Author: Samira Prasad

From the Toronto Star article

The federal government is asking gay and bisexual men to reduce their number of sexual partners to curb the spread of monkeypox. But community health workers and advocates say that spread is being fuelled by the lack of government support, financial and otherwise, for those who are at risk.

“The Public Health Agency of Canada recommends practicing safer sex (and) having fewer sexual partners, particularly anonymous partners, even when they don’t have symptoms, can also reduce your risk of getting infected,” said Dr. Theresa Tam, Canada’s chief public health officer, at a news conference Wednesday. Tam also stressed the value of vaccination in thwarting the disease.

Dr. Darrell Tan, an infectious diseases physician at St. Michael’s Hospital, told the Star that he and his colleagues who are rushing to study the virus to improve public policy and patient care are noticing many patients struggling with the financial consequences of isolation.

The illness spread mostly after prolonged close contact, through respiratory droplets — from breathing, talking, coughing or sneezing — or through skin-to-skin contact, or contact with objects that have been used by someone with the virus.

Lamb said there needs to be compensation for lost wages and funding services that support patients through isolation. Tam stating that she is encouraging provinces and territories to implement supports is not enough, he said.

“Municipally, Toronto Public Health have been very good in trying to reach out to the community and take direction when needed. But when someone gets monkeypox and they aren’t able to isolate at home, what are they going to do?” he said.

From the Toronto Star article

As cases of monkeypox continue to grow in Canada and globally, academics and advocates are urging governments to bring in paid sick days for all, as illnesses like monkeypox are unpredictable and can require extended periods of isolation.

And with rising cases, observers in Canada are welcoming a World Health Organization move to declare monkeypox a global health emergency, saying they hope it will lead governments and institutions to take the outbreak seriously and improve care.

Researchers are quickly studying the virus and its impact on Canadian patients, including concerns around stigma, to help inform patient care and public policy.

That declaration by the WHO has been overdue, says Dr. Darrell Tan, an infectious diseases physician at St. Michael’s Hospital. Tan is a co-principal investigator and operational co-lead of the monkeypox rapid research response led by the Emerging and Pandemic Infections Consortium (EPIC) at the University of Toronto.

“Monkeypox has been spreading to more and more non-endemic countries countries at a really rapid pace in the last two months,” said Tan. “The rapidity of that spread was alarming to those of us who work in this field. And we’re seeing these patients suffering.”

Monkeypox should have been deemed a global health emergency weeks ago, he said, and stigma toward gay and bisexual men, whom the virus is currently affecting in large numbers, is likely a reason for the delay.

“It was perhaps not perceived as ‘important enough’ of a threat,” and that can be read as quite problematic, stigmatizing and hurtful to our communities who have been suffering.”

Tan hopes the WHO announcement will lead more institutions to mobilize on a global scale, and spark funding for front-line community organizations that are engaging with public health and stretching shoestring budgets to care for the LGBTQ+ community.

“There’s tremendous research that needs to happen at breakneck speed,” he said.

“I hope it can enable more support for people who are living with this infection. One of the key points that myself, my colleagues have observed … is that people have difficulty adhering with public health requirements because of the financial toll.”

Dr. Sharmistha Mishra is an assistant professor at the Institutes of Health Policy Management and Evaluation at the U of T and also a co-principal investigator and operational co-lead of EPIC’s monkeypox research initiative. She said supporting individuals and households with isolation is a public health necessity with a virus such as monkeypox, and that means paid sick leave.

Mishra, Tan and colleagues are engaged in cohort studies to understand symptoms, viral shedding (when a person releases a virus’s particles through pathways like talking or eating), examining how the immune system responds to monkeypox, how the virus is transmitted, and looking at the virus’s genetic code.

Though research is at its early stages, they have learned that the virus’s incubation period can be from five to 21 days (with an average of about seven), as well as of difficulties isolating, she said.

Community leadership and working with researchers has allowed them to study the virus more quickly, know what issues to prioritize and understand that more supports need to be in place, she said.

From the Toronto Star article

Even with her teenage brother in extreme pain, his knee swollen from a bad fall and looking like a melon, Luna Garcia’s family hesitated to take him to hospital.

Instead, they waited a day to see a doctor, acting only when the suffering became excruciating for the 15-year-old — all because the undocumented Toronto family feared hospital staff would ask for their immigration status and demand fees upfront that the family couldn’t afford.

But thanks to the Ontario government’s temporary measure to extend health care to uninsured residents during the pandemic, there was none of that. Garcia’s brother got the medical attention he needed and avoided lasting damage to his knee.

Health-care providers say that during the pandemic they saw first-hand the improvement in the care of the uninsured. They now hope the “milestone changes” will stay.

