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Testing Options for Long
COVID Assessment

The use of various diagnostic tests for Long COVID should be considered for patients with ongoing symptoms associated with Long COVID to assess for conditions that may respond to treatment, once basic testing such as complete blood count, basic metabolic profile and liver function tests have been completed. The CDC recommends that laboratory testing be guided by the patient’s history, physical examination, and clinical findings.

How is the test performed?

Blood and Urine Samples
Individual tests are performed using patients’ Blood and Urine Samples as per their respective laboratory requirements

Testing Options to Consider for Long COVID Assessment

We understand the symptoms can vary and present in different ways for those who suspect they are struggling with Long COVID, as such, we want to do everything we can as a health care organization to assist health care providers and their patients to identify Long COVID symptoms and make informed decisions on next steps to support the patient in their health journey.

The use of various diagnostic tests for Long COVID should be considered for patients with ongoing symptoms associated with long COVID to assess for conditions that may respond to treatment, once basic testing such as complete blood count, basic metabolic profile and liver function tests have been completed. The CDC recommends that laboratory testing be guided by the patient’s history, physical examination, and clinical findings.

To support health care providers and their patients, we have prepared two test menus to assist with Long COVID assessment. There is a Basic test menu, which can support health care providers in following up to related tests that have already been completed. And there is an Expanded test menu that is a recommended work up for use with patients that have not been tested before.

Please see the FAQs below for more details on what is included in both test menus.

FAQs

Long COVID consists of a wide range of new, returning, or ongoing health issues that people experience after being infected with the virus that causes COVID-19. Most people with COVID-19 get better within a few days to a few weeks after infection, so at least four weeks after infection is the start of when Long COVID conditions could first be identified. Anyone who was infected can experience these conditions. Most people with Long COVID conditions experienced symptoms days after first learning they had COVID-19, but some people who later experienced these conditions did not know when they got infected.

Some of the signs and symptoms of Long COVID include:

  • Fatigue
  • Memory problems
  • Sleep disturbances
  • Shortness of breath
  • Anxiety and depression
  • General pain and discomfort
  • Difficulty thinking or concentrating
  • Post-traumatic stress disorder (PTSD)

About 10-30% of patients continue with lingering symptoms four or more weeks after COVID-19 infection, including those who had mild, or no symptoms termed as Long COVID. The CDC recommends laboratory testing be guided by the patient’s history, physical examination, and clinical findings. Specialized tests might be considered if symptoms persist for 12 weeks post COVID. There are a group of individual tests, such as Vitamin D, that can be considered for evaluation of persistent symptoms.

If you had a confirmed case of COVID-19 or suspect that you may have had COVID-19 in the past, even if you were asymptomatic, and you are now experiencing symptoms associated with Long COVID, you should have a discussion with your healthcare provider about whether certain tests, like a Vitamin D test, are right for you.

Your doctor may order testing if you meet the following criteria:

  • You are experiencing the signs and symptoms of Long COVID
  • You were, or suspect you were, infected with the virus that causes COVID-19
  • You have already had basic testing such as complete blood count, basic metabolic profile and liver function tests completed with inconclusive results

All testing that relates to Long COVID is completed by LifeLabs at a Patient Service Centre or via our mobile lab service (available in select cities) through simple blood and urine samples. You will require a test requisition signed by your healthcare provider.

For tests not covered by a provincial health plan, payment can be made by you at one of LifeLabs’ Patient Service Centres at the time of sample collection. For convenience, Visa, Mastercard and Debit Cards are accepted.

You are encouraged to check with your private healthcare insurer to see if coverage is provided.

All test results will be provided directly to your doctor for discussion with you.
Certain test results are available on LifeLabs’ patient results portal. LifeLabs® aims to have results available in MyCareCompass within 5-10 business days from sample collection if you provided your Personal Health Number (PHN) or Health Card Number (HCN) at your appointment. Your PHN or HCN will not be used for billing purposes.

References:
https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html
https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/symptoms/post-covid-19-condition.html
https://www.mlo-online.com/disease/infectious-disease/article/21257612/the-longterm-health-consequences-of-covid19

FAQs

There are two suggested work ups offered for assessment and evaluation of patients with Long COVID conditions. The expanded work up was created for testing of patients that have not been tested before. Whereas the basic test work up was created for follow up testing. For a complete list of the individual tests in each suggested work up, please see below.

Long COVID Expanded Test Menu

LifeLab’s Long COVID Expanded Test Menu – This offering is to be considered if no previous testing was performed.
Category Lab Tests OHIP covered MSP covered

Blood count, electrolytes and renal function

 

Complete Blood Count with possible Iron Studies to Follow Yes Yes
Basic Metabolic Tests Some Some
Urinalysis Complete Yes Yes
Liver Function Liver Function Tests Some Some
Inflammatory Markers C-reactive Protein Yes Yes****
ESR – Erythrocyte Sedimentation Rate Yes Yes
Ferritin Yes Yes
Thyroid Function TSH Yes Yes
Free T4 Yes Yes***
Vitamin Deficiencies Vitamin D No* No**
Vitamin B12 Yes Yes

