Author: Emily Holton

By Nav Persaud and Steve Morgan

THE GLOBE AND MAIL

After coining the term “caremongering” during the COVID-19 pandemic, Canadians have shown each other, and the world, that it’s possible to work together to collectively ensure that everyone’s needs are adequately met. Communities are rallying to support neighbours and strangers alike. Celebrities are raising millions of dollars for charities.

But some problems are too big for community mobilization, which is why robust public policies are still needed to support all Canadians during and after this crisis.

One such policy would be the creation of a national pharmacare program. Since the 1960s, five separate national commissions have recommended that medically necessary prescription drugs be included in Canada’s universal public-health insurance system. Just last year, Prime Minister Justin Trudeau’s Advisory Council on the Implementation of National Pharmacare produced an evidence-based and practical implementation plan that would begin this year.

Some might question whether Canada can afford national pharmacare in the wake of the COVID-19 pandemic as governments face massive deficits, but the case for such a program has never been stronger. Canada’s current patchwork of private and public drug plans wastes billions of dollars each year.

For every citizen, we spend at least 50 per cent more on pharmaceuticals than countries with universal single-payer pharmacare systems (for example, Britain). These other countries do not save money by using fewer medicines than we do – their collective purchasing power yields lower drug prices for brand-name and generic drugs. Canada could do this, too, while improving access to medicines at the same time.

…In a widely circulated report he co-authored last month, Dr. Andrew Pinto called on all Canadian jurisdictions to begin collecting data on the race of COVID-19 patients using a uniform questionnaire, to be able to compare results nationally.

“We need to recognize that crises don’t affect everybody the same,” he said in an interview. “Without the data, we won’t be able to see that and direct resources and effort to where they’re most needed.”

So far the country is moving toward a clearer picture of ethnic disparities in fits and starts, although the non-profit Canadian Institute for Health Information has endorsed Dr. Pinto’s report, and offered to help compile such data.

Toronto’s Medical Officer of Health, Eileen de Villa, said in an interview that the city’s public health agency will start gathering ethnic data as part of its COVID-19 case investigation process by the week of May 18, once it has the technical capacity. “We’re pretty much ready to go,” she said.

“The best way to do it is by ourselves, for ourselves.”

Dr. Janet Smylie has dedicated much of her over two-decade career as a Métis physician and leader in the field of Indigenous health to shedding light on the injustices Indigenous people face in Canada’s health-care system.

It’s why Indigenous Services Canada will be working with her on short-term and long-term analysis of data on the novel coronavirus pandemic’s impact on Indigenous communities, in an effort to address some of the data gaps that exist between Indigenous populations on and off reserve.

“It’s a broken system,” said Smylie.

“Even though there are all these jurisdictional divides in this health information system where it’s way harder to identify our people with COVID in cities, now people are trying to work together and admit there’s gaps. We need to bring things together.”

Dr. Janet Smylie speaks with CBC News’ Rosemary Barton on the lack of COVID-19 data for urban Indigenous communities in Canada.

“I’m very concerned right now. In fact I’ve been very concerned – and working with others to try to address this complicated problem – since the onset of the pandemic here in Canada… Currently we are faced with a federal and jurisdictional hot potato, and unfortunately it’s not only in the delivery of health services, it’s also in our health information systems. I see an opportunity to bridge that gap.” – Dr. Janet Smylie

The previous week, CBC News reporter Natasha Fatah interviewed Dr. Smylie on the same topic, following an announcement by Indigenous Services Minister Marc Miller that Ottawa was pledging $250,000 to launch Dr. Smylie’s new data modelling platform, to inform the government’s responses to the virus’s spread in Indigenous communities.

Canada's Minister of Indigenous Services highlighted that data gaps exist on COVID-19 cases for Indigenous communities

We speak with Dr. Janet Smylie, Research Chair with Unity Health Toronto, & Dalla Lana School of Public Health at U of T #cdnpolihttps://t.co/5fQvbCco2D pic.twitter.com/1H5hBZ6WYN

— Natasha Fatah (@NatashaFatah) May 9, 2020

Canada must improve its COVID-19 data collection efforts for First Nations, Inuit and Métis communities if it wants to better understand how the novel coronavirus is impacting Indigenous people across the country, Indigenous Services Minister Marc Miller said Saturday.

“We are learning from past experience with responding to pandemics in Canada … that we need to recognize and understand [Indigenous populations] have a higher risk of being disproportionately impacted by COVID-19,” Miller said. “Along with better access to testing, we are acutely aware of the need to do better, more robust and routinely collected disaggregated data.”