“As a front-line provider, I have seen many patients access urgent health-care services, life-saving treatments at times, that they would otherwise either have been denied or felt afraid seeking,” said Dr. Ritika Goel, a Toronto family physician.

“We have seen the benefits of these changes and we want for them to be made permanent.”

However, as many pandemic-driven health policies have been either relaxed or scrapped, advocates in Ontario fear that the province’s interim health coverage for the uninsured will be next on the chopping block.

Prior to the start of the pandemic in Canada in March 2020, advocates say about half a million children and adults in Ontario were without public health insurance at any given time. They included new immigrants, returning Canadian citizens caught up in the three-month waiting period, temporary foreign workers between contracts, international students and non-status residents.

To reduce barriers to access health care during the pandemic, the province has not only relaxed eligibility to include the uninsured, but also removed the three-month waiting period for OHIP coverage.

Goel is part of a coalition of front-line health professionals and community groups that has launched a petition to urge the province to make the existing directives a permanent program to ensure universal access to health care services for all Ontario residents. They have planned a rally at Queen’s Park next Wednesday.

“Many things during COVID have been unpredictable. What we know is that the pandemic has unearthed so many inequities, including that between people who have health insurance and those who do not. We worry that many of the social benefits that have come through in this time are being rolled back,” said Goel.

“But it’s in the interest of the government and the people of Ontario, health-care providers and the health-care system to ensure access for all people living in Ontario.” (Campaign organizers say Quebec and British Columbia also made health care more available to the uninsured during the pandemic, to lesser extents.)

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Toronto pediatrician Dr. Shazeen Suleman said that before the pandemic, she would see uninsured children coming into her office only when they were “acutely unwell”; sometimes she would have to refer them to emergency.

She said that conditions such as asthma and even chronic illnesses like diabetes benefit from community physicians monitoring patients’ conditions so they don’t have to show up in hospital only when they are in crisis.

“We’re still in COVID and to turn back the clock at this point is going to have disastrous outcomes. We hear every day about how our system is at its breaking point and to then add another extra burden of having individuals come in at death’s door will be disastrous,” said Suleman.

The interim policy has also simplified the administrative work for health-care providers and alleviated their stress and burnout, Suleman noted, saying that in the past “I might have been one who was trying to rack my brains (about) how to get care for someone who didn’t have insurance. Now it’s opened up.”

From The Globe and Mail article

Construction workers have been disproportionately affected by the worsening opioid crisis, accounting for about one in 13 opioid-related deaths in Ontario between 2017 and 2020, according to a new report published Thursday.

The report, led by researchers from the Ontario Drug Policy Research Network (ODPRN), found 428 Ontarians who were working or previously employed in the construction industry died of opioid toxicity during the 30-month period they investigated. That amounted to 7.9 per cent of the total 5,386 opioid-related deaths within that time span, even though those working in the construction industry represent 3.6 per cent of the province’s overall population.

Nearly 80 per cent of these deaths occurred at the individual’s home, the researchers found. Very few occurred on a construction site or at a hotel or motel used for work purposes.

“That was really the first thing that stood out to us is that these are overdoses happening in people’s homes and they’re happening when there aren’t people around to intervene,” said lead author Dr. Tara Gomes, who is a principal investigator of the ODPRN, a provincial network of researchers.

From the North York Mirror article

While one expert argues the response from Toronto to monkeypox spreading through a marginalized queer community has been ideal, another thinks more support is needed. Both agreed a flashback to historical HIV stigma toward sexual minority men should be avoided.

The disease, which is endemic to many African countries, spreads through respiratory droplets and physical contact. It has infected 194 people in Toronto, with the first Canadian case reported on May 19 in Montreal.

According to Darrell Tan, a clinician and scientist at the division of infectious diseases at St Michael’s Hospital, municipal public health data combined with international research collaboration, indicates 99 per cent plus of monkeypox infections in nonendemic countries are of men who have sex with men (MSM).

Following Ontario Ministry of Health guidelines, Toronto has been providing vaccine clinics to just sexual minority men. However, it’s aftercare support where the city falls flat, Michael Kwag, director of knowledge exchange and policy development at Community-Based Research Centre, said.

From the Toronto Star article

Len Tooley is one of at least 539 Canadians who have contracted monkeypox in the past two months. He’s going public, to let others know that they aren’t alone.

He says the community of gay and bisexual men currently most at risk for monkeypox has largely been left in the dark by public health when it comes to how to take care of themselves if they become sick.

“There’s really no information. People can be really on their own.”

