Post COVID-19 Condition

(also known as Long COVID)

Updated: September 16, 2021
NEW  Understanding the Post COVID-19 Condition (Long COVID) and the Expected Burden for Ontario (September 2021) Publication of the Ontario COVID-19 Science Advisory Table. Provides conservative estimate of 57,000 to 78,000 Ontarians had or might be presently affected by the post-COVID 19 condition. Health system management and supportive policies are needed for Ontario to manage the burden of post COVID-19 condition. 
 Rehabilitation for Clients with Post COVID-19 Condition (Long COVID) (August 2021) Guidance for Canadian Rehabilitation and Exercise Professionals on the Post COVID-19 condition and rehabilitation management strategies.
 Effectiveness of Rehabilitation Interventions for People with Long COVID (July 2021) Briefing note completed by the Research, Analysis, and Evaluation Branch of the Ontario Ministry of Health based on information provided by members of the COVID-19 Evidence Synthesis Network. This note provides a summary of research on rehabilitation care models for people experiencing debilitating COVID symptoms, and the effectiveness of rehabilitation interventions.
 Rehab for Post COVID-19 Condition: Learnings from experiences to date (July 2021) This informational webinar from the Rehabilitative Care Alliance in Ontario, Canada provides learnings about:
  • The long-term complications of COVID-19.
  • The development and implementation of Alberta's Post COVID-19 Rehabilitation Response Framework.
  • An interdisciplinary streamlined approach to Post-COVID-19 rehabilitation at The Ottawa Hospital.
  • Integrated assessment and treatment for the management of Post-COVID-19 Syndrome in patients with occupationally acquired COVID-19.
 COVID-19 Scientific Advisory Group Rapid Evidence Report (July 2021) Alberta Health Services publication. Updated review of prolonged symptoms after acute COVID-19 infection.
UPDATED COVID-19 Rehabilitation Standards. Rehabilitation of adults who are hospitalised due to acute COVID-19 or Long COVID: physiotherapy service delivery (July 2021) The Chartered Society of Physiotherapy in the United Kingdom has published a new version of its COVID-19 rehabilitation standards, which provides specific guidance about community-based rehab for people with COVID-19 and Long Covid.
 Long COVID Treatment: Take control of fatigue (July 2021) Video published for patients by University Health Network, Cornerstone Physiotherapy, Research Institute for Aging, University of Waterloo. Outlines how to manage fatigue with pacing, and what can make fatigue worse.
Prevalence of post-COVID-19 symptoms in hospitalized and non-hospitalized COVID-19 survivors: A systematic review and meta-analysis (June 2021) Data synthesis was categorized at 30, 60, and ≥90 days post hospitalization or diagnosis. Fatigue and dyspnea were the most prevalent post-COVID-19 symptoms, particularly 60 and ≥90 days.
 Prevalence of long-term effects in individuals diagnosed with COVID-19: a living systematic review (June 2021) Systematic review of the prevalence of post COVID-19 conditions (4-12 and >12 weeks), including the frequency of symptoms, sequelae and difficulties individuals living with post COVID-19 conditions have conducting usual activities.
 Care Models for Long COVID: A Rapid Systematic Review (June 2021) This review was funded by Alberta Health Services, the SPOR Evidence Alliance (SPOR EA), and the COVID-19 Evidence Network to support Decision-making (COVID-END). Authors identified international care models describing the integration of primary care, rehabilitation services and specialized assessment clinics for Long COVID.
World Physiotherapy response to COVID-19 Briefing paper 9 (June 2021) Provides an overview of safe rehabilitation approaches for people living with Long COVID.
 Rehabilitation & Allied Health Practice Considerations Post COVID-19 (June 2021) Resource developed by Alberta Health Services intended to provide guidance to support rehabilitation and allied health providers across the care continuum who are working with patients recovering from symptoms of COVID-19.
Expanding our understanding of post COVID-19 condition: Webinar 2 (June 2021) This second WHO webinar presented the consensus clinical case definition from a global Delphi exercise and expanded on understanding the mechanisms that may cause post COVID-19 condition and the care models to manage it.
