Author: Emily Holton

The pandemic has radically changed the way Ontarians get appointments with their family doctors, with office visits dropping by almost 80 per cent and virtual-care visits jumping by a whopping 5,600 per cent, a new study shows.

“The change in care from personal to virtual was expected but the magnitude was a surprise, especially the precipitous decline in in-person visits,” said lead author Dr. Rick Glazier.

To get a sense of the pandemic’s impact on primary care, researchers from ICES, an independent, non-profit research institute, and Unity Health Toronto compared billing data from 2020 to 2019, looking specifically at the time period from March to July in both years.

They found that the number of office visits per 1,000 per day went to 1.57 from 7.53, for a drop of 79.1 per cent.

The number of virtual visits per 1,000 people per day went to 3.92 from .07, for an increase of 5,608 per cent.

Total primary care visits — including those done in-person and virtually — decreased by 28 per cent. The number of visits per 1,000 people per day went to 5.51 from 7.66.

Senior author Dr. Tara Kiran said it was reassuring to see that those with the highest care needs maintained higher levels of care.

“Sadly the pandemic has generally widened gaps in equity and many people are not getting the support they need. But our findings suggest that primary care was preserved for those who needed it most. We found the people who were older and sicker had the smallest reduction in overall primary care visits,” she said.

Medical Post journalists reached out to talk off-the-record to doctors in the power structure and asked them which doctors they think have power. Congratulations to MAP scientists Drs. Tara Kiran and Kamran Khan, who were named numbers 12 and 19 on the Medical Post’s 2021 Power List.

Dr. Stephen Hwang, a physician with St. Michael’s Hospital who holds a weekly clinic at Seaton House with Toronto’s Inner City Health Associates, told the Star the site had a “significant number” of older men, and residents who dealt with medical conditions that increased their risk for severe COVID-19 infections.

While the shelter houses fewer seniors with acute medical needs than it did a few years ago, as many moved to a separate site, Hwang said there was still a high prevalence of chronic lung disease and cardiovascular disease among residents, as well as a high prevalence of mental health and substance use issues, muscular-skeletal injuries and chronic conditions impairing mobility.

“If 65 per cent of all workers in the GTA are doing essential work that doesn’t enable them to stay at home, clearly that’s not a sufficient strategy to prevent further spread illness and death,” said Farah Mawani, a social epidemiologist at Unity Health’s MAP Centre for Urban Health Solutions.

“Essential work should not be a death sentence.”

Canada’s COVID-19 vaccine rollout has gotten off to a sluggish start, but there could be lessons to learn from countries such as Israel, which has vaccination clinics operating around the clock. MAP’s Dr. Tara Kiran was on CBC The National to discuss what we can learn from countries like Israel that have vaccination clinics running around the clock.

Confusing. Contradictory. Convoluted. Communications and public-health experts say that the Tories’ strategies have largely been a failure — but that there’s a chance to change course

From the TVO article:

…Farah Mawani, a social and psychiatric epidemiologist with the hospital network Unity Health Toronto, says that the government would have benefitted from not just releasing a policy but also communicating “what can prevent us from moving in the more dangerous stages of the plan — how can we stay in Stage 1, assuming we can.”

…Mawani says the government could also choose to adopt a community-based and trauma-informed approach. That could mean doing more consultations with community leaders to keep the message in line with the reality on the ground — and communicating in a way that “recognizes that we are experiencing a collective trauma.”

“If you’re communicating as if you’re all in this together and you’re actually working together, that has a different tone than if you’re communicating an order to people to do things,” Mawani says. “The type and tone of communication that takes into account the trauma and impact on various different communities looks very different to what we’ve seen so far.”

A pilot project that aimed to vaccinate homeless people in Toronto’s shelters has been put on hold due to a vaccine shortage, local officials said Wednesday.

The rollout of the vaccine to the city’s 100 shelters was paused because of a shortage of the vaccine from Pfizer-BioNTech, which announced last week it would delay the delivery of the COVID-19 vaccines to Canada due to production issues.

Dr. Stephen Hwang of St. Michael’s Hospital, which is helping run the project with the city and several other organizations, said 55 residents and 30 staff at Scarborough Village Residence, a city-run shelter in the east end, got their first dose on Friday.

“It was, overall, a resounding success,” said Hwang, a physician and research scientist who works with the homeless.

“We’re pleased that it’s actually rolling out because it really should be a high priority to get people who are experiencing homelessness vaccinated.”

“It’s something that we do have to work on and certainly for people experiencing homelessness a degree of skepticism or mistrust of the health-care system is probably a bit higher than in the general population,” Hwang said.

Vaccinations at a shelter for Indigenous men was also paused as was the plan to vaccinate those living at the downtown Strathcona Hotel, where many of the city’s homeless moved to after living in encampments much of the year.

Hwang said he was hopeful the vaccines would only be delayed by a few weeks.

He said the team, which includes the Inner City Health Associates, a group of 100 physicians who work at shelters and drop-ins across the city, would analyze the progress of the pilot and fine-tune it before it’s rolled out to the rest of the shelters.

“The goal is to develop a playbook so that we can have a plan that we can go out to immunize people in shelters across the city,” he said.

Retail stores, health-care facilities among top community sources for 6-week period, provincial data shows

From the CBC News article:

…Toronto social epidemiologist Dr. Farah Mawani said other factors may have been at play in the high number of workplace-related cases.

“If people are in precarious positions — where they don’t have a commitment to a longer contract, their income is low, they have limited benefits … they’re in a position where they don’t have the power to challenge lack of safety in the workplace,” she said.

“They don’t have the power to choose to stay at home if they’re sick or if a member of their household is sick.”

She said it’s important to look at some of the systemic factors that might prevent someone from working from home.

“One thing that we do know globally, and certainly in Canada, [is] a very high proportion of people working in precarious employment conditions are our racialized people. And many of them are also immigrants who are underemployed.”

Montreal and Toronto have launched pilot projects to start vaccinating people who are homeless against COVID-19. MAP Director Dr. Stephen Hwang told CBC The National that officials have several challenges to overcome, including a lack of trust in the health system.