”

The National Institutes of Health has launched a research initiative to study the potential consequences of being infected with the coronavirus, including long covid, with the goal of identifying causes as well as means of prevention and treatment. It is building a nationwide study population to conduct that research.

In the meantime, experts said, long covid shouldn’t be dismissed or taken lightly. “This is real, definable, and causes significant patient suffering,” said Bruce Levy, chief of the division of pulmonary and critical care medicine at Brigham and Women’s Hospital in Boston. “The majority of people who got acutely infected felt totally normal before they had their infection, and now they don’t feel normal. That’s jarring.”

Long covid is destroying careers, leaving economic distress in its wake

The Washington Post spoke with experts who are researching and treating long covid, and compiled answers to some of the most commonly asked questions about the condition. Please keep in mind that because covid and its potential long-term effects are continuing to be studied and understood, many of these answers are not definitive, and information is likely to change.

WHAT TO KNOW

What is long covid?

“It kind of depends on who you ask right now,” Vanichkachorn said, “and that’s a reflection of how much, or how little, we know about this condition right now.”

Generally, he said, long covid is “a state where a person experiences symptoms greater than what we would normally expect for the normal recovery from covid.”

But some experts consider symptoms that linger for four weeks or longer to be long covid while others say symptoms should persist for at least 12 weeks before a patient is diagnosed with the condition.

Even prominent public health agencies have somewhat different definitions. For example, one definition from the World Health Organization states:

“Post COVID-19 condition occurs individuals with a history of probable or confirmed SARS CoV-2 infection, usually 3 months from the onset of COVID-19 with symptoms and that last for at least 2 months and cannot be explained by an alternative diagnosis.”

Meanwhile, the Centers for Disease Control and Prevention defines the condition as:

Post-COVID conditions are a wide range of new, returning, or ongoing health problems people can experience four or more weeks after first being infected with the virus that causes COVID-19. Even people who did not have COVID-19 symptoms in the days or weeks after they were infected can have post-COVID conditions. These conditions can present as different types and combinations of health problems for different lengths of time.

The CDC lists more than a dozen symptoms potentially associated with long covid, noting that they can be new or ongoing, and can occur in anyone who was infected with the coronavirus, regardless of severity. The WHO notes that symptoms typically have an impact on everyday functioning and they may fluctuate or relapse over time.

“The most hallmark feature is profound fatigue,” Vanichkachorn said. Patients have reported feeling exhausted for hours or days after doing simple tasks, such as taking a dog for a walk around the block.

Other common symptoms include “brain fog,” or difficulties with cognition and memory, pulmonary issues such as shortness of breath or lingering cough, heart-related problems and gastrointestinal complaints.

In other words, long covid can affect “almost every single body system,” said Daniel Karel, a primary care provider and clinical instructor in medicine in the division of general internal medicine at George Washington University.

How many people get long covid?

It’s been difficult to pin down what percentage of people who contract the coronavirus go on to develop long-term symptoms of covid-19, experts said, partly because the condition is still fairly new. Existing research figures and estimates from experts range from single-digit percentages to upward of 30, 40 or 50 percent.

“Plenty of young people with no other medical problems can come down with very, very serious and life-altering symptoms,” Karel said. “You don’t have to be sick. You could be young, you could be healthy and unfortunately really suffer.”

Read more at: What is long covid? Current understanding about risks, symptoms and recovery.

Is Two-Tier Health Care Growing in BC? The Tyee

Two seniors were told they would need to pay $4,600 each to keep seeing their 
            family doctor after he moved to a Telus clinic.
[Note: text in blue are hot links]

Andrew MacLeod February 28 – 2022 / TheTyee.ca Andrew MacLeod is The Tyee’s Legislative Bureau Chief in Victoria and the author of All Together Healthy (Douglas & McIntyre, 2018). Find him on Twitter or reach him at amacleod@thetyee.ca.

[Excerpt] At 84, Lieta Robinson had a tough choice to make after receiving a letter from her doctor.

