Author: Emily Holton

By Stephen Hwang and Jeffrey Siegel

THE HOMELESS HUB

The cold weather has arrived in Toronto. At the same time, many of the places people use to warm up are not accessible. Due to COVID-19 pandemic measures, coffee shops and fast food restaurants are closed to indoor dining. Libraries are no longer letting people in, and many community centres have shut down. The community centres that are open are largely only offering bathroom access. Drop-ins designed to offer indoor space to people experiencing homelessness are also in shorter supply—there are approximately 19 drop-ins offering access to indoor space in February 2021, compared to 51 in 2019.

Health care providers have already noted the toll this loss of informal space is taking on people, describing an increase in cold-related injuries. This is supported by research from St. Michael’s Hospital demonstrating that while extreme cold temperatures put people at higher risk of hypothermia, most cases of injury and death due to cold occur in moderate winter weather. It is imperative that easily-accessible space is made available to everyone, 24-hours a day, and is not restricted to cold weather alerts.

But the risk of COVID-19 transmission in indoor spaces is real—recent data from St. Michael’s Hospital makes this clear. Much of this risk comes from the fact that transmission is airborne. The good news is that there are many steps that can be taken to reduce these risks, including the implementation of better ventilation and filtration practices. 

It begins by opening up access to large, well-ventilated spaces, and keeping a very low occupancy relative to the space (for example, a few dozen people in a large arena). Physical distancing and masking protocols are also critical in reducing airborne transmission. When it comes to ventilation and filtration, lower-cost steps include the use of high quality portable filtration devices; running existing fans that exhaust to the outside (such as bathroom and kitchen fans); opening doors and windows where possible; paying careful attention to bathroom ventilation; learning more about how some devices affect airflow; and, periodically airing out spaces. 

Those responsible for congregate spaces can also consult experts about the possibility of making small but impactful adjustments to heating, ventilation and air conditioning systems (also known as HVAC systems) to improve air quality. For example, some HVAC systems may be able to accommodate a higher-quality filter, or bring in more outside air. To address air quality in a comprehensive manner, an HVAC professional can assess a building’s entire ventilation system. If there is a budget for capital improvements, they may propose ways to retrofit the HVAC system, or suggest that it be replaced. 

Each space and situation is different, and it’s difficult to make generic recommendations. Luckily, there are many resources that address air quality and COVID-19. We’ve put together a brief survey of strategies here. In January, the Public Health Agency of Canada released a report on ventilation strategies and COVID-19. Public Health Ontario also has a document on ventilation and a guide to using portable air filters. For more detail, the American Society of Heating, Refrigerating and Air-Conditioning Engineers has produced a guide to “Epidemic Building Readiness,” and the Canadian Standards Association has released “Workplaces and COVID-19: Occupational Health and Safety Considerations for Reopening and Operating During the Pandemic.”

We encourage those responsible for congregate spaces to review these resources and to think about how to apply these principles and strategies. We also encourage people to consult with indoor air quality and infection control experts—many experts work for public institutions such as universities, and can provide advice. Finally, we encourage funders large and small to make rapid-access funds available immediately to help congregate spaces of all kinds improve air quality, and reduce airborne transmission of COVID-19. 

Investments to improve indoor air quality will reduce transmission risk of COVID-19 and other airborne infectious diseases. They will improve health and quality of life for those who use, live in, and work in congregate settings. They will also help to ensure that key indoor spaces can stay open, even during a pandemic. 

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Stephen Hwang is a physician and the Director of MAP Centre for Urban Health Solutions at St. Michael’s Hospital, a site of Unity Health Toronto.

Jeffrey Siegel is an air quality expert and a Professor in the Department of Civil and Mineral Engineering at the University of Toronto.

Laws that expand the right to shoot to kill in perceived self-defense yield unequal consequences in the justice system depending on whether the person shot was white, according to research published Monday.

So-called “stand your ground” laws, one of which was passed in Ohio last year, are also associated with a modest to robust increase in violent crime rates in states that implemented them, according to findings published in the American Journal of Public Health.

There’s variation in the data. For instance, Florida, the first state to implement the idea in 2005, experienced a “robust” increase in violent crime rates, whereas the effect was more muted elsewhere.

“I think what we can really decisively say is there’s no positive effect of these laws,” said lead researcher and MAP postdoctoral fellow Dr. Alexa Yakubovich in an interview. “There’s no evidence that these laws are reducing violence or reducing crime.”

Please note, this data is from 2020/21, is outdated, and will not be updated.

Toronto has long had a deficiency of safe indoor public spaces for those experiencing homelessness to access during the cold winter season, and a new study demonstrates just how much this issue has been exacerbated by the COVID-19 pandemic.

The project, called Changes in informal access to selected indoor public spaces in Toronto and carried out by MAP Centre For Urban Health Solutions, looks at five different types of public indoor spaces —  24-hour restaurants, warming centres, libraries/community centres, drop-ins, and Out of the Colds — and uses maps to show how many were lost during the 2020/2021 winter season.

“There is a severe lack of access to indoor public space, even during cold weather alerts. The City of Toronto’s ‘Winter Plan for People Experiencing Homelessness’ does not address this lack of access,” reads a summary of the study.

“Although the situation has been exacerbated by the pandemic, the lack of safe, accessible, indoor space in Toronto, in particular during the winter, is a longstanding issue.”

The first two maps, which compare 24-hour chain coffee shops and restaurants open during the winter of 2019/2020 with those in 2020/2021, show that there were 105 restaurants and coffee shops open all night and located close to 24-hour transit in Toronto last year…

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.”