From the CBC News article

Ontario researchers are looking into reasons behind the busiest times in the province’s emergency departments to help relieve the extreme burden facing hospital staff.

Within the last year, hospitals in eastern Ontario and across the province have reported reaching or exceeding capacity as COVID-19 cases surge.

“It’s been a two-year sprint for us,” said Dr. Atul Kapur, who works in the emergency department of The Ottawa Hospital.

He said with COVID-19 protocols and the volume of patients coming through the doors, the hospital’s ER is currently “at or very close to our historic peaks.”

This wave is different than earlier waves of the pandemic, though, as data shows visits to the emergency room have not coincided with the case peaks of the pandemic, according to Dr. Tara Kiran, a family physician at St. Michael’s Hospital and a researcher at the University of Toronto

Kiran said ERs have typically been at their busiest when overall COVID-19 cases were down in the province. Researchers also found emergency department volume was higher in Ontario in the year leading up to the pandemic compared to the pandemic months.

From the Toronto Star article

To mark how far we’ve come during the COVID-19 pandemic, the Star has profiled 20 of the people who helped get more than 25 million doses into arms.

Tara Kiran — The family doctor

As a family physician at St. Michael’s Hospital, Dr. Tara Kiran knew she would one day help vaccinate her own patients against COVID-19.

But even before vaccines arrived in Canada, Kiran also knew she could play a larger role, as vice-chair of quality and innovation at the University of Toronto’s Department of Family and Community Medicine.

With U of T colleagues, Kiran created interactive online modules for primary care physicians — accessible to anyone — to provide guidance on the vaccines, from the safety of mRNA vaccines to how to help patients feel confident.

Kiran put aside her other academic work to produce the modules, which she calls a “one-stop way for people to learn” to help bring emerging evidence to the doctor’s office.

Throughout the pandemic, Kiran has co-led bi-weekly webinars for primary care physicians covering top-of-mind COVID issues. Since vaccines were approved, 600 to 900 family doctors regularly join the webinars, many telling Kiran they provide a place to review the latest evidence and a sense of community during a challenging time.

“The notes I get telling me it’s made a difference make my day,” says Kiran, who has also used her platform to push for a more equitable pandemic response.

This year, the Star profiled Kiran’s efforts to help hesitant patients feel more confident. The story followed a mother and daughter as they consulted Kiran on whether to get vaccinated.

“We think of anti-vaxxers as an extreme group. But there are so many people who come from humble circumstances who’ve been struggling with the decision about their vaccines. I think (the story) helped people to empathize and better understand what people are going through when they’re not sure about a vaccine.”

A study of all clinical practice guidelines published in national general medical journals in Australia, Canada, the United Kingdom, and the United States over a period of eight years – including the pandemic period – has found that the panels developing recommendations are mostly made up of white men and frequently exclude racialized women.

The study, led by researchers at St. Michael’s Hospital of Unity Health Toronto, reviewed 237 clinical practice guidelines published between June 2014 and June 2021, including those related to COVID-19. A total of 3,696 unique guideline panel members were involved in the development of these guidelines. Only seven per cent of panel members were racialized women, while white men made up 46 per cent of members.

The findings, published in The Lancet, suggest that clinical guidelines – which offer recommendations for health care professionals on how to diagnose and treat a medical condition and shape the care patients receive – may not be developed by those most qualified and this could have negative implications for patients.

“Panels can make recommendations about which medicines should be used, who should be screened for cancers and when surgery is appropriate,” said Dr. Nav Persaud, lead author of the study and a Scientist at the MAP Centre for Urban Health Solutions at Unity Health Toronto.

“It’s important that panels are made up of individuals best positioned to provide important guidance. We know that many important roles tend to be filled by white men,” said Dr. Persaud, who is also a family physician at St. Michael’s Hospital of Unity Health Toronto.

The study also found 79 per cent of guideline panels included four or more white men while nearly 40 per cent included no racialized women. The findings were similar across the four international jurisdictions analyzed – where the most common category of panel member was white men and the least common was racialized women.

The authors are calling for greater transparency in panel recruitment processes and say that guideline producers should ensure that they fairly or equitably recruit and retain panel members. They are also calling for governments and other funders to require fair processes. Twenty-eight per cent of guidelines either did not mention the selection process or declared that the panel was formed without explaining how.

“This finding by itself is a reason to view guidelines in general with some skepticism. In particular, we should question whether these guidelines will exacerbate existing health inequities,” said Dr. Persaud.

Op-ed by Dr. Nav Persaud from the The Hill Times

Covid-19 will not take a break this holiday season, so we must remain focused on slowing its spread and on addressing what underlies each wave. Just as global vaccine inequity puts us all at risk by leaving billions unprotected, unfairness here at home continues to threaten health. While we focus on omicron’s rise, now is the time to implement changes that will make Canada more resilient to threats like this pandemic.