She and her 88-year-old husband could start looking for another doctor, joining the roughly 760,000 British Columbians who aren’t attached to any primary care provider. Or they could each pay an annual fee to stay with him when he moved to a Vancouver clinic owned by the telecommunications company Telus.

“We are really upset,” said Robinson. “We’re seniors, and we’ve had good health care, but this has kind of upset us.”

She and her husband had been with Dr. Geoffrey Edwards for some 36 years, staying with him as he moved from clinic to clinic, from Burnaby to Kerrisdale. They are in “pretty good health,” but at an age where they need care from time to time.

According to the letter the couple received from Edwards, the fee for each of them would be $4,600 for the first year, then $3,600 for each year after that.

While Robinson and her husband could afford the fees, she said, the wider implications bothered them.

“This is most disturbing if doctors are going to give up their general practice and go into something like this,” she said. “If everybody did this, then what happens to our health care?”

Edwards didn’t return calls by publication time. The clinic he is moving to operates using a model that has been described as being in “a legal grey area.” The model has long been contentious.

Under the Medicare Protection Act, doctors who receive payments under the public Medical Services Plan may not charge a patient directly for any service normally paid for through public insurance.

Telus has spent more than $2.5 billion expanding into health care, seeing it as a way to differentiate itself from its telecommunications competitors and grow revenues.

It bought clinics operating under the brands Medisys, Copeman Healthcare and Horizon Occupational Health Solutions in 2018.

Telus said the annual fees patients like Lieta Robinson face if they want to stay with their doctors are not for necessary services covered by the provincial Medical Services Plan. They are for services that the public system doesn’t cover, Telus said in an email.

Telus said most of the doctors working in its clinics “continue to work in the public sector seeing patients for MSP-covered primary care services.” In fact, the company argued, by focusing on wellness the clinics help “alleviate the burden on our overall health-care system” by keeping people healthy. 

The Copeman clinic, now owned by Telus, made the same argument in 2006 when the Medical Services Commission began an 18-month investigation that eventually concluded the clinic was operating legally.

One person who didn’t buy the argument was Adrian Dix, then opposition health critic, now health minister. He said the private clinics were undermining the basic principles of public health care.

Is Two-Tier Health Care Growing in BC?

Extreme heat linked to increases in mental health ER visits: study


© KATHRYN ELSESSER/AFP via Getty Images



BY SHARON UDASIN – 02/23/22 

[Excerpt] Waves of extreme heat, which are on the rise due to climate change, are linked to an uptick in emergency room visits for mental health conditions, a new study has determined.

On such hotter-than-normal days over the past decade, emergency department check-ins for any mental health condition surged by 8 percent in comparison to days of optimal temperature, according to the scientists, who shared their results on Wednesday in the journal JAMA Psychiatry.

The authors also identified robust connections between such temperatures and emergency room (ER) visits for specific mental health conditions, including substance use disorders; anxiety- and stress-related disorders; mood disorders; self-harm; childhood-onset behavioral disorders and schizophrenia, schizotypal and delusional disorders.

While the implications of extreme heat for physical ailments have been well documented, the potential connection between elevated temperatures and mental health issues remains poorly understood, according to the authors.

To draw their conclusions, the scientists analyzed a pool of 3.4 million emergency department visits among 2.2 million adults in the contiguous U.S. during warm season months — May to September — from 2010 in 2019. About 57 percent of these individuals were women, with a median age of 51 years old.

Looking at links between extreme heat and emergency department visits for any type of mental health condition, the authors calculated an “incidence rate ratio” of 1.08 in comparison to a baseline of 1.0. This meant that mental health visits to the ER of any type experienced an 8-percent increase on such days.

For substance use disorders specifically, the ratio was also 1.08, while for anxiety and stress-related disorders it was 1.07; mood disorders were 1.07; self-harm was 1.06; childhood-onset behavioral disorders it was 1.11 and for schizophrenia, schizotypal and delusional disorders it was 1.05.

While associations were higher in men than in women, the authors found no evidence of differential links according to age groups, which they said contrasted previous findings.

The connection between heat and ER visits across a variety of mental health outcomes demonstrates that this external stressor is not likely specific to any one condition, Nori-Sarma explained.