Also, with people faced with weeks of missed work after a monkeypox diagnosis, Tooley says the province’s sick days are inadequate and two years into a pandemic, the health-care system is still not built up to care for those with unpredictable illness.

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[Dr. Darrell] Tan, who is also an associate professor of medicine at the University of Toronto, said the emergence of monkeypox in the community is very new, and it’s challenging to sort out the public health response and how best to support patients.

Levels of patient care should include individualized care and support, like offering symptom relief or suggestions, he says. How to care for patients with monkeypox is something the system is learning through avenues like community engagement, he adds.

“We’re getting input at all stages of the way,” he says. “I agree that there isn’t much (information) out there.”

The response to monkeypox so far from Canada and provinces including Ontario and Quebec has been adequate, but communication can be improved regarding more inclusive language in vaccination eligibility, as it should include non-binary people and trans women, says Todd Coleman, an epidemiologist specializing in LGBTQ health.

Coleman says community health organizations are also taking up the job of getting public health information out and offering support, and they do so with less funding and resources.

“They tend to mobilize and work on a diminished capacity of what’s available to public health agencies,” he says.

Tooley worked at a clinic for a decade, testing people for HIV. He says he saw the effects of shame and stigma.

And that’s why he wants to dismantle that stigma when it comes to monkeypox.

“Nobody deserves this, nobody asked for this. Monkeypox and all other infectious diseases are bigger than any one person has control over.

Media release from CIHR

July 7, 2022 — Ottawa, ON — Canadian Institutes of Health Research

When COVID-19 first emerged, the Government of Canada and the research community quickly stepped up to develop testing approaches, public health measures, and new vaccines to protect Canadians from the health challenges of the COVID-19 pandemic. The Government of Canada is also investing in safe and effective COVID-19 therapeutics, including antiviral medications. In response to the pressing need to further evaluate the clinical and cost effectiveness of these treatments in non-hospitalized patients, the Canadian Institutes of Health Research joined forces with Health Canada and the Public Health Agency of Canada.  

Today, the Honourable Jean-Yves Duclos, Minister of Health, announced an investment of $10 million under this collaboration to create a pan-Canadian platform to advance research into the effectiveness and clinical challenges of new COVID-19 treatments in non-hospitalized patients. The Canadian ADAptive Platform Trial of COVID-19 Therapeutics in Community Settings (Can-ADAPT COVID) will be led by Dr. Andrew Pinto, Director of the Upstream Lab at St. Michael’s Hospital, a site of Unity Health Toronto, and a Professor at the University of Toronto.

In collaboration with patients, community partners, and research networks across Canada, the United Kingdom and the European Union, Dr. Pinto and his team will investigate outpatient medications for COVID-19 such as nirmatrelvir/ritonavir (brand name Paxlovid™) and provide key insights into whether treatments prevent hospitalization and post COVID-19 condition (“long COVID”). This study will also offer timely evidence to clinical researchers, health system managers, and public health officials in Canada and abroad.

Quotes

“Our government reacted quickly at the start of the pandemic and will keep working to keep Canadians safe. This includes providing vaccines and therapeutics to Canadians, to lessen the health impacts of COVID-19 and post COVID-19 condition symptoms in patients. Dr. Pinto’s platform will allow the research team to test new treatments as they emerge and to quickly respond to the dynamic nature of global pandemics and other health emergencies.”
The Honourable Jean-Yves Duclos
Minister of Health

“This research will provide new insights and timely evidence in support of public health and clinical decision making for the effective roll out of new antiviral medications developed to treat non-hospitalized COVID-19 patients.”
Dr. Tammy Clifford
Vice-President, Research – Learning Health Systems
Canadian Institutes of Health Research

“As part of our continued response to address the health challenges of the pandemic, we continue to work closely with our partners at the Canadian Institutes of Health Research and Health Canada to further investigate new COVID-19 antiviral medications. This study will provide important evidence on treatment effectiveness that will better inform our collective response to the COVID-19 pandemic.”
Dr. Theresa Tam
Chief Public Health Officer of Canada

Quick facts

• Many drugs are being evaluated in Canada and around the world as potential treatments for COVID-19. Health Canada has authorized several of these for use in Canada.
• To provide ongoing evidence to inform treatment guidelines for COVID-19, the Government of Canada is investing $10 million in the Canadian ADAptive Platform Trial of COVID-19 Therapeutics in Community Settings (Can-ADAPT COVID). This platform will evaluate the clinical and cost effectiveness of COVID-19 treatments.
• Can-ADAPT COVID will enable information sharing with clinical researchers from the United Kingdom and the European Union for quicker results.

