Homeless: Search for solution grows more urgent than ever

From The Catholic Register

As Canada’s largest city panics over a series of random stranger attacks, there is sudden media and political attention on Toronto’s exploding homeless population, especially the homeless who appear to be addicted or mentally ill.

“I have no doubt that these incidents have been taking place, but I think they are being over-reported,” Common Table volunteer Paul Pynchoski told The Catholic Register. “Certain aspects of them are repeated over and over again.”

The Common Table at Redeemer Anglican Church in downtown Toronto functions as a kind of community centre for Toronto’s homeless, providing meals, nursing, a book club, art and craft activities and a warm place to sit and talk.

Whether or not the attackers in nine headline-grabbing instances of stranger violence since Dec. 8 are homeless, or mentally ill, or addicted is mostly unknown. In one of the highest-profile cases, a homeless man, Ken Lee, was killed in an alleged swarming attack by eight teenaged girls between the ages of 13 and 16.

Media focus on the homeless, mentally ill and addicted has been everywhere.

“Are Toronto’s attacks linked to homelessness? Not necessarily,” Toronto Star columnist Bruce Arthur wrote in his Jan. 29 take on the situation. “But we know Toronto closed three of its 23 shelter hotels late in 2022 and plans to close five more in 2023; the pandemic increase in funding that accounts for 30 per cent of shelter beds has dried up.”

On Jan. 28, Toronto Sun columnist Warren Kinsella called Toronto “a scene out of Stanley Kubrick’s dystopian Clockwork Orange” and blamed the deinstitutionalization of the mentally ill.

“We have jettisoned the moral duty we owe those fellow citizens who desperately need psychiatric help. People who were protected, and helped, in psychiatric hospitals,” Kinsell wrote. “We’ve dropped them into the back alleys.”

A dangerous increase in the toxicity of street drugs gets the blame in a Jan. 27 Globe and Mail column by Gary Mason, headlined “Random acts of violence? Better get used to it.”

Toronto Mayor John Tory has dispatched 80 more police officers to patrol the transit system. He has called for a national conference on the issue and told CP24 Breakfast he’s “not timid” about drawing connections between mental health and violence in public places. 

Tory’s plan also adds security guards and “Community Safety Ambassadors” working in the TTC system who are directed to deal with the city’s homeless population.

The mayor is pushing to add $48.3 million to Toronto’s police budget to cover about 200 more officers and programs addressing youth violence. The actual link between mental illness, homelessness and violence may not be so straightforward, pointed out psychiatrist Jack Haggarty. People suffering psychosis are at times a risk to others, he said.

“But they actually die from other causes 15 years earlier than the average person, and they have a higher risk of actually being victimized by others,” Haggarty told The Catholic Register.

Their treatment at the hands of others, their vulnerability to physical ailments and the risk of suicide make the mentally ill on the street vulnerable. A media picture of the homeless as a threat to the rest of us bothers Pynchoski, who leads a book club for the homeless.

“I don’t think the media is intentionally doing this, but I think we’re being pushed toward, ‘Oh God, we have to get tough on crime,’” he said. “It’s not a response of ‘What are the needs that are not being met here?’ We want to deal with the symptoms but we never want to deal with the problem.”

Just before the drumbeat of violent incidents grabbed the spotlight, Toronto’s Catholic hospital system put out a note to the city about how they’re dealing with the problem of Toronto’s 8,000 to 10,000 homeless people.

“We are seeing an increasing number of people with cold-related injuries. Routinely, we care for people who are homeless and suffering direct complications of cold weather: hypothermia, frostbite, swelling and infections, and exacerbation of pre-existing conditions,” said the Jan. 17 note on the Unity Health website. “We also see patients who require medical assistance because of the strategies used to survive outside in unpredictable weather. These include injuries from sleeping in unsafe areas or overdoses from substance use. We are also seeing many unhoused patients coming into our emergency departments simply looking for a space to shelter.”

Hospitals can’t solve Toronto’s homelessness problem, said St. Michael’s Hospital research scientist Dr. Stephen Hwang, an internationally renowned expert on health and homelessness.

“There’s no sense in which the health care system, or hospitals, can solve homelessness,” he told The Catholic Register. 

“What we’re seeing is that the failures and gaps in our system are causing people to end up on the doorstep of our hospitals. Hospitals are simply the place of last resort for many people.”