“Rather, we think of it as exacerbating existing mental health conditions,” she said.

While the authors described their study as “filling an important gap in existing literature,” they also acknowledged its limitations.

For example, the scientists said that they did not consider meteorological conditions aside from heat, such as precipitation or cloud cover, which could also alter mental health. Data providing individual-level characteristics like race and ethnicity, socioeconomic means and occupation was not available, while the focus on ER visits meant focusing on severe mental health presentations only, the authors added.

In addition, the scientists said they could only access data on individuals who have commercial health insurance or Medicare Advantage, meaning that many lower-income patients could not be included. This absence may have led to a “skewing of the sample toward wealthier socioeconomic status” and could limit the generalizability of the study, according to the authors. 

“We do think that our study is an underestimate of the actual burden of high temperature on mental health since we rely on data among insured individuals, and we are missing the potentially very vulnerable population of uninsured individuals,” Nori-Sarma told The Hill.

“Our findings indicate that the needs for mental health services may be especially high during times when extreme heat is being predicted, giving us a leg up on preparing the healthcare system to address those needs,” Nori-Sarma added.

Extreme heat linked to increases in mental health ER visits: study

Extreme heat linked to increases in mental health ER visits: study


© KATHRYN ELSESSER/AFP via Getty Images



BY SHARON UDASIN – 02/23/22 

[Excerpt] Waves of extreme heat, which are on the rise due to climate change, are linked to an uptick in emergency room visits for mental health conditions, a new study has determined.

On such hotter-than-normal days over the past decade, emergency department check-ins for any mental health condition surged by 8 percent in comparison to days of optimal temperature, according to the scientists, who shared their results on Wednesday in the journal JAMA Psychiatry.

The authors also identified robust connections between such temperatures and emergency room (ER) visits for specific mental health conditions, including substance use disorders; anxiety- and stress-related disorders; mood disorders; self-harm; childhood-onset behavioral disorders and schizophrenia, schizotypal and delusional disorders.

While the implications of extreme heat for physical ailments have been well documented, the potential connection between elevated temperatures and mental health issues remains poorly understood, according to the authors.

To draw their conclusions, the scientists analyzed a pool of 3.4 million emergency department visits among 2.2 million adults in the contiguous U.S. during warm season months — May to September — from 2010 in 2019. About 57 percent of these individuals were women, with a median age of 51 years old.

Looking at links between extreme heat and emergency department visits for any type of mental health condition, the authors calculated an “incidence rate ratio” of 1.08 in comparison to a baseline of 1.0. This meant that mental health visits to the ER of any type experienced an 8-percent increase on such days.

For substance use disorders specifically, the ratio was also 1.08, while for anxiety and stress-related disorders it was 1.07; mood disorders were 1.07; self-harm was 1.06; childhood-onset behavioral disorders it was 1.11 and for schizophrenia, schizotypal and delusional disorders it was 1.05.

While associations were higher in men than in women, the authors found no evidence of differential links according to age groups, which they said contrasted previous findings.

The connection between heat and ER visits across a variety of mental health outcomes demonstrates that this external stressor is not likely specific to any one condition, Nori-Sarma explained.

“Rather, we think of it as exacerbating existing mental health conditions,” she said.

While the authors described their study as “filling an important gap in existing literature,” they also acknowledged its limitations.

For example, the scientists said that they did not consider meteorological conditions aside from heat, such as precipitation or cloud cover, which could also alter mental health. Data providing individual-level characteristics like race and ethnicity, socioeconomic means and occupation was not available, while the focus on ER visits meant focusing on severe mental health presentations only, the authors added.

In addition, the scientists said they could only access data on individuals who have commercial health insurance or Medicare Advantage, meaning that many lower-income patients could not be included. This absence may have led to a “skewing of the sample toward wealthier socioeconomic status” and could limit the generalizability of the study, according to the authors. 

“We do think that our study is an underestimate of the actual burden of high temperature on mental health since we rely on data among insured individuals, and we are missing the potentially very vulnerable population of uninsured individuals,” Nori-Sarma told The Hill.

