Four years ago, Sonja Mally was a busy tattoo artist with a photographic memory and penchant for long hikes.

Now, the 38-year-old Toronto woman considers it a good day if she can do a small drawing, muster the energy to walk around the block or 鈥減erform very basic tasks.鈥�

鈥淚t鈥檚 a hard thing to have to explain to people why maybe one day you might be doing fine and the next day you can鈥檛 find the words to complete a sentence,鈥� Mally said.

Debilitating long-COVID symptoms ended the career she loved and forced her to go on Ontario government disability payments, which she supplements with some part-time administrative work.

Mally鈥檚 world changed in March 2020, when she got what she thought was a mild cold 鈥� 鈥渘othing that I thought was going to slow me down.鈥�

鈥淚t was what happened afterwards that was devastating for me.鈥�

That COVID-19 infection led to respiratory problems and extreme fatigue. Then came more terrifying symptoms, including brain fog so severe that the artist couldn鈥檛 draw a clock during a neurology exam, as well as 鈥渆xcruciating pain鈥� that 鈥渇elt like my veins were on fire.鈥�

The biggest difference between now and then, Mally said, is that the health-care community now recognizes long COVID is real.

鈥淚 don鈥檛 have to have that battle with medical practitioners (anymore) trying to convince them that this condition that I have exists.鈥�

A recent Statistics Canada report estimated 3.5 million people in Canada, or 11.7 per cent of the adult population, reported 鈥渓ong-term symptoms鈥� lasting at least three months after COVID-19 infection as of June 2023.

Many of those meet the World Health Organization鈥檚 definition of long COVID 鈥� also called post COVID-19 condition 鈥� which is 鈥渢he continuation or development of new symptoms three months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least two months with no other explanation.鈥�

Forty-two per cent of the people in Canada reporting lasting symptoms had them for a year or more 鈥� and for many, they haven鈥檛 resolved, StatCan鈥檚 report said.

But Canadian doctors and scientists want long COVID patients to know that research is accelerating.

Long COVID Web, a research network of close to 600 health-care practitioners, scientists and patients across Canada, aims to not only help manage symptoms, but also find 鈥渟olutions to get rid of long COVID,鈥� said Dr. Angela Cheung, the network鈥檚 lead and a senior physician-scientist at University Health Network in Toronto.

Long COVID affects many different systems in the body, Cheung said, with the most common symptoms including fatigue, brain fog, cardiovascular problems and shortness of breath.

Cheung has seen many patients improve, and 鈥渜uite a few鈥� have even returned to their 鈥渂aseline鈥� functioning before COVID.

鈥淲hy some can return to baseline and others cannot, I鈥檓 not sure. But certainly it鈥檚 something that we need to better understand,鈥� she said.

Susie Goulding of Cambridge, Ont., got infected around the same time as Mally back in 2020 and said she could barely function with similarly life-changing symptoms.

She gradually improved enough to run her flower shop and care for her 15-year-old son, but she still struggles with lingering brain fog.

鈥淚 think I鈥檝e healed to a plateau,鈥� said Goulding, 56.

鈥淚 have a lot of issues with word-finding and with the stamina of my brain. I can only do so much.鈥�

A few months into her illness, Goulding started a Facebook group called COVID Long-Haulers Support Group Canada. Three and a half years later, there are close to 20,000 members, she said.

鈥淚t just kills me when people join our group and they said they had no idea (this could happen to them). You know, it鈥檚 sad,鈥� she said.

Many long COVID patients live in fear of getting reinfected with COVID-19, or any other virus, because it can wipe out any recovery gains they鈥檝e made, said Goulding.

鈥淚t鈥檚 really like the world has forgotten about COVID and has moved on and all of the safety precautions that were meant to keep people safe are no longer there,鈥� she said.

鈥淎nd so we have to navigate through the world as best as we can with our safety parameters in mind.鈥�

Mally had a glimpse of hope last year, when she was 鈥渇inally able to walk, go for little hikes again 鈥� I was just functioning on a much more normal kind of level.鈥�

But she was only able to enjoy it for a couple of months before she caught a cold, despite taking precautions such as masking.

鈥淚 lost all that progress. I was in bed again for months and unable to do anything,鈥� she said. 鈥淚鈥檓 still trying to work my way back from that.鈥�

One dangerous misconception is that long COVID only happened to people who were infected earlier in the pandemic, said researchers.

Cheung saidit鈥檚 possible the Omicron variant carries a smaller risk of long COVID than the previous Alpha or Delta variants did, but the risk is still significant becauseso many more people are infected with Omicron.

鈥淭his variant can and does cause long COVID,鈥� said Dr. Jim Russell, a professor of medicine at the University of British Columbia and another researcher for Long COVID Web.

There鈥檚 growing evidence that vaccinations not only protect against dying and hospitalizations but against long COVID too, Russell said.

Like Cheung, Russell is hopeful they will find ways to treat long COVID by getting at the root of what causes it.

鈥淚 can鈥檛 help but believe that between Europe, U.S., Australia, Canada, we鈥檙e going to start seeing breakthroughs within the next year,鈥� he said.

One of the main theories Russell is studying is overactive or sustained inflammation.

鈥淲hen you get infected, your body turns on an inflammatory response to kill the virus 鈥� and you need that inflammatory response to recover,鈥� Russell said.

鈥�(But) this inflammation, unfortunately, doesn鈥檛 turn off in some people, and it keeps going for months,鈥� likely damaging organs including the lungs and the brain that lead to long COVID symptoms, he said.

Researchers are also looking at immune system dysregulation, disruption of the microbiome in the gut, damage to endothelial cells in organs and unusual persistence of the virus in the body as other plausible theories for causes of long COVID.

Goulding, who joined the patient advisory group for Long COVID Web, said these are encouraging developments for long COVID sufferers.

鈥淒on鈥檛 give up hope yet,鈥� she said.

鈥淲hen the research is just getting rolling, you know, there are going to be interventions that are going to help people.鈥�

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