Post-acute health care burden after SARS-CoV-2 infection
1. In this retrospective cohort study, community-dwelling adults that tested positive for SARS-CoV-2 had a significantly increased number of healthcare encounters when compared to their test-negative counterparts.
2. At the 99th percentile of healthcare use, females who tested positive for SARS-CoV-2 had an approximately 7 additional days in hospital per-person-year and males had approximately 9 more days in hospital than their test-negative counterparts.
Evidence Rating Level: 2 (Good)
During the COVID-19 pandemic, there were >600 million infections with SARS-CoV-2 and 6.5 million deaths reported worldwide as of September 2022, though this is likely a gross underestimation as many infections have gone undetected. It is difficult to estimate the public health effects of COVID-19; previous evidence studying the first pandemic wave found increased long-term morbidity in those who were infected with SARS-CoV-2. According to the World Health Organization, approximately 10-20% of those infected develop a post-COVID-19 condition (long COVID), and evidence from before the emergence of the Omicron variant has reported similar findings. Given the extent of the pandemic and long-term consequences, it is imperative for healthcare funders, policy makers, and clinicians to better understand the post-acute infection healthcare burden of COVID-19 to plan accordingly. This retrospective cohort study aims to quantify the burden of healthcare in community-dwelling adults in Ontario. Included were community-dwelling adults who underwent polymerase chain reaction (PCR) testing for SARS-CoV-2 between January 2020 and March 2021 in Ontario. Those with positive test results were matched with a person with a negative test result with similar demographic and health characteristics. The primary outcome in this study was healthcare encounters, including days in hospital, outpatient encounters, home care visits, emergency department visits, and days in a long-term care facility. Overall, more than 11 million PCR tests were completed, with 268,521 individuals testing positive for SARS-CoV-2 (7.4% positivity rate). The matching was successful for 99% of patients; the matched cohort consisted of 531,702 people. With respect to the primary outcome, in females, the per-person-year rates of each type of healthcare encounter were significantly higher in test-positive females than for test-negative females. The absolute increase in total healthcare encounters at the mean was 2.0. However, of note, at the 99th percentile, test-positive females had a greatly increased number of healthcare encounters, including 28.37 more home care encounters per-person-years and 6.48 additional days in hospital. A similar pattern was seen in males, with a significantly higher per-person-year rate for all healthcare encounter types with the exception of home care visits and emergency department visits. The absolute increase in total healthcare encounters at the mean was 0.66. Similar to females, at the 99th percentile, test-positive males had an additional 8.69 days in hospital compared to their test-negative counterparts. Overall, the findings from this retrospective study suggest a significant increase in the healthcare burden following a COVID-19 infection, especially in the top 1% of users of healthcare resources. At the 99th percentile, test-positive females had approximately 7 additional days in hospital per-person-year and males had approximately 9 more days in hospital than their test-negative counterparts. A major limitation of this study was that healthcare burden was likely underestimated due to the decrease in healthcare during the initial COVID-19 pandemic. Furthermore, the severity of healthcare encounters was not considered due to the nature of the data available. In conclusion, this study is incredibly important to quantify the healthcare burden of long COVID on the healthcare system and will hopefully guide future decision-making by stakeholders to prepare for the healthcare demand caused by the COVID-19 pandemic.
Click to read the study in CMAJ
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