Thank you, Mr. Chair and members of the committee, for offering me the opportunity to speak with you today. The thoughts that I will be sharing with you reflect my experiences during the COVID-19 pandemic as an infectious diseases specialist, researcher and director of the post-COVID-19 research clinic of the Montreal Clinical Research Institute. The views shared today are my own.
The COVID-19 pandemic began one year after I was recruited to the Montreal Clinical Research Institute. Prior to this recruitment, I spent eight years at the United States National Institutes of Health, completing my infectious diseases training within the National Institute of Allergy and Infectious Diseases, which is led by Dr. Anthony Fauci. During this time, I also obtained my Ph.D. at the University of Cambridge. This combined training in medicine and basic science laboratory research was essential in allowing me to anticipate, at the start of this pandemic, that there would be long-term sequelae of COVID-19. As such, I submitted a proposal for funding to CIHR in May 2020, which was unfortunately not retained. However, eight months later, I obtained sufficient funding from the Quebec government to allow for the opening of Quebec’s first long COVID research clinic.
This research clinic represents a novel clinical infrastructure where every patient is enrolled in a research protocol, allowing for a comprehensive clinical evaluation, parallel data collection, human specimen biobanking, and by extension, the completion of laboratory research almost simultaneously within the same building. We are therefore able to perform translational research, which is research where we have the privilege of learning first-hand from the lived experience of patients with long COVID, and can then use this information to inform our research questions in the laboratory.
According to the World Health Organization, WHO, post-COVID‑19 illness, or long COVID, is a condition that occurs in people who have had COVID‑19, usually three months after the initial infection, with symptoms that last at least two months and cannot be explained by any other diagnosis. Symptoms may occur even after an acute asymptomatic infection or after initial recovery, and may fluctuate over time.
The diagnosis of long COVID is therefore complex and often requires longitudinal follow‑up. In addition, the symptoms associated with long COVID are numerous, and many of them, such as fatigue and shortness of breath, overlap with other diseases. Some sequelae of long COVID can last more than two years, be extremely debilitating, and negatively impact patients' personal and professional lives, resulting in a number of patients being unable to return to work.
With a conservative estimated prevalence of 10%, the number of patients with the disease far exceeds the capacity of the specialist clinics already established in Canada, which can be costly to the Canadian health care system, as some patients may develop additional complications, while others will have to undergo several additional tests, in addition to being referred to several specialists.
Long COVID is a complex diagnosis to make, made even more complex by the fact that we do not yet have a full understanding of the cause of this condition. The management of long COVID is also challenging as it requires a multidisciplinary approach and we are currently lacking specific pharmacological treatment options. Without fully understanding the mechanisms that underlie the novel disease entity that is long COVID, it is challenging to identify reliable biomarkers that may either predict who will develop long COVID or help make a long COVID diagnosis. These biomarkers are especially important in the context where COVID testing by PCR is not available to all. Most importantly, the understanding of the disease mechanism is ultimately essential to identify therapeutic targets that may quicken the recovery from long COVID, especially if these treatments are administered early on in the course of the disease.
It is within this context that we need to be forward thinking and maximize our learning when faced with a new clinical entity such as long COVID or even a new infectious disease. One way to maximize this learning with a structured and efficient approach is through a translational research infrastructure that is integrated into clinical care pathways. The integration of a research clinic model, such as the one established at the Montreal Clinical Research Institute, into specialized centres across Canada would be essential for the rapid identification of diagnostic biomarkers and new therapeutic targets. This model would be even more effective if it were integrated into a network that would use standardized protocols and have an established infrastructure for real-time data sharing and integration. With this coordinated and rapid approach, we would further distinguish ourselves as a country, not only in the context of long COVID but also in the management of other complex and chronic diseases.
In addition, such an infrastructure would foster collaborations between government, industry and academia at both the national and international levels. Undoubtedly, these efforts will also allow us to be better prepared to rapidly manage the next pandemic.
I thank you again for the opportunity to speak to these issues, and I welcome any questions that you may have.