Evaluating and Caring for Patients with Post-COVID Conditions: Interim Guidance (June 2021) Based on current information, this interim guidance document suggests many post-COVID conditions can be managed by primary care providers, with the incorporation of patient-centered approaches to optimize the quality of life and function in affected patients. Also indicates that understanding of post-COVID conditions remains incomplete and guidance for healthcare professionals will likely change over time as the evidence evolves.
Assessment of the Frequency and Variety of Persistent Symptoms Among Patients With COVID-19 (May 2021) A systematic review of the frequency and variety of persistent symptoms after COVID-19 infection. Found most frequently occurring symptoms included shortness of breath/dyspnea, fatigue or exhaustion, and sleep disorders or insomnia. Authors found were wide variations in the design and quality of the studies.
 Understanding Long COVID-19 (May 2021) This Briefing Note was completed by the Research, Analysis, and Evaluation Branch of the Ontario Ministry of Health based on information provided by members of the COVID-19 Evidence Synthesis Network. This note summarizes the research evidence associated with “long COVID”, including definitions, risk factors (i.e., sex/gender, age), symptomatology, prognosis, therapeutics, and other emerging research findings.
Rehabilitation post-COVID-19: cross-sectional observations using the Stanford Hall remote assessment tool (May 2021) This study describes the creation of a remote COVID-19 rehabilitation assessment tool to allow timely triage, assessment and management. Found that 3 months after acute COVID-19 illness, SOB, fatigue, cough and anxiety/mood disturbances were the most commonly reported ongoing symptoms. Findings highlight the need to plan rehabilitation services for all patients with symptoms consistent and high clinical suspicion of post-COVID-19 syndrome, irrespective of test results, as there may be the potential for deterioration in symptoms for patients experiencing difficulties accessing rehabilitation.
Count the cost of disability caused by COVID-19 (May 2021) Commentary article outlines the importance of quantifying how COVID-19 contributes to ill health and impacts well-being and productivity. Authors suggest that focusing only on cases and deaths hides the pandemic’s lasting health burden on people, societies and economies.
 How scientists are teasing apart the biology of Long COVID (April 2021) Interview with Emilia Liana Falcone, an infectious disease specialist at the Montreal Clinical Research Institute, and Michael Sneller, an infectious disease specialist at the National Institute of Allergy and Infectious Diseases (NIAID).
Postural orthostatic tachycardia syndrome (POTS) and other autonomic disorders after COVID 19 infection: a case series of 20 patients (April 2021) Authors found that POTS and other common autonomic disorders can follow COVID-19 in previously healthy non-hospitalized patients who experience significant disability 6–8 months after an acute infection, and these patients require appropriate diagnostic and therapeutic interventions to improve their symptoms and functional status.
Humility and Acceptance: Working Within Our Limits With Long COVID and Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (April 2021) Editorial article that discusses concerns about long COVID and ME, outlines safety recommendations for rehabilitation and shares resources to improve care for those with post viral illnesses
 Long-COVID-19 Clinics: Evidence Synthesis Briefing Note (April 2021)  This Briefing Note was completed by the Research, Analysis, and Evaluation Branch (Ministry of Health) based on information provided by members of the COVID-19 Evidence Synthesis Network. Analysis for Ontario indicates: There is little published data on the administration of long COVID rehabilitation clinics. Ontario’s Ministry of Health should continue to monitor grey and research literature for emerging information about governance structures and outcomes of such models to inform any future considerations.
A COVID-19 Rehabilitation Prospective Surveillance Model for Use by Physiotherapists (April 2021)

