Author: Emily Holton

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.

From the Toronto Star article:

…It was Osler, according to a journal article co-authored by Toronto doctor Nav Persaud, who wrote, “I hate Latin Americans.” In a speech, Osler said, “What are we to do when the yellow and brown men begin to swarm over” to Canada, which he considered “a White man’s country.”

Osler defenders criticized the article, saying it nitpicked some ill-chosen words made in private and ignored Osler’s noble actions.

Persaud’s article, which argues that medical school lectures lionize Osler and whitewash his legacy, also briefly mentioned the four Indigenous skulls Osler gave to Virchow.

Persaud, raised near Keele Street and Wilson Avenue and educated at the University of Toronto and as a Rhodes Scholar at Oxford University, has a laser-guided conscience.

While a medical student at U of T, he asked for a meeting with professors to point out that a pain management course included a book provided free to students and that was paid for by Purdue Pharma, maker of OxyContin. His approach was spurned as impertinent. He persisted. Eventually U of T dropped the book and a lecturer with financial ties to Purdue, then the university strengthened its conflict-of-interest guidelines.

Persaud first heard of the skulls in 2018 from Dr. Philip Berger, a mentor whom Persaud trained under at St. Michael’s Hospital.

A semi-retired physician, Berger, recently sat on the governing council of Ontario’s doctor regulator, the College of Physicians and Surgeons.

He is also a troublemaker. He occupied politicians’ offices and marched in protests to fight for healthcare for refugees. He once yelled “Go back to Ottawa!” to a federal cabinet minister making a speech on stage in Nathan Phillips Square. As he was led away by security, an incredulous journalist asked him and his colleagues, “Are you real doctors?”

When he heard from a Israeli colleague about Osler’s gift to Virchow, Berger recalls thinking: “William Osler is a deity in medicine. He is an icon of heroic proportions in Canada. Osler was viewed as a humanitarian, and humanitarians don’t go giving skulls as gift to a colleague.”

Berger told Persaud he wanted to find the remains. He wanted to know how the skulls were taken from their original resting ground. And who took them. And did they ask permission.

This article was Part 1 of a series. Read Part 2: When the dead come to you, you pay attention:’ Inside the quest to bring home four Indigenous skulls taken to Europe more than a century ago

By Tara Kiran, Jeff Kwong, and Noah Ivers

Since Canada approved our first COVID-19 vaccine, our attention has been focused on ensuring adequate vaccine supply, figuring out distribution and storage and deciding who gets it first. There’s been little discussion, though, about who will be giving the vaccine and where.

This fall’s flu shot campaign offers important lessons. Flu immunization was more important than ever because of COVID-19 but there were still needless hiccups in execution – worry and confusion about the supply, lack of clarity on whether to prioritize those at highest risk and, at times, finger pointing instead of collaboration.

But we have the opportunity to learn from our past. Key to the vaccine rollout’s success will be exceptional collaboration between primary care teams, community pharmacists and public health units – the three sectors that deliver the majority of vaccines in Canada.

Each sector plays a unique role. Family doctors and their teams have longstanding relationships with patients. These relationships are built on foundations of trust from which we can relay scientific information and directly address patients’ fears – from missing out on the vaccine to adverse effects. We can also use our records to identify priority groups and proactively reach out to them.

In an announcement by the Government of Canada earlier today, Dr. Gillian Booth was awarded a prestigious Tier 1 Canada Research Chair.

An endocrinologist and internationally recognized researcher, Dr. Booth investigates and designs evidence-based solutions to address the socioeconomic, environmental and health-care factors behind Canada’s diabetes epidemic.

“I’m so grateful to have been nominated by St. Michael’s Hospital and the University of Toronto,” said Dr. Booth. “This CRC will enable me to answer questions that we haven’t been able to answer yet, about the complex relationships between our built environment, our health, and health inequities – and about how best to intervene through strategic policy change.”

Dr. Booth’s research has already revealed important links between neighbourhood characteristics (such as walkability, retail food options, socioeconomic status) and residents’ risk of obesity and diabetes. However, she says that we are just beginning to understand how these different exposures work together to influence our health.

“For example, walkability is associated with better health outcomes,” said Dr. Booth, “But our research has shown that if you live in a walkable area with a lot of traffic-related air pollution, that pollution negates a lot of those benefits. It’s not always a simple cause-and-effect equation.”

