Nov 2, 2021

U of T Researchers Seek to Understand COVID-19 Recovery

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By Erin Howe

Many people who experience COVID-19 get better on their own at home, but for others the road to recovery can be long and challenging.

Several factors influence patient recovery, including age, general health and pre-existing medical conditions. Ventilation, sedative drugs and other interventions in the intensive care unit (ICU) may be crucial and life-saving, but can also come with consequences. 

“​The majority of patients who require mechanical ventilation for a week or more are unable to walk at the time of their ICU discharge, and it may take them months or up to one year or longer to recover,” says Margaret Herridge, a professor in the department of medicine and the Institute of Medical Science at the University of Toronto’s Temerty Faculty of Medicine.

Critically ill patients may ​require mechanical ventilation weeks or months, which may lead to lung injury and compromise respiratory muscles. Rapid muscle breakdown and immobility may further aggravate muscle loss and cause profound weakness.

These changes can result in functional dependency and compromise a person’s ability to carry out regular daily activities or return to work. “Many patients are left with life-long functional disability, cognitive and mood disorders,” says Herridge, who is also a senior scientistat Toronto General Hospital Research Institute (TGHRI) and respiratory and critical care physician at University Health Network.

Herridge is one of several U of T researchers studying COVID-19 recovery and finding better ways to care for this new generation of patients, and their caregivers.

Dr. Angela Cheung, KY and Betty Ho Chair in Integrative Medicine
Professor Angela Cheung

She is co-leading the Canadian COVID-19 Prospective Cohort study (CanCOV) with Angela Cheung, also a professor in medicine and the Institute of Medical Science. The​ study explores short- and long-term outcomes for hospitalized and non-hospitalized COVID-19 patients, and how aspects such as genomics, demographics and social factors influence disease progression and severity.

CanCOV includes about 2000 patients and family caregivers and more than 100 investigators from specialties including respiratory medicine, physical medicine and rehabilitation, critical care, occupational therapy, genetics and basic sciences. 

“We see patients and caregivers as a dyad. How people recover from illness is often tied to how they’re cared for,” says Cheung, who is also the KY and Betty Ho Chair of Integrative Medicine, and is a senior scientist at TGHRI and Schroeder Arthritis Institute.

“And we’ve learned from other conditions, ​including acute respiratory distress syndrome and SARS, ​that caregivers ​may acquire new mood disorders including anxiety, depression and post-traumatic stress disorder,” Cheung says.

The need to better understand COVID-19 recovery is significant.

Data from the Canadian Institute for Health Information shows that in the first 14 months of the pandemic, there were more than 42,000 hospital stays for people with a COVID-19 diagnosis, which lasted on average two weeks. Of that group, roughly 8,400 were admitted to an ICU. 

A recent publication by the Ontario Science Table reveals that as many as 78,000 people in this province may have had or currently live with long-COVID, a condition that can include fatigue, joint pain, brain fog, muscle and chest pain, and shortness of breath.

Kelly O'Brien recently co-authored a commentary in BMJ Global Health conceptualizing long-COVID as an episodic condition
Associate Professor Kelly O'Brien

Kelly O’Brien is a physiotherapist and professor in the department of physical therapy and the Rehabilitation Sciences Institute, and a Canada Research Chair in Episodic Disability and Rehabilitation. She previously focused on disability in HIV/AIDs and sees parallels with long-COVID.

O’Brien recently co-authored a commentary in BMJ Global Health on conceptualizing long-COVID as an episodic condition.

“Health-related challenges or symptoms experienced by adults living with long-COVID can overlap, relapse, remit and change over time,” O’Brien says. “These characteristics resemble episodic disability, a concept derived from the context of HIV, where health challenges are multidimensional in nature affecting physical, cognitive, mental, and social health domains.”

Those challenges can fluctuate — sometimes unpredictably — daily or over longer periods of time, O’Brien adds.
O’Brien is also part of a team working on a CIHR-funded study, which will establish a patient-reported outcome measure to capture the nature and extent of episodic disability in people living with long-COVID. The work will help guide access to rehabilitation, evaluate interventions and inform workplace policies.

In addition to her research, O’Brien is a member of Long COVID Physio, a patient-led association of physiotherapists who live with long-COVID and allies, which collaborated with World Physiotherapy to develop a briefing paper on rehabilitation approaches including physical activity.

Long-COVID and other manifestations of the disease are taking a toll on family caregivers.

Professors Margaret Herridge and Jill Cameron are two of several U of T researchers studying COVID-19 recovery and finding better ways to care for patients, and their caregivers
Professors Margaret Herridge and Jill Cameron

Jill Cameron is a professor of occupational science and occupational therapy who studies caregiving and its impact on family members who assume this critical role.

She says the impact of COVID-19 on caregivers will prove to be intense, if what she and her colleagues have learned in the context of other conditions like dementia and stroke hold true.

“Caregivers have to do more with less support,” says Cameron, who is also involved in the CanCOV study. “Throughout the pandemic, friends and family members haven’t been as able to come help as they might have prior to COVID.”

Professional services that would typically provide home visits have also been limited, Cameron notes. “Public health measures have reduced the number of visits, and factors like cleaning protocols result in longer turnaround time between visits, which means workers can’t see the same caseloads,” Cameron says.

Early data from other studies and jurisdictions show increased caregiver stress and poorer mental health outcomes during the pandemic, as well as more restrictions on caregivers’ other work, leisure activities and care for other family members.

These impacts on caregivers are also likely to affect the wellbeing of COVID-19 patients for whom caregivers provide. Research into these consequences is an emerging field, says Cameron, but she notes that in the context of stroke, there is a connection between caregiver depression and patients who are more likely to be hospitalized in the year following their stroke.

Cameron says that while she hopes to never see another pandemic, she is excited about the research that is helping people through the current one. “We’re doing great things, and we’re learning a lot here,” she says.