This study presents a prospective surveillance model to facilitate early identification and management of long-term COVID-19 sequelae.

How scientists are teasing apart the biology of Long COVID (April 2021) Q&A article with Emilia Liana Falcone, an infectious disease specialist at the Montreal Clinical Research Institute, and Michael Sneller, an infectious disease specialist at the National Institute of Allergy and Infectious Diseases (NIAID), who are each leading a large Long COVID clinical trial.
Long COVID Speech and Language Therapists (April 2021) YouTube panel discussion from the UK (1:07) discusses the role of speech and language therapists in the management of patients in the acute and long term phase of COVID-19 infection including those living with Long COVID
Long COVID Dietitians (April 2021) YouTube panel discussion from the UK (54:25) discusses the nutritional implications for those living with Long COVID and the importance of Dietitians in the management across the patient pathway
Fatigue and Breathlessness in Long COVID (April 2021) YouTube panel discussion from the UK (59:09) discusses the symptoms of fatigue, breathlessness, breathing pattern symptoms and post-exertional fatigue in those living with Long COVID. 
Breathing Pattern Disorder and Implications in Long COVID (April 2021) YouTube panel discussion from the UK (59:15) discusses the definition and diagnosis of breathing pattern disorder (BPD) as well as the implications of presentation before moving onto therapeutic interventions. It also discusses the unique presentation they are seeing in people with acute COVID-19 and those suffering long-term symptoms including what is known as Long COVID.
Vocational Rehabilitation and Return to Work planning (April 2021) YouTube panel discussion from the UK (1:05) discusses vocational rehabilitation and planning for a return to work in the context of COVID-19
What are we seeing in Long COVID clinics and why? (April 2021) YouTube panel discussion from the UK (1:06) discusses experiences of what health care professionals and Long COVID clinics. Includes an Occupational Therapist who is recovering from COVID-19.
Post-COVID Conditions: Information for Healthcare Providers (April 2021) Brief overview of post-COVID conditions published by the Centres for Disease Control and Prevention
COVID-19 (coronavirus): Long-term effects (April 2021) Overview from the Mayo Clinic of long-term symptoms and complications of COVID-19.
Expanding our understanding of post COVID-19 condition: Report of a WHO webinar (April 2021) Summary of an international discussion on the Post COVID-19 condition: lessons learned; what we know; discussion of clinical case definition and research gaps/methods.
WHO Update on Clinical Long Term Effects of COVID-19 (March 2021)

Data of the COVID-19 global situation as of the date of publication and overview of long-term sequelae

Recovered not restored: Long-term health consequences after mild COVID-19 in non-hospitalized patients (March 2021) Authors present a longitudinal, prospective analysis of health consequences in patients who initially presented with no or minor symptoms of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection.
Living with Covid19 – Second review (March 2021) This is the second of two dynamic reviews of the evidence around experience of the enduring symptoms following a COVID-19 infection completed by the National Institute of Health Research. Further research into Long-COVID is recommended along with design and evaluation of new service delivery models that provide rapid access to an increasing number of people with Long-COVID.
Long COVID, A Comprehensive Systematic Scoping Review (March 2021) Review found ambiguity in the definition of Long-COVID has impaired proper recognition and management of those requiring additional support following the resolution of the acute phase of this infection. Authors indicate findings highlight the need for a multidisciplinary approach, support, and rehabilitation for these patients in terms of long-term mental and physical health.

 Post COVID-19 Rehabilitation Response Framework Summary Report (March 2021)


 Post COVID-19 Rehabilitation Response Appendices: Pathways, Toolkits & Resources (March 2021) 

Published by the Neurosciences, Rehabilitation & Vision Strategic Clinical Network of Alberta Health Services. Outlines 19 rehabilitation recommendations, pathways and considerations for providers across the continuum to assess functional impairment and determine the appropriate rehab needs for patients experiencing Post COVID-19 Syndrome. Appendices listed as a separate document.

Published by the Neurosciences, Rehabilitation & Vision Strategic Clinical Network of Alberta Health Services. Outlines care pathways, tools for assessing functional status and symptom checklist among other resources. Summary report listed as a separate document.