Looking at a problem that has spread and deepened decade after decade since the 1980s, Hwang does not believe Toronto or Canada should just resign itself to the inevitability of tent cities, people in sleeping bags on city streets, open drug use on the subway and thousands in the shelter system with no way out.

“This is a problem that is definitely solvable. We didn’t get into this situation in months, or just 15 years,” said Hwang. “It’s been a problem that’s been building for a long time. It’s going to take us a while to turn this ship around, but it is possible to do so.”

Hwang’s prescription for a solution begins with an honest look at the problem. Even if many homeless people are obviously mentally ill or addicted or both, homelessness is not primarily a mental health issue, he said.

“A game changer”: Dual HIV-Syphilis rapid test approved for use in Canada

From Unity Health Toronto

Clinical trial led by University of Alberta and Unity Health Toronto paves way for approval

Federal regulators have approved the licensure of an all-in-one rapid device that allows Canadians to simultaneously be tested for HIV and syphilis. Canada is the first country to approve and implement a dual-target device in North America that can produce results in as little as 60 seconds.

The approval was made possible, in part, by the results of a two-year clinical trial led by researchers at the University of Alberta and St. Michael’s Hospital, a site of Unity Health Toronto. The results were included as part of the device manufacturer’s submission to Health Canada and were necessary for the regulators’ review and approval.

recent report by the Public Health Agency of Canada showed spiking rates of syphilis in the country, primarily among young women. From 2017 to 2021, rates of syphilis among females increased by 729 per cent, compared with 96 per cent among males. Syphilis infection can increase the risk of HIV acquisition and transmission, and co-infection creates a high risk of neurological problems. Cases of congenital syphilis – which is present at birth – are at crisis levels for young mothers, particularly those from persons of First Nations ethnicity. Ninety-six cases of congenital syphilis were reported in 2021, compared with seven cases in 2017.

“We need urgent actions to mobilize testing, treatment and connections to care for syphilis and HIV that are culturally appropriate, and that can reach and meet people where they are. They won’t come to us because the health and public health system has failed them – we need to go to them,” says Dr. Sean B. Rourke, a scientist at MAP Centre for Urban Health Solutions, a world-leading research centre housed at St. Michael’s Hospital, and the Director of REACH Nexus, a national research group working on how to address access and treatment for HIV, Hepatitis C and other sexually transmitted and blood-borne infections.

Rourke spearheaded the cross-Canada clinical trial which evaluated and proved the accuracy of HIV-self tests. Health Canada approved the tests for use in November 2020 based on the results of the trial.

The Point of care Tests for Syphilis and HIV (PoSH) Study launched in August 2020 and analyzed two different test devices among over 1,500 participants in clinical settings in Edmonton and northern Alberta. The study found both devices to be 100 per cent accurate in identifying HIV infection, and more than 98 per cent accurate in detecting active syphilis. Both test kits provide a test result in under five minutes using a fingerstick blood specimen.

Among the study participants, 24 tested positive for HIV on both devices and were confirmed by a lab test – four of those were new diagnoses. Acting on the device’s instantaneous nature, connecting participants to care and early treatment was a key priority of the study. Of the 20 people previously diagnosed with HIV, nine were on antiretroviral therapy, and all 24 participants were linked or relinked to care. There were 202 cases of infectious syphilis and the majority (87.4 per cent) were treated immediately following point of care test positive results. An additional 32 of 34 (94.1 per cent) participants with infectious syphilis who did not receive treatment at the test visit were treated within a median of four days.

“These extremely rapid point of care tests for the diagnosis of syphilis and HIV are much needed and a game changer for Canada. We were able to save costs associated with an additional clinic visit, reducing the number of cases lost to follow up, and prevent ongoing disease transmission,” says Dr. Ameeta Singh, the study’s principal investigator and an infectious disease physician with the University of Alberta.

Health Canada is approving the INSTI® Multiplex HIV-1/2 Syphilis Antibody Test, which is manufactured by bioLytical Laboratories Inc. in British Columbia. To do the test, a health provider obtains a fingerstick blood specimen, places a single drop of blood with the materials provided in the kit, follows the simple procedure instructions provided in the package, and reads the result in as little as one minute. The health provider can then offer treatment or linkage to care based on the test result. In February 2023, a dual-target device that produces results in 15 minutes was approved in the United States.

The study was jointly funded by Canadian Institutes of Health Research (CIHR) Centre for REACH Nexus at MAP St. Michael’s Hospital, Canadian Foundation for AIDS Research (CANFAR), Indigenous Services Canada, Alberta Health and Alberta Health Services.

