This section below summarizes information identified on long COVID-19 clinics across jurisdictions.

Scientific Evidence

Staffing:

Multidisciplinary Staff: A qualitative study (N=59; United Kingdom) that documented long COVID patients’ lived experiences generated patient-informed quality principles for long COVID services, including the provision of multidisciplinary rehabilitation teams that include rehabilitation, respiratory and cardiac consultants, physiotherapists, occupational therapists, psychologists and (if needed) neurologists.

International Scan

Long COVID Clinics:

• Long COVID clinics were identified in the United States (US), the United Kingdom (UK), and Italy.
  • US: An NBC News article (March 2021) reported that 80 post-COVID clinics identified in 31 US states are actively engaging with COVID-19 patients who continue to have symptoms months after their acute infection cleared; 64 US clinics surveyed have seen a combined total of nearly 10,000 patients. A Becker’s Hospital Review article (April 2021) stated that 30 hospitals and health systems have launched post-COVID-19 clinics in the US.
  • UK: According to a December 2020 news release, NHS England had established 68 long COVID-19 clinics across the country; the release reported that 10 sites were operational in London seven in the East of England; eight in each of the Midlands, the South East, and the South West respectively; nine in the North West; and 18 across the North East and Yorkshire. An additional 12 sites were earmarked to launch in January 2021 in the East Midlands, Lancashire, Cornwall and Isle of Wight.
  • Italy: An Outpatient COVID-19 Follow-up Clinic in Milan is part of a 2020 observational study on patients with COVID-19 performed at San Raffaele University Hospital.

Funding:

• NHS England and NHS Improvement provided two funding investments to support the establishment of long COVID assessments clinics that will support the anticipated demand in England in 2021/2022:
  • CAD $17.42 million in October 2020; and
  • CAD $41.81 in March 2021.

Staffing:

• The team in Milan’s Outpatient COVID-19 Follow-up Clinic is multidisciplinary, comprising internists, neurologists, psychiatrists, cardiologists, nutritionists, and nephrologists.

Program delivery:

• All hospitalized patients are offered the opportunity to participate in Milan’s Outpatient COVID-19 Follow-up Clinic. Outpatient visits are scheduled at four weeks, three months, and six months after hospital discharge. For patients managed at home after discharge from the emergency department, telephonic consultation by a trained physician is used to discriminate patients for whom the follow-up visit is recommended.

Guidelines for Long COVID Clinics:

• Guidelines for establishing long COVID clinics were identified in the US and the UK:
  • UK: In December 2020, the National Institute for Health and Care Excellence (NICE) in partnership with the Scottish Intercollegiate Guidelines Network (SIGN) and the Royal College of General Practitioners published a guideline for clinicians on the management and care of people with long-term effects of COVID-19. The NICE guidelines also make recommendations in a number of other key areas:
    • Assessing people with new or ongoing symptoms after acute COVID-19;
    • Investigations and referral;
    • Planning care;
    • Management, including self-management, supported self-management, and rehabilitation;
    • Follow-up and monitoring; and
    • Service organization.
• The guideline also includes a number of key recommendations for research which will help inform and enhance future versions as evidence and practice develops.
  • US: Recognizing the increasing need for post COVID clinics, the National Institutes of Health (NIH) and the US Centers for Disease Control and Prevention (CDC) are currently developing protocols for these centers; established centers such as The Mount Sinai Hospital in New York City are offering guidance to those just getting up and running. No additional information was identified.

Canadian Scan

Private Clinics:

• Lifemark Health Group, a chain of private physiotherapy and rehabilitation clinics, offers a Post COVID-19 Rehabilitation and Recovery Program in six provincial jurisdictions: British Columbia, Alberta, Ontario, Nova Scotia, New Brunswick, and Newfoundland and Labrador. The program emphasizes a multidisciplinary approach to treatment and provides care in person and virtually.
  • Staffing: Staffing includes health care providers from 15 disciplines, including: Physiotherapy; occupational therapy; vestibular therapy; kinesiology; athletic therapy; chiropractic, massage therapy; psychology/social work; dietitian; and speech language pathology.
  • Funding: Health insurance providers reimburse all, or a portion, of the fees. Coverage includes: All third-party insurance; extended health benefits; worker’s compensation; and motor vehicle accident insurance.

Public Clinics:

• Clinics have been identified in British Columbia (Post-COVID-19 Recovery Clinic), and Quebec (Montreal Clinical Research Institute Post-COVID-19 Clinic). Each clinic is staffed by an interdisciplinary team of specialists. For example:
  • Post-COVID-19 Recovery Clinic (BC): Since February 2021, a network of three post COVID-19 recovery clinics provide specialized care and follow-up for patients recovering from COVID-19: Vancouver General Hospital (Vancouver); St. Paul’s Hospital (Vancouver); and Jim Pattison Outpatient Care and Surgery Centre (Surrey). The BC program is provincially funded by the Provincial Health Services Authority (PHSA) and works in partnership with BC’s regional health authorities, patients, and research organizations.

Ontario Scan

• A COVID-19 Rehabilitation Clinic has been established in association with the University Health Network (UHN).

Program Delivery and Staffing:

• The program at UHN (Ontario) is multidisciplinary, and is staffed by an interprofessional team of clinicians, including: A psychiatrist; a geriatrician; occupational therapists; physiotherapists; an occupational/physiotherapy assistant; a social worker; a registered nurse; and a service coordinator.

The COVID-19 Evidence Synthesis Network is comprised of groups specializing in evidence synthesis and knowledge translation. The group has committed to provide their expertise to provide high-quality, relevant, and timely synthesized research evidence about COVID-19 to inform decision makers as the pandemic continues. The following members of the Network provided evidence synthesis products that were used to develop this Evidence Synthesis Briefing Note:

• Ontario Health (Cancer Care Ontario); and
• McMaster Health Forum