‘We are going to be tested again’: Experts on Canada’s pandemic response

From CTV News

A panel of experts made further calls for an independent inquiry into Canada’s COVID-19 response on Tuesday, stressing that the country’s pandemic response must be reviewed before it’s tested once again.

The experts, who penned a series of articles on Canada’s pandemic response that were recently published by the BMJ medical journal, shared their findings at a webinar on Tuesday.

Dr. Sharmistha Mishra, one of the authors, and an infectious disease epidemiologist and physician at University of Toronto and Unity Health Toronto, started her presentation with a number. “52,750,” she said in the webinar, referring to the reported deaths in Canada directly related to COVID-19 as of June 2023.

Dr. Mishra said an independent, public inquiry into the country’s COVID-19 response would summarize what happened over the past three years and allow the country to better prepare for the future.

“An independent, public inquiry could systematically — and with scientific humility — get at why. And getting at the why in a nuanced way has to come with transformative action, implementation, and would also come with evaluations of the changes that are being made and that have been made,” Mishra said.

“We are going to be tested again.”

Published Monday, the experts’ seven-article series was a collaboration from 13 organizations across the country, including physicians, nurses, researchers, legal experts, and humanitarian specialists, aiming to understand the medical and societal complexities of pandemic responses on a national scale.

‘We can’t have 50,000 deaths and not ask why’: Researchers call on Canada to hold national COVID-19 inquiry

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From the Toronto Star

Canadian researchers are calling for an independent national inquiry into the country’s COVID-19 strategy, stating that major pandemic failures hampered Canada’s emergency response, including its ability to protect the most vulnerable.

In a series of papers published Monday in the BMJ (British Medical Journal), researchers point to data that shows Canada did not fare well in some aspects of its pandemic response, highlighting how COVID ravaged the country’s long-term-care homes — leading to a disproportionate number of deaths.

And, they warn, Canada’s relative successes, such as its high vaccination rates, obscure persistent geographical, social and economic COVID inequities across the country.

As of June, Canada’s cumulative COVID death rate of 1,372 per million exceeded the global average of 855 per million and was higher than Australia’s rate of 814 deaths per million people, according to figures released Monday.

And while Canada has one of the lowest death rates among G10 nations, lower-income Ontarians have died of COVID at much higher rates than those with higher incomes — even after the rollout of vaccines, antiviral medications and COVID treatments.

New data published in the BMJ series shows that rates of COVID hospitalizations and deaths in Ontario remained threefold higher in the lowest-income neighbourhoods, compared to the highest-income areas across seven pandemic waves.

“We are calling for an inquiry that will hold our governments and our public health systems accountable,” said Dr. Sharmistha Mishra, one of the co-authors of the series and an infectious disease physician and mathematical modeler at St. Michael’s Hospital, a part of Unity Health Toronto.

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« Il est impossible de déplorer 50 000 morts sans s’interroger sur les raisons de ces décès » : Des chercheurs demandent au Canada d’organiser une enquête nationale sur la COVID-19

Tiré du Toronto Star

Des chercheurs canadiens réclament une enquête nationale indépendante sur la stratégie COVID-19 du pays, affirmant que les échecs majeurs dans la lutte contre la pandémie ont entravé les mesures d’urgence du Canada, y compris sa capacité à protéger les personnes les plus vulnérables.

Dans une série d’articles publiés lundi dans le BMJ (British Medical Journal), des chercheurs soulignent les données qui montrent que le Canada n’a pas été à la hauteur dans certains aspects de sa réaction à la pandémie, soulignant la façon dont la COVID-19 a fait des ravages dans les maisons de soins de longue durée du pays, entraînant un nombre démesuré de décès.

Selon eux, les résultats relativement bons du Canada, notamment en ce qui concerne ses taux élevés de vaccination, masquent des inégalités géographiques, sociales et économiques persistantes dans à l’échelle du pays.

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How should we handle the toxic drug-supply crisis? Experts weigh in.

From Healthy Debate

Recent news coverage has highlighted the deepening divide in the politics of the toxic drug-supply crisis.

In Alberta, the United Conservative Party is moving ahead with plans to enact the controversial Compassionate Intervention Act. The act gives police and family members the ability to refer adults and youth into involuntary substance-use treatment if they “pose a risk to themselves and others.”