Long COVID Basic Test Menu

LifeLab’s Long COVID Basic Test Menu – This offering is to be considered for persistent symptoms if initial testing such as Complete Blood Count, Basic Metabolic Profile, and Liver Function Tests have been completed.
Category Lab Tests OHIP covered MSP covered

Blood count, electrolytes and renal function

Urinalysis, Complete Yes Yes
Thyroid Function TSH with Reflex to Free T4 Yes Yes
Inflammatory Markers C-Reactive Protein (CRP) Yes Yes****
Vitamin Deficiencies Vitamin D, 25-Hydroxy, Total, Immunoassay No* No**
Vitamin B12 (Cobalamin) Yes Yes

OHIP: *L606 25-hydroxy vitamin D is insured for persons with the following conditions: osteoporosis, rickets, osteopenia, malabsorption syndromes and renal disease, or for persons who are on medications that affect vitamin D metabolism

MSP: ** 92455: Vitamin D (1,25 dihydroxy) and T92460: Vitamin D (25 Hydroxy-cholecalciferol)

Notes:

  1. T92460 is not intended for other metabolites of Vitamin D.
  2. Payable only for beneficiaries under the age of 19 years or when ordered by a specialist.

***Thyroid disease tests:

  1. TSH is the preferred test for the initial investigation of thyroid disease and for monitoring thyroid hormone replacement therapy.
  2. ) For the initial diagnosis of thyroid disease, confirmation of an abnormal TSH with a free T4 is indicated.

Laboratories should only perform fT3 in addition to fT4 and TSH if the TSH is abnormal but the fT4 is not elevated and there is suspected hyperthyroidism. Laboratories may substitute free hormone assays when total T4 or T3 are ordered
****91300 – C – reactive protein: When requested concurrently with 90515 (Sedimentation rate), only 91300 is payable

Basic Metabolic Tests

  1. Calcium
  2. Carbon Dioxide
  3. Chloride
  4. Creatinine with GFR Estimated
  5. Glucose
  6. Potassium
  7. Sodium
  8. Urea Nitrogen (BUN)
  9. BUN/Creatinine Ratio

# Blood Urea Nitrogen (BUN) and BUN/Creatinine Ratio are not covered by MSP

Liver Function Tests

  1. Albumin
  2. Globulin (calculated)
  3. Albumin/Globulin Ratio (calculated)
  4. Total Bilirubin
  5.  Alkaline Phosphatase (ALP)
  6. Alanine transaminase (ALT)
  7. Total Protein
  8. Lactic dehydrogenase (LDH) total
  9. Prothrombin time (PT)
  10. Aspartate transaminase (AST)
  11. Gamma-glutamyltransferase (GGT)

# AST and GGT are not covered by both OHIP and MSP

#OHIP disclaimer:

L222 SGOT (AST) is only insured for persons when ordered by or on the advice of a physician with expertise in hepatic disorders.

  •  [Commentary: Physicians must write “uninsured” beside the test name if the test is not an insured service. The patient will be responsible for payment. It is the authorized healthcare practitioner’s responsibility to inform the patient when the service is not an insured service and that the patient is expected to pay for the service].

#MSP disclaimer:

  1. Fee item 91065 Alanine aminotransferase (ALT) is the preferred liver function test and is a superior marker of hepatocellular damage compared to the 91210 Aspartate aminotransferase (AST) test. 3-17 Revised as of January 1, 2019
  2. In addition, measurement of AST 91210 in conjunction with ALT 91065 rarely adds clinical value and should not be co-billed, unless clinically indicated.
  3. 91210 AST should only be requested to evaluate liver fibrosis or steatohepatitis

 

If your patient is experiencing symptoms associated with Long COVID, you may consider ordering these tests. The CDC has provided recommendations on its website for public education and awareness around Long COVID.

The CDC recommends: “Before ordering laboratory testing for post-COVID conditions, the goals of testing should be clear to the healthcare professional and to the patient. Laboratory testing should be guided by the patient history, physical examination, and clinical findings.”

Patients can get their samples collected at a LifeLabs location and must present a requisition form signed by a physician or healthcare provider.

Healthcare providers may order these tests by individually selecting the test name on the requisition or by writing the test name in the ‘other tests’ section of the standard requisition form as applicable.

It is recommended that healthcare providers explain coverage criteria to patients for some of the tests included in the expanded and basic test menu. Payment for tests not covered by provincial health plans will be charged by LifeLabs at the time of sample collection.

Separate individual test reports with respective reference ranges will be provided for all tests ordered by the physician. As these are individual tests, there will be no combined test report and interpretation provided.

The cost will vary depending on the selection of tests ordered and whether they are covered by OHIP in Ontario and MSP in British Columbia.

For tests not covered by a provincial health plan, payment can be made by the patient at one of LifeLabs’ Patient Service Centres at the time of sample collection. For convenience, Visa, Mastercard and Debit Cards are accepted.

Patients are encouraged to check with their private healthcare insurer to see if coverage is provided.

While many of our tests offer a 24-48 turnaround time on results once received by the lab, test turnaround times for Long COVID may vary depending on the selection of tests ordered.

We have a wealth of medical experts available to support you in interpreting test results.

Consults with our experts are available upon request. Request medical consultation.

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