The solutions Dr. Booth’s research points to are often at the level of public policy – particularly those related to urban planning and the built environment. As part of her CRC, Dr. Booth and her team will design tools (e.g. data maps, cost/benefit predictive models) to help policy makers weigh the potential health benefits of different policy options for different contexts, and to assess how much investment is required in order to make a meaningful impact on the health of a population.

As a further catalyst, she is leading a national network to help built-environment research teams learn from each others’ experiences to help accelerate the implementation of evidence into policy.

“I’m concerned that although there’s more and more focus on healthier neighbourhood design in Canada, these interventions are likely to end up in neighbourhoods that are wealthier and healthier to begin with,” said Dr. Booth. “We need to learn more about how policy making can be more equitable and impactful. This CRC is a really exciting step in my work to help make that happen.”

MAP is now home to seven Canada Research Chairs in total:

• Dr. Gillian Booth: Canada Research Chair in Policy Solutions for Diabetes Prevention and Management
• Dr. Ann Burchell: Canada Research Chair in Sexually Transmitted Infection Prevention
• Dr. Sharmistha Mishra: Canada Research Chair in Mathematical Modeling and Program Science
• Dr. Patricia O’Campo: Canada Research Chair in Population Health Intervention Research
• Dr. Nav Persaud: Canada Research Chair in Health Justice
• Dr. Janet Smylie: Canada Research Chair in Advancing Generative Health Services for Indigenous Populations in Canada
• Dr. Darrell Tan: Canada Research Chair in HIV Prevention and STI Research

Learn more about Dr. Booth’s research:

COVID-19 and diabetes: Clinical Outcomes and Navigated NEtwork Care Today (CONNECT)

Solutions Network: Urban Design for Better Health

CBC NEWS

Researchers are hoping to recruit participants starting next week for a study that will look at how big a problem COVID-19 is among people experiencing homelessness in Toronto.

Dr. Stephen Hwang, director of MAP Centre for Urban Health Solutions at St. Michael’s Hospital, will lead a research team on what is being called the COVENANT Study.

The year-long project has received $1.9 million in federal funding through the COVID-19 Immunity Task Force, a organization formed by the federal government in late April to track virus spread in Canada.

“People experiencing homelessness are at greatly increased risk of getting COVID-19. However, we don’t know what proportion of the homeless population has been exposed to COVID over the last year,” Hwang said on Wednesday.

The specialist in general internal medicine said the study aims to gather evidence that will guide public health measures across the country to curb spread of COVID-19 among unhoused people. The research team will include university and hospital experts in epidemiology and lab testing.

“It’s really important that we obtain this information so that we can intervene to control the infection and also understand the importance of potentially prioritizing this population for the vaccine when it’s available,” Hwang said.

THE GLOBE AND MAIL

After years of living in shelters and other precarious housing, Dawn Hill found permanent refuge and the mental-health support she needed after being chosen to participate in a ground-breaking study based at St. Michael’s Hospital.

Her tiny basement apartment in Toronto’s east end is a haven, a place to finally call home.

Dawn (not her real name) spent her early teenage years in group homes – which, she says, “had no patience” with her behaviour, caused in large part by undiagnosed depression and obsessive-compulsive disorder. By 16, she was on her own, working however she could to earn a living.

Her greatest sorrow was losing custody of her son and daughter 15 years ago, due to her mental-health challenges. “That was the worst thing that ever happened to me,” she says. “I lost my kids, and I lost my way.”

Recruited while she was staying at a shelter, Dawn, now 45, was chosen in 2011 to participate in At Home/Chez Soi, a large-scale randomized controlled national study to evaluate Housing First, a solution designed to end chronic homelessness among people with mental illness.

Launched and led in Toronto by St. Michael’s Hospital’s Dr. Stephen Hwang, it is one of several initiatives he has spearheaded aimed at improving the health of people who are homeless or vulnerably housed. Director of the hospital’s MAP Centre for Urban Health Solutions, Dr. Hwang is one of the world’s leading researchers in the field of homelessness, housing and health.

He joined St. Michael’s 24 years ago, as its first research scientist focused on the social determinants of health. Over the years, he says, the hospital has developed into “an international powerhouse” in the field. “It’s been a remarkable transition,” he says.

Dr. Hwang, who is also St. Michael’s Chair in Homelessness, Housing and Health, explores the intersecting health crises that affect people who lack adequate housing, particularly relevant today as COVID-19 turns a spotlight on the problems of homelessness.