Associated links

• CanTreatCOVID
• COVID-19 treatments

Contacts

Marie-France Proulx
Press Secretary
Office of the Honourable Jean-Yves Duclos
Minister of Health
613-957-0200

Media Relations
Canadian Institutes of Health Research
mediarelations@cihr-irsc.gc.ca

From the Toronto Star article

Lower-income Ontarians continue to die of COVID-19 at much higher rates than those with higher incomes — a troubling pattern repeated in each of the province’s six pandemic waves, new data shows.

In yet another indication that COVID is not an equal-opportunity illness, researchers at the University of Toronto have found that death rates from the virus in Ontario’s lowest-income neighbourhoods have been roughly double those in the province’s richest areas throughout the pandemic.

That COVID deaths remain disproportionately concentrated in lower-income neighbourhoods even after the rollout of vaccines, antiviral medications and COVID treatments — in addition to seemingly endless calls for equitable access to public health resources — illustrates that for many the pandemic is far from over.

“It begs the question: Among whom are we flattening the curve?” said Dr. Sharmistha Mishra, an infectious disease physician and mathematical modeller at Toronto’s St. Michael’s Hospital. Mishra heads a research team that analyzes COVID mortality data. She shared the sixth-wave analysis with the Star; the team’s analysis of the other five waves has been previously presented by the Ontario COVID-19 Science Advisory Table.

With another wave of the virus expected this fall, Mishra and other experts are calling for the province to further fund tailored prevention and treatment strategies for the most vulnerable, including older Ontarians and communities with the lowest income brackets.

From the Medical Xpress article

A new study conducted in Canada found that children who attended centre-based childcare between 1 and 4 years of age had a lower body mass index (BMI) and were less likely to be overweight or obese in later childhood than children who had non-parental childcare that was home-based or provided by relatives or nannies. These associations were stronger for children from lower income families.

“Although more research is needed, our findings suggest that centre-based childcare may help level socioeconomic-related health disadvantages for children from low-income families,” said Michaela Kucab, a graduate student at St. Michael’s Hospital, a site of Unity Health Toronto, and the University of Toronto, both in Canada.

Kucab will present the findings online at Nutrition 2022 Live Online, the flagship annual meeting of the American Society for Nutrition held June 14-16.

“We hope this work draws much-needed attention to prioritizing centre-based childcare while also encouraging future research on the impact of centre-based childcare on growth and other important health and developmental outcomes in children,” said the study’s senior author Jonathon Maguire, MD, from St. Michael’s Hospital.

Previous studies evaluating the relationship between childcare attendance and obesity have primarily focused on comparing parental care with non-parental childcare settings.

From CBC News

In late May, not long after he’d gotten through a mild bout of COVID-19, Peter Kelly spiked a sudden fever. He quickly realized it wasn’t the tail end of a COVID infection.

Over a period of several days, the Toronto resident became exhausted, and his muscles began to ache. His temperature oscillated between chills and night sweats. Then, strange sores started to appear on different parts of his body — eventually around two dozen that he could see, mostly on his legs, and painful ones hidden from view in his rectum. 

As a professional dancer, Kelly is used to pain. He’s been injured a lot — most recently, a broken rib that’s still healing — and has serious eczema, a skin condition that can cause an itchy or burning sensation. 

But Kelly had never experienced something as excruciating as the unexplained lesions emerging on sensitive areas of his body.

“This was on another level,” he later recalled. “You can’t control it. It feels like razor blades in a way, shocking you constantly.”

What followed was nearly a month of tests, three emergency room trips, one infected sore, and finally, a lab-confirmed diagnosis: Monkeypox virus or, as it’s known throughout the scientific community, MPXV.

“The physical aspect of what I went through was pretty bad, for certain moments. But what I realized was the mental health aspect of all of this was probably the main thing I was dealing with,” he said. 

“It’s such a long quarantine period.”

He’s not the only one facing pain, uncertainty and what can be a period of weeks-long isolation.

More than 200 Canadians and counting have been infected with MPXV as a result of a global outbreak that began in May. It’s a virus known for long-lasting, often painful symptoms, and people are contagious until they recover.

Physicians, advocates, and health officials are now calling for more financial and housing support to ensure people can quarantine safely, if needed, for weeks on end — with COVID offering some key lessons on how to handle this emerging public health emergency.

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“Many folks during that long period, if they’re forced to isolate, are not going to be able to go to work, are not going to be able to pay their bills, pay the rent, put food on the table,” said Dr. Darrell Tan, an infectious diseases specialist who has treated multiple patients with MPXV at St. Michael’s Hospital in Toronto.

“And these very, very real challenges that people face, because of their willingness to adhere to public health principles, is something that I think we, as a society, have to take responsibility for.”