Author: Samira Prasad

By Marlene Leung, Unity Health Toronto

In an office in downtown Toronto, a dedicated team of Unity Health researchers is using math to tackle some of the world’s most pressing health problems, including COVID-19, Ebola, HIV and human mpox (monkeypox).

The Research Group in Mathematical Modeling and Program Science develops and uses math models to better understand, analyze and predict epidemics. Housed within the MAP Centre for Urban Health Solutions and led by principal investigator Dr. Sharmistha Mishra, the lab includes data scientists, mathematical modelers, epidemiologists, biostatisticians, graduate students and research associates. Together, they use math and data to understand the factors driving infectious disease transmission in the hopes of helping to craft more tailored, impactful solutions.

Grounding the lab is a deep commitment to public health, equity and scientific inquiry, says Mishra, who is also a MAP scientist and infectious disease physician at Unity Health. This means taking nothing for granted about viruses, human behavior, and the structural factors that could be fueling disease transmission, she said.

“Our models are really part of the science that serves communities… we approach our modeling with that lens,” she said. “We challenge and interrogate assumptions that go into what we think we understand about epidemics.”

From the Toronto Star article

A fiery explosion beneath a Toronto bridge, which burned hot under the nighttime sky after propane tanks left in an encampment burst, is raising fears about how to keep the city’s homeless population safely warm this winter — particularly amid a growing squeeze on the shelter system.

The explosion took place late Saturday on Nov. 26. Officials didn’t know how the fire started, describing the setting as an empty encampment. No known injuries were sustained, and though transportation officers were dispatched to be sure, the bridge didn’t appear to suffer damage.

But the fiery scene illustrates a looming tension in Toronto. When winter sets in, those facing homelessness outdoors find ways to stay warm and stave off frostbite, in many cases involving propane heat that city and fire officials have labelled as dangerous. Those officials have urged people to come inside instead — but this year, that’s an especially tough task, with more than 180 people on average turned away each day in October after calling the shelter intake line.

And while a coroner’s inquest years ago recommended the city offer people safer heating sources in the wintertime — as a way to prevent death — it’s a suggestion that hasn’t been heeded.

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When people try to survive the winter outdoors, they often turns up in the St. Michael’s Hospital emergency room. Last winter, hospital staff reported a rising number of people arriving in search of shelter and help for cold-weather injuries. At least one person died of hypothermia.

“Every time someone dies of hypothermia, it’s unnecessary,” said Dr. Carolyn Snider, the hospital’s chief of emergency medicine. She suggested more advanced planning for when warming centres open based on forecasts of extreme weather, to give those staying on Toronto’s streets more notice. While the ER tries its best to hand out wool socks, hats, gloves and jackets to patients staying outdoors, she said places to properly warm up were critical.

By Jennifer Stranges, Unity Health Toronto

For more than two decades, St. Michael’s Hospital has led the way in HIV care and is now home to Ontario’s largest HIV program in Ontario, serving 1,700 patients.

It is also where you’ll find two dynamic healthcare leaders who have been here since the beginning. Dr. Gordon Arbess launched his career as a family doctor drawn to helping patients experiencing this deadly disease. Back then, he was also referring patients to Dr. Sean Rourke, a young neuropsychologist and scientist trying to understand and improve promising new treatments. “We bombarded Sean in those early days!” Dr. Arbess laughs.   

Today, Dr. Arbess is the Clinical Director of the HIV/AIDS program with the St. Michael’s Academic Family Health Team. Dr. Sean Rourke is a Scientist with MAP Centre for Urban Health Solutions and the Director of REACH Nexus, a national research group working on how to address HIV, Hepatitis C and other sexually transmitted and blood-borne infections.

We spoke with Arbess and Rourke about their long histories serving people with HIV and AIDS, how far treatment has come — and what still needs to be done.

Tell me about yourself and why HIV/AIDS is an area you’ve focused your career on.

Arbess: I’m a primary care physician at St. Michael’s and I initially started my career at the Wellesley Hospital before it merged with St. Mike’s. I fell into this area because I did medical school at Queen’s University and while there, I met an individual who was single-handedly going into the community and penitentiaries to treat people living with HIV and Hepatitis C – I was really intrigued. When I moved to Toronto and did my residency with Wellesley Hospital, I was drawn to the work. When the hospital merged with St. Michael’s – a Catholic hospital – there were concerns among those of us doing this work about what that would mean. But it panned out beautifully and we’ve always felt well supported. I feel fortunate to be doing this type of work. It’s extremely rewarding work and it touches on all facets of humankind.