About St. Michael’s Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

About Unity Health Toronto

Unity Health Toronto, comprised of Providence Healthcare, St. Joseph’s Health Centre and St. Michael’s Hospital, works to advance the health of everyone in our urban communities and beyond. Our health network serves patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education. For more information, visit www.unityhealth.to.

About the University of Alberta

The University of Alberta in Edmonton is one of the top teaching and research universities in Canada, with an international reputation for excellence across the humanities, sciences, creative arts, business, engineering and health sciences. The university and its people remain dedicated to the promise made in 1908 by founding president Henry Marshall Tory that knowledge shall be used for “uplifting the whole people.” www.ualberta.ca

In Toronto, more than three homeless people died on average every week last year, new data shows

From the Toronto Star article

More than three homeless Torontonians died every week last year, new public health data shows — a total of 187 lives lost while battling with housing precarity in Canada’s largest city.

Lives were taken by cancers and cardiovascular diseases, by pneumonia and accidents. More than anything, people died because of toxic drug supply — identified as the cause of 47 per cent of the deaths among the homeless population that were known to public health in 2022.

The new numbers underscore a grim reality — that, if you are homeless in Toronto, your life expectancy is decades less than the general population. For men, Toronto Public Health found the median age of deaths among people facing homelessness last year was 55 years of age, versus 79 years in the overall city population. For women, the median age of deaths amid housing precarity was just 42 years old, versus an overall life expectancy citywide of 84.

And at least three of the deaths last year were people age 19 or younger, the data shows. “The idea that people are dying without housing as teenagers, I think it speaks to structural failures, systemic failures,” said Greg Cook, an outreach worker with Sanctuary Toronto. “For someone to die a preventable death as a teenager I think is really, really unjust — it’s not just tragic.”

Overall, he sees the death toll as evidence of a crisis that has mounted for years, as Toronto’s homeless population has soared to more than 10,800 people. “Everybody should be able to have housing that they feel secure and safe in, and that’s obviously not the case,” he said.

The worst year for homeless deaths in recent memory was 2021, when Toronto set a despairing record of 223 deaths, or more than four a week. While last year had slightly fewer, the toll is still worse than it was in the recent past, with 144 deaths in 2020, 128 in 2019 and 94 in 2018.

With far more deaths owing to overdoses than any other single cause, Cook urged all levels of government to adopt more urgency on addressing the city’s toxic street drug supply. Toronto’s drug checking service, which measures the contents of illicit substances, has warned that almost all their recent samples of fentanyl are mixed with other highly potent opioids like carfentanil as well as benzodiazepine-related drugs.

Harm reduction advocate Zoe Dodd said current responses to Toronto’s drug toxicity have felt like “a patchwork,” and urged mandatory training on prevention and responses in homeless service settings. “It’s devastating, because death brings more death, and grief brings more grief.”

Opinion: Newborns in Canada must have better primary-care access

Op-ed in The Globe and Mail by Dr. Sloane Freeman

The OurCare national research survey estimates that 6.5 million Canadians over the age of 18 lack a primary-care physician, and a significant number of these people are parents with newborns.

Without a primary-care provider, newborns are especially vulnerable to falling through the cracks within our health care system. This is an even greater problem for newcomer families and those who are not familiar with navigating the Canadian health system.

Newborns require multiple doctor visits in the first days and weeks of life to monitor feeding, weight gain and possible jaundice. Babies born prematurely or with a low birth weight need even closer surveillance. Without close monitoring and follow-up babies are at risk of dehydration, jaundice, serious infections and unrecognized congenital health problems.

Many parents bring their newborns to emergency departments and urgent-care centres because they have nowhere else to turn. Some provinces have set up mobile clinics for newborns who don’t have a family doctor.

As hospital-based pediatricians in the downtown core, my colleagues and I ask every parent of a newborn if they have access to a primary-care doctor for their child. Most of the time the answer is a resounding “No.” Even for parents who do have primary-care providers for their newborns, long travel times and challenges in scheduling appointments make it difficult for them to access care within the first few days of life.

This crisis was heightened during the pandemic, when in-person health care access was restricted. Virtual care falls short for newborns who require physical examinations and weight checks to assess hydration status and growth. Another important consideration is that routine immunizations begin at two months of age, leaving little time for families to secure a primary-care provider for their infants to begin vaccinations.