Lack of follow-up data on Canadians who have had COVID-19 could hamper efforts to understand potential post-infection conditions, such as diabetes and brain fog, experts warn.
They say the pandemic’s impact on Canadian health systems and society could last for years, but preparations for it have been sparked by a lack of data.
Dr Kashif Pirzada, an emergency physician at Humber River Hospital in Toronto, said relying on rapid home testing for COVID-19 was a major obstacle to data collection.
“They are not monitored centrally and there are very few resources available to these patients,” he said, although COVID-19 appears to cause diabetes, brain fog or other conditions “very often.”
“If five or 10 percent of our population becomes disabled, which is part of the percentages we are looking at, it will be a huge problem for our workforce, for overall health,” said Pirzada, who is also a clinical assistant. professor at McMaster University.
Dr Akshay Jain, an endocrinologist in Surrey, British Columbia, said Canada could “monitor an avalanche of diabetes cases from the COVID pandemic”.
But Jane said that as far as he knew, Health Canada was not collecting data on the effects of COVID-19.
People with mild symptoms often fail to contact their doctors, which worsens the data situation, said Jane, who also stressed that reading home tests was problematic.
“I just think the health system, as well as the public, needs to know about both the immediate short-term and long-term effects of COVID,” Jane said.
“You know, the effects of the pandemic will stay with us for many years to come. So, I think we need to be aware of that and watch out for conditions like diabetes and the complications that come with it.”
Asked if and how it tracks the condition after COVID-19 and people who have had the disease, Health Canada provided a series of links to vaccination information and daily updates on new cases.
“Health systems are the responsibility of every province and territory,” it said.
Jane said studies in the United States and Germany showed that the risk of developing diabetes was about 46 percent higher for those who had COVID-19 than those who were not infected.
It is unclear why people with COVID-19 develop diabetes, Jane said.
One theory is that COVID-19 causes an “inflammatory tsunami” that increases insulin resistance, he said, while another is that steroids used to treat severe COVID-19 can lead to diabetes.
About nine percent of adults in Canada have been diagnosed with diabetes, Jane said. But pre-diabetes and undiagnosed diabetes increase the figure to nearly 30 percent, he said.
“This is already a very high number, and then adding COVID to the mix will probably increase those numbers even more.”
In October 2020, Madhu Rao from Toronto tested positive for COVID-19. Eighteen months later, he said he still “feels out of breath from time to time.”
Rao said he was worried it was something to do with his heart because he had read that COVID-19 was causing heart problems.
The test instead revealed that he was a “borderline diabetic” with high blood sugar levels, Rao said.
He said he had no problems with his blood sugar before receiving COVID-19 and described himself as otherwise healthy and active with a normal weight.
His doctor told him she saw many patients with high blood sugar and some developing diabetes after COVID-19, and put him on a strict diet, he said.
“She told me that all I could do was keep putting it off.”
A November 2020 study in the journal Diabetes, Obesity and Metabolism showed that 14.4% of patients with COVID-19 were diagnosed with diabetes.
“Recent reports suggest that newly diagnosed diabetes may lead to a higher risk of a poor prognosis for COVID-19 than without diabetes or pre-existing diabetes,” the report said.
“Therefore, patients with COVID-19 with newly diagnosed diabetes should be treated early and appropriately and closely monitored for the development of diabetes mellitus and other long-term cardiometabolic disorders.”
Jane said she agreed and “anyone with a mild form of COVID” should talk to a doctor about whether they should be screened for diabetes.
Another condition that is often associated with COVID-19 is the feeling of confusion known as brain fog. An analysis of several studies in the Journal of the Neurological Sciences in March found that up to 32% of patients reported brain fog about three months after becoming infected with COVID-19.
Professor Theresa Liu-Ambrose, chair of research in Canada at the Javad Mouafagian Center for Brain Health at the University of British Columbia, said there was not enough data to know how many Canadians were affected by the condition, how persistent it was it and what the symptoms and consequences are.
Liu-Ambrose said the Canadian Long-Term Aging Study, a long-term research project across the country, depicts subjects’ brains and assessed their knowledge over the next three years to identify differences between people who had COVID-19 and those who had they did not have.
However, she said the memory fog was largely a subjective complaint, so quantifying it could be a challenge.
Dr. Jurgen Maslani of Saskatchewan tested positive for COVID-19 in March, then returned to work about two weeks after thinking he had fully recovered.
But after visiting a patient, he couldn’t remember the details of what they were discussing, and he realized that “something was wrong.”
“So I quit my job right away because it wasn’t safe,” Maslanie said.
He also felt anxious, though he wasn’t sure if it was a symptom of brain fog or anxiety about it.
“I had the feeling that something was just chemically excluded in my head,” he said.
It took about three weeks for the symptoms to disappear and he is now feeling normal, he said.
But Liu-Ambrose said no one knows what will happen if the brain fog is not treated.
“Any long-term impact of COVID-19 on the brain and our knowledge can be significant,” said Liu-Ambrose.
“These changes could potentially be related to or predict a future decline or risk of dementia. We do not know, but there is certainly such a possibility if these subjective complaints reflect the actual changes in the brain.
“This is an emerging area that needs to be addressed and needs to be explored more.”
Even a modest risk of conditions after COVID can lead to a significant burden on health care, given the large number of COVID cases.
Jane, a diabetes expert, said US data showed an additional 18 cases of diabetes per 1,000 people if they had COVID-19.
That could turn “thousands more Canadians at risk of developing type 2 diabetes,” he said, calling for closer monitoring of diabetic complications, including heart attack, stroke, kidney damage and vision loss.
“If we look at the whole picture together, we see a huge burden on the Canadian health care system, which we haven’t recognized yet, but it’s just waiting to happen.”
As for the former COVID-19 sufferer, Rao said, it’s probably a good idea to pay attention to every single symptom after he gets sick.
“If I had just ignored it as physical fatigue or something, I wouldn’t have known my blood sugar was rising.
Maslani, speaking both as a doctor and as a person who has experienced the long-term effects of COVID-19, said it was “extremely important to monitor” 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 gather data,” he said.
“First, you can’t analyze and fix a problem unless you have all the right data.”
This Canadian Press report was first published on June 4, 2022.
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