Rourke: I’m a neuropsychologist by training and a scientist, but I see myself more as a social entrepreneur now. I have a similar path to the start of my career as Gord – I started at the Wellesley-St. Michael’s Hospital. It was my first job and I’m still here! 1995 was a critical juncture in HIV because combination therapy was coming online. There was a lot of optimism that those therapies would ‘solve everything’. The concern at the time in my area of expertise was if the medications would eliminate dementia, and they have, but they haven’t eliminated this milder condition. So I was recruited to set up a clinical research program to explore the brain and cognitive health, and that’s how I started to work with Gord over 25 years ago.

St. Michael’s is a place with incredible, extraordinary people who are so committed, and like Gord said, to have the hospital behind the work we do on the clinical side, research, education – it makes our lives busy, we’re always over-extended – but it’s a real pleasure to be in a place where you get so much support. Today my work is about this: there are so many solutions, now it’s about getting them to people.

From Starbucks Canada

The impact of AIDS is felt around the globe in communities and homes near and far. An estimated 38.4 million people worldwide are living with HIV as of the end of 2021 and 650,000 000 people died from AIDS-related illnesses in that same year, according to the UNAIDS. Progress is being made, but still four decades into the HIV response, inequalities persist for the most basic services like testing and treatment. 

This is why the Starbucks Canada Pride, Black, Pan-Asian and Indigenous Partner Networks are teaming up with MAP Centre for Urban Health Solutions, and I-AM.health, a first-in-Canada national program to raise awareness and action on HIV self-testing. Starbucks partners (employees) can visit I-AM.health/StarbucksPN to know their status and get access to free and completely anonymous HIV self-testing. 

“It is so special to collectively come together as Partner Networks, a vast and diverse representation of the Starbucks partner population, to raise awareness and action about HIV self-testing that is free and confidential, while also encouraging our partners to take their health into their own hands with such an incredible program like I’m Ready to Know. With World Aids Day around the corner, we wanted to show solidarity and demonstrate how our partners are united with the cause.” 

-Steven Snyder, co-chair of Canada Pride Partner Network

From the Canadian Medical Association Journal press release

A modelling study to explore optimal allocation of vaccines against monkeypox virus (MPXV) provides a road map for public health to maximize the impact of a limited supply of vaccines. The article, published in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.221232, confirms that prioritizing vaccines to larger networks with more initial infections and greater potential for spread is best.

“We hope that these insights can be applied by policy-makers across diverse and dynamic epidemic contexts across Canada and beyond to maximize infections averted early in an epidemic with limited vaccine supply,” says Dr. Sharmistha Mishra, MAP Centre for Urban Health Solutions, Unity Health Toronto.

As of November 4, 2022, there were 1444 cases of MPXV in Canada, disproportionately among gay, bisexual and other men who have sex with men (GBMSM). A very limited supply of smallpox vaccines is available and is being prioritized to populations experiencing disproportionate risks.

Researchers modelled two hypothetical cities as interconnected networks with a combined GBMSM community size of 100 000. The team then varied the characteristics of the two cities across a range of plausible settings and simulated roll-out of 5000 vaccine doses shortly after the first detected case of MPXV.

They found that the strongest factors for optimal vaccine allocation between the cities were the relative reproduction number (epidemic potential) in each city, share of initial cases, and city (or network) size. If a larger city had greater epidemic potential and most of the initial cases, it was best to allocate the majority of vaccines to that city. The team varied the reproduction number with a single parameter, but they highlight how many factors could influence local epidemic potential, including the density and characteristics of the sexual network, access to prevention and care, and the underlying social and structural contexts that shape both sexual networks and access.

“Under our modelling assumptions, we found that vaccines could generally avert more infections when prioritized to a larger network, a network with more initial infections and a network with greater epidemic potential,” writes Jesse Knight, lead author and PhD candidate at the University of Toronto and MAP Centre for Urban Health Solutions, Unity Health Toronto. “Our findings further highlight the importance of global vaccine equity in responding to outbreaks, and also in preventing them in the first place,” he says.

The study emphasizes the interconnectedness of regions and that a population-level perspective is necessary.

“Strategic prioritization of a limited vaccine supply by network-level risk factors can maximize infections averted over short time horizons in the context of an emerging epidemic, such as the current global MPXV outbreak,” conclude the authors.