“Our findings indicate that the needs for mental health services may be especially high during times when extreme heat is being predicted, giving us a leg up on preparing the healthcare system to address those needs,” Nori-Sarma added.

Extreme heat linked to increases in mental health ER visits: study

BC AHSN: COVID-19 Research Inventory

The BC Academic Health Science Network (BC AHSN) is committed to providing BC’s health research community with the best possible provincial resources during the COVID-19 pandemic, and beyond.

To help meet this commitment, we’ve created this page, which will help you navigate our unified response from the research community during COVID-19.

Together with the BC Ministry of Health, the Michael Smith Foundation for Health ResearchBC Centre for Disease Control and additional partners, we’re working to ensure that researchers/research teams based in BC are offered diverse resources and supports so that our research impacts are recognized within BC, nationally and internationally.

To access more data, please visit: https://www.bcahsn.ca/initiatives/covid-19-response/covid-19-unit-inventories-resources

RCCbc – Rural Health Conference May 13-15

Date: May 13-15, 2022

Location: Penticton, British Columbia/Virtual Sessions

Penticton Lakeside Resort in Penticton, BC

Details: Join us—in person—for this highly-anticipated rural health event, with illuminating rural-relevant CME plenaries and breakout sessions, hands-on skills workshops, and wellness breaks to keep you moving. We are eager to reconnect with many of you and have built in many opportunities for networking and catching up. Come celebrate ‘togetherness’ with colleagues at fun-packed evening social events offered and extracurricular activities that we’ve organized. For those of you who are unable to attend in person, we encourage you to register for the virtual option.

Conference Highlights:

  • Social and networking events and activities to reconnect with rural health colleagues
  • Wellness opportunities, including chair massages, yoga, and stretching sessions
  • Family-friendly event, with complimentary childcare during conference hours
  • Interactive group sessions and hands-on skills workshops geared towards rural practitioners
  • Rural Locum Networking event with luncheon
  • Add-on courses: HOUSE-OB, HOUSE-EM, CASTED: Emergency, CASTED: Fracture Clinic, and The CARE Course

 
Agenda: View the program agenda

Registration: Link to register

For more information, click on: BC Rural Health Conference

Central Okanagan Hospice Association

https://hospicecoha.org/

Executive Director – Natasha Girard natasha@hospicecoha.org 
250-763-5511 ext 103.

Help Make a Difference

There are many ways to get involved to help the dying, grieving and their loved ones in the Central Okanagan.

Volunteer  Donate

Programs & Services

If you are living with a serious illness, caregiving for someone living with a serious illness or grieving the loss of a someone – COHA can help.

Get Involved

There are so many ways to get involved and be apart of a caring community. Find out how you can help – COHA Cares.

Ways to Give

It is because of the generosity of so many people, hundreds of individuals, families and friends access our programs at no cost – Make your gift count.

COHA is creating a community where
no one has to die or grieve alone.

COHA serves the Central Okanagan from Peachland to Oyama. Offering compassionate supportive care programs where people need it when they need it. Individuals and families are likely to experience many thoughts and feelings over the course of illness and through grief. Everyone’s experience is unique and COHA can help every step of the way.

In partnership with the Central Okanagan Hospice Palliative Care Program of Interior Health, COHA is committed to “Helping people with a serious illness live to the fullest until they die, and to help their loved one to be supported in their grief.”

YouTube

Newsworthy

Find all the latest COHA news, events and articles, all in one convenient place.

Marcy Cohen, researcher – Vancouver

Marcy Cohen is a research associate with the Canadian Centre for Policy Alternatives and an adjunct faculty member in Health Sciences at Simon Fraser University. She has co-authored a number of research and policy studies looking at public solutions to the current challenges in our health care system. 

To read some of Marcy’s work, click on: https://bcrhn.ca/a-higher-standard-in-ltc-homes/

and/or: https://bcrhn.ca/rising-to-the-challenge-how-bcs-community-based-seniors-service-agencies-stepped-up-during-covid-19/