Miller said Ottawa has already pledged $250,000 for improved data collection efforts [led by Dr. Janet Smylie] that would lead to more accurate modelling of the virus’s spread in Indigenous communities and better inform the government’s response.

Also mentioned in NOW Toronto: During a press conference, Miller said the federal government is providing $250,000 to a project led by Toronto-based Métis research scientist Janet Smylie at Toronto’s St. Michael’s Hospital to create a tracking and response platform that will allow for better understanding and data modelling of COVID-19 cases in Indigenous populations.

This week, 250 Toronto families received a package of swabs in the mail. Parents will swab their kids and themselves and send the samples back to be tested for COVID-19, and repeat this weekly — a faucet of data to help answer urgent questions about the role children play in driving transmission of the coronavirus.

The TARGet Kids study, which aims to enrol 1,000 families, is one of two major ongoing research projects in Canada that have rapidly pivoted in recent weeks to help answer the many unknowns about COVID-19 and children. Both will help inform policies to determine when it’s safe to reopen schools and daycares, which have been shuttered here since March — a necessary intervention, but also a brutal drag on children’s learning, parents’ mental health, and the economy, since most working parents rely on child care.

Drug samples expected to be opioids were more contaminated than other expected drug types, according to a report released by the Centre on Drug Policy Evaluation (CDPE), housed within the Li Ka Shing Knowledge Institute at St. Michael’s Hospital of Unity Health Toronto. The report, titled What’s in Toronto’s Drug Supply?, is an initiative of the Drug Checking Service, and is the first of its kind in Canada.

The report amasses results from 543 samples for a variety of unregulated drugs checked by the service from its launch date on October 10, 2019 until March 31, 2020.

Of the 543 samples checked, 46 per cent were expected to be fentanyl and only six per cent of expected fentanyl samples contained only fentanyl. The report also found unexpected noteworthy drugs were often found in Toronto’s drug supply. For example, benzodiazepines and benzodiazepine-related drugs were unexpectedly found in 36 per cent of expected fentanyl samples.

“These results provide a novel portrait of the dangers posed by Toronto’s unregulated drug supply and highlight a gap in our understanding of the drug supply,” said Dr. Dan Werb, director, CDPE and a scientist at St. Michael’s Hospital’s MAP Centre for Urban Health Solutions.

“In the midst of the COVID-19 pandemic, we are seeing a very disturbing spike in overdoses. The findings suggest the need to support people who are drug dependent with a safe supply of drugs. Cities like Vancouver, which has now instituted a city-wide program providing access to standard-dose opioids for people who are at risk of overdose, are a model of success in this area.”

People who use drugs in Toronto have long advocated for access to drug checking. In response, the Centre on Drug Policy Evaluation is coordinating a drug checking pilot operating out of three frontline harm reduction agencies in the downtown core: Parkdale Queen West Community Health Centre (Queen West site), South Riverdale Community Health Centre, and The Works at Toronto Public Health. Samples are transported to laboratories at St. Michael’s Hospital and the Centre for Addiction and Mental Health, where they are analyzed using sophisticated lab-based technologies.

“Many members of the public will be surprised to see in the report that fentanyl was the expected drug for 46 per cent of samples,” said Lorraine Barnaby, Urban Health Manager of Supervised Consumption Services at Parkdale Queen West Community Health Centre.

“This aligns with what we have seen over the past five years, as fentanyl has steadily become the leading cause of overdose deaths in Toronto. With the risk of overdose so high, it’s important that along with access to a safe drug supply program, we also have drug checking services to inform people of what is in the unregulated drug supply so that they are able to make more informed choices.”

Toronto’s Drug Checking Service reports on drug samples checked bi-weekly, which are contributed by people who use drugs to protect themselves from poisoning. The reports are available to the public sign up by emailing drugchecking@cdpe.org. Be sure to follow the Centre on Drug Policy Evaluation on Facebook and Twitter for updates.

Photo: MAP Scientist Dr. Darrell Tan, with his co-leads Dr. Adrienne Chan and Dr. Allison McGeer.

A team of scientists from St. Michael’s Hospital, Sinai Health and Sunnybrook Health Sciences Centre have launched a clinical trial to understand whether an existing drug used for HIV treatment and prevention may work to prevent COVID-19 infection.

The trial will examine whether post-exposure prophylaxis (PEP), which is a medication a person takes once they’ve been exposed to a virus to prevent infection, could halt or slow the spread of COVID-19 in groups of people who have been exposed to a confirmed case. The drug in question – Kaletra (lopinavir/ritonavir as PEP) – has long been used in this capacity to prevent HIV in those who have been exposed to the virus.