The province has said those referred to the “intervention commission” would be offered several services, including addiction treatment, and that enlisting would be voluntary in most cases. But others have criticized the act, calling it a violation of Charter rights.

In the past few months, publications like the National Post have run several stories that have been critical of safer-supply programs. Conservative leader Pierre Poilievre has called on the Liberal government to cancel its safer-supply program and instead put resources toward treatment. However, many experts have highlighted the shortcomings of recovery-oriented strategies alone.

In 2022, 7,328 people in Canada died from opioid toxicity, an average of 20 people per day. Among those, 87 per cent of deaths occurred in British Columbia, Alberta and Ontario.

While political debates have muddied the water on effective policy options to address toxic drug deaths, we asked a panel of experts what they see as the best path forward to address the ongoing crisis.

Zoe Dodd: When we debate things like safe supply, I think we stop having the conversation about what is actually the problem, which is that people never overdosed like this until we had a toxic drug supply. A policy change that we need to embrace is looking at legalization and regulation. This is what safe supply is ultimately doing.

The other thing that is really important in all of this is that for a lot of people who struggle around substance use, loss can be one of the bigger factors that drives them to use in particular ways. We are in a situation where we have whole families of people who have died, friends, and trying to live with that much grief and loss is a contributing factor for why people use in particular ways.

For me, harm reduction is a pragmatic approach. It’s not a left or right thing, but it’s being used as a political wedge. It’s very difficult to implement policies when there is a very hard drug-war narrative in the background and this idea that people just need to stop using drugs. Even in the face of this incredibly toxic supply, people are still using drugs. This speaks to how we need to move away from this kind of rhetoric and way of thinking because it’s not working. If we’re going to change the course of the crisis, then we need to implement policies that won’t kill people and stop spending money in ways that fund the drug war.

Can a familiar antibiotic help prevent STIs?

From the BC Centre for Disease Control newsroom

A new clinical trial is set to test whether taking the antibiotic doxycycline daily or after a sexual encounter can help prevent the bacterial sexually transmitted infections (STIs) syphilis, gonorrhea and chlamydia. 

The study is co-led by Dr. Troy Grennan, medical lead for STI/HIV Services with the B.C. Centre for Disease Control (BCCDC), and involves multiple sites across the country. Recruitment has started in Vancouver, with other Canadian sites to follow, and the goal is to recruit 560 people who are likely to be exposed to STIs. 

Study participants will be randomly assigned to one of two groups, to assess whether taking the antibiotic doxycycline reduces the chances of getting an STI after having sex with someone with an infection. The first group will take doxycycline daily as a pre-exposure prophylaxis or PrEP. The second will take doxycycline only after a sexual encounter as a post-exposure prophylaxis or PEP. This is the first study globally to compare these two STI prevention approaches.

“Rates of bacterial STIs have been increasing for well over a decade. We need new tools that are effective, safe, and acceptable to the people who use them, to help reduce the risk of infection and improve sexual health,” said Dr. Ann Burchell, a co-principal investigator based at St. Michael’s Hospital, a Unity Health site in Toronto. 

“The DISCO trial will provide important new evidence on whether the PrEP and PEP approach, so effective for HIV, can also work for other STIs.”

Toronto doctor shortage leaves millions without primary care

From Bloomberg News

Zunera Hashmi, a Toronto resident, has been anxiously waiting in line for three years to be assigned a family doctor. When she gets stressed, the 28-year-old marketing professional calls the provincial help line but hears the same message: “Wait just a bit longer.” She emails them occasionally but gets no reply.

Over 2.2 million like Hashmi don’t have a regular family physician in the province of Ontario, according to data from health-care researcher Inspire Primary Health Care, up from 1.8 million two years ago. The shortages are dire in Toronto, Canada’s most populous city and its financial capital. One in five Ontarians, most of them Toronto dwellers, could be without a family doctor in the next three years, according to the Ontario College of Family Physicians (OCFP), which represents 15,000 family doctors in the region.

“We have a full-blown health-care crisis on our hands,” said Dr. Mekalai Kumanan, president of the OCFP, which is raising an alarm. Canada’s population saw record growth in 2022, spurred in large part by an immigration-friendly policy. Older physicians are retiring but fewer medical students are choosing family medicine. And Toronto’s aging population faces ever-more medical issues.

“It’s a perfect storm,” Kumanan said.

