Author: Emily Holton

By Drs. Sloane Freeman & Ripudaman Minhas

THE TORONTO STAR

As the COVID-19 pandemic has unfolded across the globe, its impact on children has tended to be an afterthought. While the largest burden of death and disease severity was in their grandparents’ generation, children and youth have grappled with severed social ties, mounting communal stress and widespread school closures due to concerns about their role in transmission of the virus.

On Tuesday, the National Advisory Committee on Immunization (NACI) approved the use of the Pfizer-BioNTech COVID-19 vaccine in children and youth 12 years and up in Canada. This is an exciting step toward safely opening schools and achieving herd immunity. However, as pediatricians, we have big concerns about how the vaccine will be rolled out to children and youth. Optimizing rollout will require us to learn from experiences with the adult vaccination strategies, think about specific pediatric considerations and address important barriers to equitable access.

THE CONVERSATION

This May, Canadians will again be asked if they identify as a member of a set list of minority groups when filling out the long-form census. That data is used to measure the portion of Canada’s population that are designated as visible minorities, a concept and term increasingly out of step with the times.

The pandemic has laid bare racial inequalities, and racial justice activist groups, like Black Lives Matter, have put anti-Black racism high on the public agenda. Systemic racism, rather than visible minority status, is at the centre of debate. While Canadians are now talking more explicitly about race, the census has yet to catch up.

By Sheryl Spithoff and Tara Kiran

THE GLOBE AND MAIL

The health care system’s pivot to virtual care during the pandemic has sparked a corporate stampede into primary care.

Every corporation – from telecom giants to technology startups – seems to want a piece of the pie. Just within the past year, Loblaw purchased a minority stake in a telemedicine platform and launched a health and wellness app that offers reward points at its grocery stores. The goal? To become the “front door of health care.”

Virtual care services are appealing – especially to the millions of Canadians who don’t have a family doctor or who struggle to get a timely appointment with the doctor they do have. Who doesn’t like the idea of chatting with a doctor in your pajamas or skipping the waiting room?

But this shift to corporate-driven care also has a dark side. We need to be wary of the consequences.

It creates a system that is driven by profit – one where care is designed to maximize revenue, not health outcomes, and where your health data is viewed as a financial asset. Instead, we need to find ways to improve access and incorporate new technologies in a primary care system that prioritizes patient health.

From the article in The Toronto Star:

…Farah Mawani, a social epidemiologist at Unity Health’s MAP Centre for Urban Health Solutions, said she hoped the order “encourages workplaces to put more measures in place to prevent closures.”

Workplaces must “receive any support they need to do that from the city and provincial levels so that they and workers are not bearing the burden of the closures,” she added.

But further, permanent measures are also necessary, said Mawani, who recently contributed to a report on global COVID-19 economic responses for the United Nations. Those measures include permanent, robust paid sick leave and income support accessible to even the most precarious workers.

Her recently published research shows high-income countries are the least likely to offer workers paid sick leave.

“It just breaks my heart to think that we haven’t protected workers adequately, including essential workers who are enabling all of us to live through this global crisis,” said Mawani.

“We are not adequately protecting at this stage, when their lives are in the most danger of all.”

From the Global News article:

…“Because vaccines are unfortunately so scarce right now, we have to be thoughtful… That means bringing the vaccines to the individuals, the communities, the locations, the settings where we have the most transmission, where we have the most risk, and therefore where we can have also the most benefit,” says Dr. Darrell Tan.

“We need to acknowledge that risk is not equally distributed in our population because of a whole host of structural, systemic inequities. And we need to respond to that.”

From the article in The Globe and Mail:

…There must be “a very clear, transparent connection to action, because communities can be harmed by just collecting this data, and then nothing happens,” said Andrew Pinto, a public-health specialist and family physician at St. Michael’s Hospital in Toronto.

He suggested paid sick leave as a response, given the high rates of participation in essential jobs by the racialized groups who have had high rates of COVID-19. “We may start to have this information available, but … what do we do with it? And how can we ensure it’s tied to actions and that we are actually narrowing the gaps between different groups?”

Family physician and primary-care researcher Dr. Tara Kiran talks with the CBC’s Andrew Nichols about vaccines, restrictions and the rollout – and how her cohort of family doctors could help administer doses.

From the CTV News article:

…“If we don’t house people who are homeless, we often end up paying for the cost elsewhere and one of the most common places is within the health care system,” Dr. Stephen Hwang, the director of MAP Centre for Urban Health Solution at St. Michael’s Unity Health Toronto, told CTVNews.ca in a phone interview.

He said the approach prevented unnecessary hospitalizations and the new research bolstered public health officials’ general idea of allowing people with no fixed address to isolate in repurposed hotels in cities, which has be done in some Canadian cities, such as Calgary and Vancouver.

Hwang, a leading researcher in homelessness and housing who was not involved in the study, said those who were readmitted to hospital were more likely readmitted for “behavioural, mental health or addiction needs, rather than because they had worsening COVID.”

He said this finding echoed what he saw in similar programs in Toronto.

Interview with Karen McDonald, Research Program Manager at MAP’s Centre on Drug Policy Evaluation

THE GLOBE AND MAIL

A class of drugs commonly used to treat sleep and anxiety disorders is increasingly being found in the illicit opioid supply, raising the risk of overdose, producing complex overdoses that are more difficult to reverse and rendering medications used to treat substance use disorders ineffective in some cases. Drug-checking services across Canada have detected benzodiazepines in half or more of samples expected to be opioids, with adulteration increasing significantly during the pandemic. Karen McDonald, the lead for Toronto’s drug-checking service, says that 20 of the expected fentanyl samples checked over the past two months were associated with overdoses; of those, 18 contained fentanyl and at least one benzodiazepine-related drug. She says her service is working with clinical partners to study the changing drug supply, but that an unregulated market can change on a dime.