Experts have warned that the lack of follow-up data from Canadians who have had COVID-19 could hamper efforts to understand possible post-infection conditions, such as diabetes and brain fog.
They say the impact of the pandemic on Canadian health systems and society could last for years, but preparing for it is challenged by the data gap.
Dr. Kashif Pirzada, an emergency physician at Toronto’s Humber River Hospital, said reliance on rapid home tests for COVID-19 is a major barrier to data collection.
“There is no centralized follow-up and very few resources are available for these patients,” he said, although COVID-19 appeared to cause diabetes, brain fog or other conditions “very frequently.”
“If five or 10 percent of our population is disabled, which are some of the rates we’re looking at, it’s going to be a big problem for our workforce, for health in general,” Pirzada said. who is also a clinical assistant. professor at McMaster University.
Dr. Akshay Jain, an endocrinologist in Surrey, BC, said Canada “could be seeing an avalanche of diabetes cases coming out of the COVID pandemic.”
But Jain said Health Canada is not collecting data on the after-effects of COVID-19.
People with mild symptoms often did not follow up with their doctors, which made the data worse, said Jain, who also highlighted the reliance on home tests as a problem.
“I just think the healthcare system and the public need to know both the immediate short-term effects and the long-term effects of COVID,” Jain said.
“You know, the impact of the pandemic will continue for many more years. So I think we need to be aware of that and be aware of conditions like diabetes and the complications that come with it.”
When asked if and how he was monitoring post-COVID-19 conditions and people who had had the disease, Health Canada provided a series of links to vaccination information and a daily update. new cases.
“Health systems are the responsibility of every province and territory,” he said.
Jain said studies in the United States and Germany show that the risk of developing diabetes is about 46% higher for those who have had COVID-19 compared to those who have not been infected.
It is unclear why people with COVID-19 are developing diabetes, Jain said.
One theory is that COVID-19 causes an “inflammation tsunami,” which increases insulin resistance, he said, while another is that steroids used to treat severe COVID-19 can cause diabetes.
About nine per cent of Canadian adults have been diagnosed with diabetes, Jain said. But pre-diabetes and undiagnosed diabetes make the figure nearly 30 percent, he said.
“This is already a very high number, and then by throwing COVID into the mix, those numbers will probably increase even more.”
In October 2020, Madhu Rao of Toronto tested positive for COVID-19. Eighteen months later he said he still “felt out of breath from time to time”.
Rao said he was worried it had something to do with his heart because he read that COVID-19 was causing heart problems.
Instead, a review revealed that it was a “diabetic limit” with high blood glucose levels, Rao said.
He said he had no problems with his blood sugar before contracting COVID-19 and described himself as something else healthy and active with a weight in the normal range.
His doctor told him he was seeing many patients with high blood sugar levels and some developing diabetes after COVID-19 and put him on a strict diet, he said.
“He told me that all I can do is keep postponing its start.”
A November 2020 study in the journal Diabetes, Obesity and Metabolism said that 14.4% of patients with COVID-19 had been diagnosed with diabetes.
“Recent reports have shown that newly diagnosed diabetes may confer a higher risk of poor prognosis of COVID-19 than there is no diabetes or pre-existing diabetes,” he said.
“Therefore, COVID-19 patients with newly diagnosed diabetes should be managed early and monitored appropriately and closely for the onset of full-blown diabetes and other long-term cardiometabolic disorders.”
Jain said he agreed and that “everyone with mild COVID” should talk to a doctor about whether a diabetes test should be done.
Another condition commonly associated with COVID-19 is the feeling of confusion known as brain fog. An analysis of several studies on the subject in the Journal of the Neurological Sciences in March said that up to 32 percent of patients reported brain fog about three months after having COVID-19.
Professor Teresa Liu-Ambrose, the Canadian Research Chair at the Djavad Mowafaghian Center for Brain Health at the University of British Columbia, said there is not enough data to know how many Canadians have been affected by disease, how permanent it is and what the symptoms and consequences are.
Liu-Ambrose said the Canadian Longitudinal Study on Aging, a nationwide long-term research project, is taking pictures of the subjects’ brains and assessing their cognition over the next three years to identify differences between them. people who had COVID-19 and those who did not.
However, he said the memory fog was largely a subjective complaint, so quantifying it could be a challenge.
Dr. Jurgen Maslany of Saskatchewan tested positive for COVID-19 in March, then returned to work about two weeks after he thought he had fully recovered.
But after attending to a patient he did not remember the details of what they had commented on and realized that “something was not working”.
“And so I immediately retired from work because I wasn’t sure,” Maslany said.
There was also a feeling of anxiety, though he wasn’t sure if this was a symptom of brain fog or if he was worried about it.
“I felt like something was chemically off my head,” he said.
It took about three weeks for the symptoms to subside, and now it is back to normal, he said.
But Liu-Ambrose said no one knows what will happen if brain fog is not treated.
“Any long-term impact of COVID-19 on the brain and our cognition can be significant,” Liu-Ambrose said.
“These changes may be related or predict a future decrease or risk of dementia. We don’t know, but there is certainly that possibility if these subjective complaints reflect the actual changes in the brain.
“It is an emerging area that needs to be addressed and studied to a greater extent.”
Even a modest risk of post-COVID conditions could place a substantial burden on healthcare, given a high number of COVID cases.
Jain, the diabetes expert, said U.S. data showed an additional 18 cases of diabetes per 1,000 people if they had COVID-19.
This could result in “thousands more Canadians at risk for developing type 2 diabetes,” he said, which requires closer monitoring of diabetes complications such as heart attack, stroke, kidney damage and vision loss. .
“If we look at the whole picture together, we are seeing a huge burden on the Canadian health care system that we have not yet recognized, but that is waiting to happen.”
As for the former COVID-19 patient, Rao said, it is probably a good idea to pay attention to each symptom after suffering from the disease.
“If I had ignored it as physical fatigue or something, I wouldn’t have discovered that my blood sugar levels are rising.”
Speaking both as a doctor and as a person who experienced the persistent consequences of COVID-19, Maslany said it was “critically important to keep abreast” of the complications of the disease.
“I’m not sure we can find certain therapeutic options, especially in the short term, but I think it’s important to collect the data,” he said.
“First of all, you can’t analyze and fix a problem unless you have all the right data.”
This report from The Canadian Press was first published on June 4, 2022.