Lire cet article en français

From Interesting Engineering

In the early days of a virus outbreak, the way vaccine doses are distributed in different parts of a country amidst their limited supply could play a major role in controlling the infection and the rate at which it spreads. For instance, administering more COVID vaccines in a region with a large population and a high COVID infection rate could result in faster herd immunity than doing the same for an area with a small population and low rate of infection. 

Interestingly, a team of researchers at MAP, Unity Health Toronto, has proposed a mpox vaccine allocation model that aims at delivering the best results with a limited vaccine supply, according to a press release. In their study, the researchers mention that there are 1,444 patients with monkeypox, disproportionately among members of the GBMSM community (gay, bisexual, and men who have sex with men). 

They further reveal that the availability of vaccines for the GBMSM population having disproportionate risks of mpox is very limited. So they have developed an effective vaccine allocation strategy that could curb the infection in such a case. 

Une étude révolutionnaire révèle comment surmonter l’épidémie de variole simienne avec un approvisionnement limité en vaccins

Tiré de Interesting Engineering

Dans les premiers jours d’une épidémie de virus, la façon dont les doses de vaccin sont distribuées dans les différentes régions d’un pays dans un contexte d’approvisionnement limité pourrait jouer un rôle majeur dans le contrôle de l’infection et de la vitesse à laquelle elle se propage. Par exemple, l’administration d’un plus grand nombre de vaccins contre la COVID-19 dans une région à forte population et à taux d’infection élevé pourrait entraîner une immunité collective plus rapide que si l’on faisait de même dans une région à faible population et à faible taux d’infection.

Selon un communiqué de presse, une équipe de chercheurs du MAP, Unity Health Toronto, a proposé un modèle de distribution du vaccin contre la variole qui vise à obtenir les meilleurs résultats avec un approvisionnement limité. Dans leur étude, les chercheurs mentionnent qu’il y a 1 444 patients atteints de la variole simienne, de manière disproportionnée parmi les membres de la communauté GBMSM (homosexuels, bisexuels et hommes ayant des rapports sexuels avec des hommes).

Ils révèlent en outre que la disponibilité des vaccins pour la population GBMSM présentant des risques disproportionnés de variole est très limitée. Ils ont donc mis au point une stratégie efficace d’attribution de vaccins qui pourrait enrayer l’infection dans un tel cas.

From The Globe and Mail article

The medical clinic in Greater Victoria doesn’t open its doors until 8 o’clock, but two dozen people were already lined up outside in the predawn chill on a recent October morning. Reg Green, the first person in line, had been there since 5:45 a.m. He needed a doctor to review his blood pressure medication and didn’t want to lose a day’s work at his window cleaning business. The first time he went to the Westshore Urgent Primary Care Centre two weeks earlier, he said, he waited more than four hours to get a shoulder injury examined. This time, he got up extra early. “I was out of there by 8:30, so that’s all right.”

Mr. Green says he has been searching for a family doctor since his “flew the coop” four years ago and moved back to England. Finding a doctor in Victoria who is taking new patients is just about impossible. Only one clinic in the entire city has openings, Beta Therapeutics, according to the website FindaDoctorBC.ca. Its sole family doctor began charging patients a monthly fee of $110 for his services on Nov. 1, which has alarmed proponents of public health care.

With nearly no options, a growing number of people in the B.C. capital rely instead on walk-in medical clinics and long delays have become a staple of their care. In 2021, Victoria patients waited two hours and 41 minutes on average to see a doctor – the longest of any city in Canada, says a study by Medimap, a technology company that partners with about 1,200 clinics across the country to provide updates on waiting times.

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Access to primary care is getting worse in many parts of the country, according to statistics collected by The Globe and Mail and interviews with dozens of medical experts and patients.

The mismatch between the numbers on paper and what is actually happening on the ground reflects a broader problem plaguing Canada’s health care system.

The country will continue to lack that data for the foreseeable future. This month, provinces and the federal government came to an impasse in discussions about funding a pan-Canadian health data system, which would have tracked health workers and defined the tasks performed by family doctors.

“Part of the reason why we are where we are right now is that we haven’t been able to do proper health human resource planning,” said Tara Kiran, a family physician and researcher at the University of Toronto’s Department of Family and Community Medicine. “We lack the data to do that. And we haven’t understood how people are practising in real life.”

From OHA Health Systems News

By: Jennifer Stranges, Unity Health Toronto

The number of Ontario’s family physicians who stopped working doubled during the first six months of the COVID-19 pandemic compared to previous years – accounting for more than 170,000 patients losing access to a primary care provider – according to a new study.