In 2021, a survey by the hospital network Unity Health Toronto found that one in five Toronto family physicians are considering closing their practice in the next five years.

“The pandemic caused health-care professionals around the world to rethink work,” said Dr. Tara Kiran, the Fidani Chair of Improvement and Innovation at the University of Toronto. “It’s particularly challenging for those in family medicine where doctors aren’t as respected as specialists.” 

In the battle against rising opioid deaths, one vulnerable group has been overlooked

From the Toronto Star

As the opioid toxicity crisis has intensified, our image of typical drug users has received a makeover. No longer is the picture one of emaciated, strung-out souls wandering back alleys; it now includes suburbanites, upwardly mobile people with good jobs and nice homes.

But there’s still something missing from this picture: The kids. While teenagers and young adults might not fit the classic picture of drug addiction, the toxicity crisis hasn’t ignored them. But we sure have.

According to a new study led by epidemiologist Tara Gomes of the Ontario Drug Policy Research Network, deaths from opioid toxicity among Ontarians between 15 and 24 rose dramatically in the last decade. Between 2014 and 2021, overdose deaths tripled, while visits to emergency departments quadrupled.

No age group is safe

Fentanyl contributed to 94 per cent of the deaths, which shows that no age group is safe from opioid toxicity. But that’s not the most disturbing part.

This is: As deaths and hospitalizations skyrocketed, treatment uptake decreased dramatically. The rate of young adults receiving opioid agonist treatment — methadone or buprenorphine, commonly abbreviated as OAT — dropped by more than half between 2014 and 2021, while admissions to residential treatment centres declined by 72.5 per cent.

Patients experiencing homelessness in Toronto up to 18 times more likely to visit emergency departments for cold weather-related injuries, Unity Health study finds

From Unity Health Toronto

Patients experiencing homelessness are 14 to 18 times more likely to visit emergency departments (EDs) in Toronto for cold weather-related injuries compared to non-homeless patients, according to a new study from Unity Health Toronto and ICES. The findings highlight the need to increase the number and accessibility of winter services throughout the cold season to prevent future injuries and lessen the strain on city emergency departments, the researchers say.

The study, led by researchers at MAP Centre for Urban Health Solutions and published in The Canadian Journal of Emergency Medicine, also found that women experiencing homelessness had consistently higher burden of cold-related injuries compared to men experiencing homelessness, relative to their housed counterparts.

 “Injuries related to cold exposure are to some extent an unavoidable reality in Canada, but the sheer excess burden among those experiencing homelessness is largely preventable,” said Lucie Richard, senior research associate at MAP and study lead author. “Providing adequate, accessible emergency warming services is not only a compassionate imperative, it’s also necessary to prevent major health-related consequences of cold weather-related injury including nerve damage, amputation, or loss of life.”

Dr. Carolyn Snider, chief of emergency medicine at St. Michael’s Hospital, said the study highlights a significant health consequence associated with the lack of access to round-the-clock shelter, particularly in adverse weather conditions. “The distressing effects on patients observed in our emergency departments in Canada are deeply worrisome – especially as they are preventable,” she said.

How we can right-size Canada’s health system as the population grows

From the Toronto Star

Across the country, calls are growing for targeted reforms to primary care, including the expansion of team-based care, which connects patients to interdisciplinary groups made up of pharmacists, social workers, dietitians and other health-care professionals, in addition to nurses and physicians. Evidence suggests such teams improve patient outcomes.

Health leaders also want to see primary care shift to a geographic model to ensure every resident has access to a family doctor within a 30-minute drive of where they live or work. As well, there is a push to allow patients in a team-based environment have a non-physician health professional co-ordinate their care.

Such reforms are necessary given the scale of primary-care needs in the province, says Dr. Rick Glazier, scientific director of the Canadian Institutes of Health Research’s Institute of Health Services and Policy Research.

Even as the need grows for more family doctors to fill the gaps, research shows about 17 per cent of Ontarians are attached to a physician over the age of 65 who is nearing retirement. Glazier says there aren’t enough MDs graduating medical school to replace the aging workforce.

“We don’t have the generation coming behind those people who are retiring,” says Glazier, a family doctor at St. Michael’s Hospital, a part of Unity Health Toronto.

“We will need these interprofessional teams for primary care. We will not be able to do this with doctors alone.”