Researchers examine why Ontario ER visits spike when COVID-19 cases drop

From the CBC News article

Ontario researchers are looking into reasons behind the busiest times in the province’s emergency departments to help relieve the extreme burden facing hospital staff.

Within the last year, hospitals in eastern Ontario and across the province have reported reaching or exceeding capacity as COVID-19 cases surge.

“It’s been a two-year sprint for us,” said Dr. Atul Kapur, who works in the emergency department of The Ottawa Hospital.

He said with COVID-19 protocols and the volume of patients coming through the doors, the hospital’s ER is currently “at or very close to our historic peaks.”

This wave is different than earlier waves of the pandemic, though, as data shows visits to the emergency room have not coincided with the case peaks of the pandemic, according to Dr. Tara Kiran, a family physician at St. Michael’s Hospital and a researcher at the University of Toronto

Kiran said ERs have typically been at their busiest when overall COVID-19 cases were down in the province. Researchers also found emergency department volume was higher in Ontario in the year leading up to the pandemic compared to the pandemic months.

20 people who took on the biggest job of the pandemic and helped Ontario get its shots

From the Toronto Star article

To mark how far we’ve come during the COVID-19 pandemic, the Star has profiled 20 of the people who helped get more than 25 million doses into arms.

Tara Kiran — The family doctor

As a family physician at St. Michael’s Hospital, Dr. Tara Kiran knew she would one day help vaccinate her own patients against COVID-19.

But even before vaccines arrived in Canada, Kiran also knew she could play a larger role, as vice-chair of quality and innovation at the University of Toronto’s Department of Family and Community Medicine.

With U of T colleagues, Kiran created interactive online modules for primary care physicians — accessible to anyone — to provide guidance on the vaccines, from the safety of mRNA vaccines to how to help patients feel confident.

Kiran put aside her other academic work to produce the modules, which she calls a “one-stop way for people to learn” to help bring emerging evidence to the doctor’s office.

Throughout the pandemic, Kiran has co-led bi-weekly webinars for primary care physicians covering top-of-mind COVID issues. Since vaccines were approved, 600 to 900 family doctors regularly join the webinars, many telling Kiran they provide a place to review the latest evidence and a sense of community during a challenging time.

“The notes I get telling me it’s made a difference make my day,” says Kiran, who has also used her platform to push for a more equitable pandemic response.

This year, the Star profiled Kiran’s efforts to help hesitant patients feel more confident. The story followed a mother and daughter as they consulted Kiran on whether to get vaccinated.

“We think of anti-vaxxers as an extreme group. But there are so many people who come from humble circumstances who’ve been struggling with the decision about their vaccines. I think (the story) helped people to empathize and better understand what people are going through when they’re not sure about a vaccine.”

Racialized women frequently excluded from developing medical guidance: study

A study of all clinical practice guidelines published in national general medical journals in Australia, Canada, the United Kingdom, and the United States over a period of eight years – including the pandemic period – has found that the panels developing recommendations are mostly made up of white men and frequently exclude racialized women.

The study, led by researchers at St. Michael’s Hospital of Unity Health Toronto, reviewed 237 clinical practice guidelines published between June 2014 and June 2021, including those related to COVID-19. A total of 3,696 unique guideline panel members were involved in the development of these guidelines. Only seven per cent of panel members were racialized women, while white men made up 46 per cent of members.

The findings, published in The Lancet, suggest that clinical guidelines – which offer recommendations for health care professionals on how to diagnose and treat a medical condition and shape the care patients receive – may not be developed by those most qualified and this could have negative implications for patients.

“Panels can make recommendations about which medicines should be used, who should be screened for cancers and when surgery is appropriate,” said Dr. Nav Persaud, lead author of the study and a Scientist at the MAP Centre for Urban Health Solutions at Unity Health Toronto.

“It’s important that panels are made up of individuals best positioned to provide important guidance. We know that many important roles tend to be filled by white men,” said Dr. Persaud, who is also a family physician at St. Michael’s Hospital of Unity Health Toronto.

The study also found 79 per cent of guideline panels included four or more white men while nearly 40 per cent included no racialized women. The findings were similar across the four international jurisdictions analyzed – where the most common category of panel member was white men and the least common was racialized women.

The authors are calling for greater transparency in panel recruitment processes and say that guideline producers should ensure that they fairly or equitably recruit and retain panel members. They are also calling for governments and other funders to require fair processes. Twenty-eight per cent of guidelines either did not mention the selection process or declared that the panel was formed without explaining how.

“This finding by itself is a reason to view guidelines in general with some skepticism. In particular, we should question whether these guidelines will exacerbate existing health inequities,” said Dr. Persaud.

Path to a stronger, more resilient Canada starts with equity

Op-ed by Dr. Nav Persaud from the The Hill Times

Covid-19 will not take a break this holiday season, so we must remain focused on slowing its spread and on addressing what underlies each wave. Just as global vaccine inequity puts us all at risk by leaving billions unprotected, unfairness here at home continues to threaten health. While we focus on omicron’s rise, now is the time to implement changes that will make Canada more resilient to threats like this pandemic.

We just co-authored a report outlining 13 recommendations toward an equitable pandemic recovery. If paid sick leave will not made available to everyone during this pandemic of a virus that causes a cough, when will we ever get it? Studies show that paid sick leave reduces the spread of infectious diseases.

People with a low income were more likely to be affected by Covid and less able to adhere to public health advice. A universal living income has been studied in many countries including Finland and we know that that financial security can be provided without discouraging people from working.