The research, led by Unity Health Toronto and ICES and published in Annals of Family Medicine, showed nearly three per cent of Ontario’s practicing family physicians stopped working during the first six months of the pandemic.

The study comes as the healthcare system in Ontario grapples with unprecedented pressures, including staffing shortages and a surge of patients seeking emergency care.

 “Nearly 1.8 million Ontarians don’t have a regular family physician. Our findings suggest things are only going to get worse, which is really concerning because family medicine is the front door to our health system,” said Dr. Tara Kiran, lead author of the study and a family physician at St. Michael’s Hospital of Unity Health Toronto.

“The family doctor shortage is difficult for people personally, but also impacts other parts of the system. For example, when people don’t have a family doctor, they are more likely to head to the emergency room,” said Dr. Kiran, who is also a scientist at the MAP Centre for Urban Health Solutions at St. Michael’s Hospital and an adjunct scientist at ICES.

Researchers used data from ICES, a non-profit research institute, to calculate the ratio of total visits between March 11, 2020 and September 29, 2020 to total visits in the same period in 2019. The analysis included each family physician who had at least 50 billing days in 2019 and counted virtual appointments as well.

TORONTO – The short film Searching for Home follows Sonia, Devin, and Anthony, three young people participating in the Transitioning Youth Out of Homelessness study led by MAP scientist Dr. Naomi Thulien. Set amidst the COVID-19 pandemic, the film is an intimate portrayal of young people on the margins.

Premiering on National Housing Day, the goal of the film is to help spark a national conversation about how Canada can better support youth who are – in many ways – trapped in cycles of poverty and homelessness, through no fault of their own.

All three protagonists of the film are exiting homelessness. Alone at 16, Sonia arrived as a refugee in Canada and immediately entered the shelter system. Now, she’s in college pursuing a practical nursing diploma. Devin is a young artist and university student living on his own after leaving a challenging home situation. Grappling with anxiety and depression, Devin is using his art to heal. Anthony has spent most of his life in foster care, group homes, and shelters. Now, he’s choosing his own path, living in an apartment with his partner and dog.

Alongside the protagonists’ stories, Searching for Home highlights the potential of portable rent subsidies as a novel and promising intervention to help end homelessness. A year of portable rent subsidies can be six times less expensive than an annual shelter stay, and can give people more autonomy and a better shot at success in forging a permanent pathway out of homelessness.

Watch the short film for free at www.searchingforhome.ca.

Listen to an interview with the filmmakers in a special episode of the MAPmaking podcast.

Learn more about the Transitioning Youth Out of Homelessness study.

The next phase of Dr. Thulien’s research will provide youth who are exiting homelessness with portable rent subsidies along with a co-designed (with youth who have experienced homelessness) leadership program and coach. This MAP research is generously supported by Even the Odds (a partnership between Staples Canada and MAP) and the Home Depot Canada Foundation. Learn more

From New Canadian Media

It is difficult enough for adults to decide to leave their home countries and start a new life in another culture, but imagine how much harder it must be for children who don’t get a choice in moving away from everything they know.

Nov. 20 is World Children’s Day and this year’s theme is equality and inclusion: “Kids will stand up for a more equal, more inclusive world,” UNICEF states in this year’s announcement. The date was first established in 1954 as Universal Children’s Day to focus on awareness and child welfare worldwide. 

Immigrant kids in Canada face several challenges, including culture shock, language barriers and adapting to a strange new life. Many of them are forced to migrate from their homelands due to war, hunger or political unrest.

“Children are extremely resilient. They are adaptable, they have many strengths,” said Shazeen Suleman, a pediatrician at St. Michael’s Hospital in Toronto and an assistant professor at the University of Toronto’s Temerty Faculty of Medicine.

“If we approach children from that perspective, then we can support them in the best way possible.”

Suleman cares for kids who are newcomers to Canada may have medical developmental diagnoses or and mental health issues. She said that in her experience, children never choose to immigrate to a new country — they come because of a decision that an adult in their life has made. 

“What children need to know is that they can be safe, that they are cared for, and that their family is there for them through all these changes,” Suleman said.

According to Statics Canada, the record number of immigrants who arrived in Canada from 2016 to 2021 increased though it was restricted in 2020 during the COVID-19 pandemic. And children of immigrants who have at least one foreign-born parent rose from 26.7 per cent in 2011 to 31.5 per cent in 2021.