“Early studies of the use of this medication as post-exposure prophylaxis therapy in other coronaviruses such as SARS and MERS have been promising,” says Dr. Darrell Tan, the study’s lead investigator who is also a scientist at MAP Centre for Urban Health Solutions and an infectious disease physician at St. Michael’s. “These are so-called ‘cousin’ viruses to COVID-19 and we want to understand whether lopinavir/ritonavir as PEP could impact its spread as well.”

Dr. Tan, along with his co-leads Dr. Allison McGeer, a senior clinician-scientist at the Lunenfeld-Tanenbaum Research Institute of Sinai Health, and Dr. Adrienne Chan, a clinician-investigator at the Sunnybrook Research Institute, will collaborate with Toronto Public Health to identify confirmed cases of COVID-19. They’ll then connect with those exposed to confirmed cases to enroll them in the study.

“A great many people from all across Toronto have worked together to get this study started,” says Dr. McGeer. “We know we need to be finding solutions that contribute to stopping the spread of this disease as quickly as possible.”

The group of contacts of one patient with confirmed COVID-19 will be identified as a ‘cluster.’ Entire clusters will be randomized to receive either the medication or no intervention. The team of researchers will then track whether or not participants develop COVID-19 by asking them to complete self-tests for the virus weekly. To limit contact, the research team will rely on courier and virtual or phone meetings with participants.

This type of a study is called a ring trial design and was an effective method of using vaccines to eradicate smallpox and test treatments for Ebola.

“Kaletra is a drug that the HIV community has been using globally for two decades, and has also been commonly used at scale in low-resource settings. This means it could be easily scaleable not just in Canada, but internationally, if we are able to demonstrate its effectiveness in the prevention of COVID-19,” says Dr. Chan, who is also an infectious diseases physician at Sunnybrook Health Sciences Centre.

Participants randomized to receive the study drug will take it for 14 days, as this is the current estimated incubation period for COVID-19.

“If this strategy works, it could be a major turning point in our global effort to stop a virus where, as we have seen, the outcomes can be devastating,” says Dr. Tan. “We are hopeful that our work will bring us closer to understanding how to slow or contain the spread of COVID-19.”

This research is funded by the Canadian Institutes of Health Research and the St. Michael’s Hospital Foundation. For the purposes of this trial, the medication, Kaletra, has been donated in-kind by AbbVie, a biopharmaceutical company. The CIHR Centre for REACH in HIV/AIDS is also supporting this work.

If you are interested in learning more about this study or how to participate, please contact the study team directly at coriprev@unityhealth.to.

MAP and the UofT Faculty of Medicine Diversity Advisory Council are teaming up to highlight community-led COVID-19 initiatives that we know are making a difference right now.

Since it launched in March, the demand for the Black Creek Community Farm Emergency Food Box program has been overwhelming.

This wonderful, community-organized farm in North York is coordinating with FoodShare to offer free drop-off of healthy food baskets to Jane-Finch neighbourhoods facing food insecurity during the COVID-19 pandemic.

If you are able, please donate here right now.

Please indicate in the ‘company’ field that you were referred by MAP. Your donation is eligible for a tax receipt.

For more information, you can read about what Black Creek Farm is doing here from TVO.

Thank you and take care – from all of us at MAP.

It’s true that COVID-19 doesn’t discriminate: anyone can get sick and potentially die from it. But the social systems that Canada has created often can discriminate. Health treatment and the outcomes aren’t always equal across all communities. Many Indigenous communities face big challenges: fewer doctors, inadequate housing and water that isn’t safe to drink. All of those issues, alongside systemic racism, can lead to especially bad health outcomes during a pandemic, Public health experts, like Canada’s Chief Public Health Officer Dr. Theresa Tam, say the health outcomes of COVID-19 could hit Indigenous communities especially hard.

Canada’s Indigenous populations have a lower life expectancy and higher rate of chronic illnesses compared to national averages. They’re also six times more likely to contract tuberculosis. The historical effects of the residential school system and discriminatory practices stemming from the Indian Act play a big role in the quality of healthcare. But there are big challenges that face these communities in the present day too.

In this 20-minute podcast, Adrian Cheung talks to Dr. Janet Smylie, one of Canada’s first Métis doctors and a lead researcher on the inequities of health care for Indigenous people in the era of COVID-19. She explains why First Nations, Inuit and Métis people are at a disproportionate risk and what must be done to fix the problem now.