 How to Support Your Recovery and Rehabilitation after COVID-19 (March 2021) Resource for patients on common symptoms people may have after COVID-19 published by Alberta Health Services Neuroscience, Rehabilitation & Vision Strategic Clinical Network.
Attributes and predictors of long COVID (March 2021) Study analyzed data from 4,182 incident cases of COVID-19 in which individuals self-reported their symptoms prospectively in the COVID Symptom Study app.
Toward Understanding COVID-19 Recovery: National Institutes of Health Workshop on Postacute COVID-19 (March 2021) Overview of a virtual workshop hosted by the National Institute of Allergy and Infectious Diseases and Centers of the National Institutes of Health in the UK to summarize existing knowledge on post-acute COVID-19 and identify key knowledge gaps regarding this condition.
Recommendations for the respiratory rehabilitation of hospitalized and discharged COVID-19 patients: A systematic review (March 2021) Systematic review and outline of respiratory rehabilitation recommendations for COVID-19 patients
A national survey of community rehabilitation service provision for people with long COVID in Scotland (March 2021) Survey results provide an overview of community rehabilitation provision for people with long COVID in Scotland.
In the wake of the pandemic. Preparing for Long COVID (March 2021) Policy brief, published by the WHO, seeks to raise awareness of Long COVID and to provide a resource for those in decision-making roles.
Sequelae in Adults at 6 Months After COVID-19 Infection (February 2021) Compared a longitudinal prospective cohort of adults with COVID-19 and those without. Approximately 30% reported persistent symptoms, with fatigue as the most frequently reported symptom.
Physical Therapists Living With Long COVID, Part 2: When "Keep Pushing" Isn't the Answer (February 2021) Blog post published in the Journal of Orthopedic & Sports Physical Therapy.
Long COVID Research: Findings & Recommendations (February 2021) Analysis of WHO survey data from global experiences: Patient Led-Research COVID-19
National Institutes of Health Workshop on Post Acute Sequelae of COVID-19: Lessons Learned (February 2021) Summary slides from forum.
Long-COVID: WHO calls on countries to offer patients more rehabilitation (February 2021) Commentary in the British Medical Journal about the need for greater recognition of and planning for the rehabilitation needs for those who have continuing symptoms of COVID-19.
Long COVID Syndrome Following Infection with SARS-CoV-2- A Devastating Influence on Health Status in Some Affected Individuals (February 2021) Review article outlining the impact on daily activities and health status for those with COVID-19, the emergence of Long COVID, and its after-effects.
Patient-made Long Covid changed COVID-19 (and the production of science, too) (February 2021) Authors are patients and researchers with Long Covid, who have contributed to making ‘Long Covid', and to advocacy around its definition and recognition.
More than 50 Long-term effects of COVID-19: a systematic review and meta-analysis (January 2021) Authors indicate that from a clinical perspective, multi-disciplinary teams are crucial to developing preventive measures, rehabilitation techniques, and clinical management strategies with whole-patient perspectives designed to address long COVID-19 care.
Epidemiology of Long-COVID: A Pragmatic Review of the Literature (January 2021) Summary of key learnings from the literature to date published by the Belgian Health Care Knowledge Centre
Summary of the Long-COVID Forum (December 2020) Slides summarizing learnings and key themes from the WHO ISARIC-GLOPID-R-Long COVID Support group meeting
Characterizing Long COVID in an International Cohort: 7 Months of Symptoms and Their Impact (December 2020) Analysis of 3,762 survey respondents across 56 countries that characterize the symptom profile and time course in patients with Long COVID, along with the impact on daily life, work, and return to baseline health.
COVID-19 rapid guideline: managing the long-term effects of COVID-19 (December 18, 2020) Guideline jointly developed by the National Institute for Health and Care Excellence (NICE), the Scottish Intercollegiate Guidelines Network (SIGN) and the Royal College of General Practitioners (RCGP). Provides an overview of identifying, assessing and managing the long-term effects of COVID-19, (‘long COVID’). It makes recommendations about care in all healthcare settings for adults, children and young people who have new or ongoing symptoms 4 weeks or more after the start of acute COVID-19. It also includes advice on organizing services for long COVID including rehabilitation.
Management of post-acute covid-19 in primary care (August 2020) Provides an overview of assessment and symptom management in primary care.
Post-discharge symptoms and rehabilitation needs in survivors of COVID‐19 infection: A cross‐sectional evaluation (July 2020) Telephone follow-up of patients discharged from hospital to determine the prevalence of post‐COVID‐19 symptoms and rehab needs.
Report: What Does COVID-19 Recovery Actually Look Like? (May 2020) An Analysis of the Prolonged COVID-19 Symptoms Survey by Patient-Led Research Team