We just co-authored a report outlining 13 recommendations toward an equitable pandemic recovery. If paid sick leave will not made available to everyone during this pandemic of a virus that causes a cough, when will we ever get it? Studies show that paid sick leave reduces the spread of infectious diseases.

People with a low income were more likely to be affected by Covid and less able to adhere to public health advice. A universal living income has been studied in many countries including Finland and we know that that financial security can be provided without discouraging people from working.

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TORONTO STAR

Opinion piece written by Dr. Sloane Freeman and Dr. Ripudaman Minhas

After coping with the isolation and uncertainty of virtual school, this fall’s return to in-person learning has been a breath of fresh air for many students.

As pediatricians working in school-based clinics in Toronto, we have witnessed the deterioration of students’ well-being with school closures. Since September, we have watched many of our patients once again thrive in in-person learning environments, with clear positive impacts on their mental, physical and academic well-being. As we nervously watch daily COVID counts and await further information about the Omicron variant, we must do everything possible to keep schools safely open.

While teachers quickly created online learning environments in response to pandemic-related school closures in spring 2020, vital pieces of the school experience could not be translated into a virtual space. Across age ranges, students have remarked on the tragic impacts of prolonged social isolation from their peers. They have mourned disrupted social customs and rites like attending birthday parties, camps, graduations, concerts and sports tournaments. We know there have been huge impacts on mental health, with record-high numbers of calls to crisis lines, mental health referrals, and admissions for eating disorders.

L’importance de l’apprentissage en personne : des nouvelles en provenance du terrain

TORONTO STAR

Article d’opinion rédigé par la D^re Sloane Freeman et le D^r Ripudaman Minhas

Après avoir fait face à l’isolement et à l’incertitude inhérents aux classes virtuelles, le retour à l’apprentissage en personne, cet automne, a constitué une véritable bouffée d’air frais pour de nombreux élèves.

En tant que pédiatres travaillant dans des cliniques scolaires à Toronto, nous avons été témoins de l’impact négatif de la fermeture des écoles sur le bien-être des élèves. Depuis septembre, nous avons vu nombre de nos patients s’épanouir à nouveau dans des environnements d’apprentissage en personne, avec des effets positifs évidents sur leur bien-être mental, physique et scolaire. Alors que nous surveillons attentivement le nombre quotidien de cas de COVID-19 et que nous espérons en savoir plus sur le variant Omicron, il est impératif de prendre toutes les mesures nécessaires pour que les écoles restent ouvertes, en toute sécurité.

Au printemps 2020, alors que les enseignantes et les enseignants ont rapidement créé des environnements d’apprentissage en ligne en réponse aux fermetures d’écoles liées à la pandémie, des éléments essentiels de l’expérience scolaire n’ont pas pu être transposés dans un espace virtuel. Quelle que soit leur tranche d’âge, les élèves ont souligné les conséquences douloureuses d’un isolement social prolongé. Ils ont dû faire le deuil de traditions et de rites sociaux, comme la participation à des fêtes d’anniversaire, à des camps de vacances, à des remises de diplômes, à des concerts et à des tournois sportifs. Nous savons qu’il y a eu d’énormes répercussions sur la santé mentale, avec un nombre record d’appels aux lignes de crise, d’aiguillages vers des services de santé mentale et d’admissions hospitalières en raison de troubles alimentaires.

From The Globe and Mail article

Fatal overdoses are the headline news in the opioid crisis. The numbers are staggering and they are getting worse: British Columbia just reported more than 200 deaths in a single month. What is often overlooked is the toll on the survivors – the walking wounded of the crisis. Some get through overdoses and suffer brain damage or other disabling consequences; others struggle with rashes, abscesses, collapsed veins or hepatitis C.

“It’s easy to project the spotlight on overdose deaths, but there are far, far more people who have experienced an overdose, lived and had long-term effects from that,” said Seonaid Nolan, a doctor at Vancouver’s St. Paul’s Hospital. Though they cheated death, “their trajectory in life has just markedly shifted.”

“My concern is that we make this broad-sweeping assumption that if people survive the overdose they’re okay,” said Tara Gomes, a scientist at St. Michael’s who was one of the authors of the Ontario study on infections. “It’s not enough just to think the overdose is reversed and they’re just back to where they were before.”

Because of the stigma that still comes with drug use, she said, many patients aren’t taken seriously, given the proper tests or treated in a timely way.

On Dec. 14, MAP Centre for Urban Health Solutions announced the 2021 winners of the first annual MAP Awards: Jemal Demeke, Genevieve Blais, and Pearl Buhariwala. The MAP Awards recognize three outstanding MAP staff, students or volunteers who have excelled in their roles and demonstrate a passion and commitment to applying MAP’s values in their work.

Jemal Demeke, Clinical Research Coordinator on Dr. Darrell Tan’s team, is the winner of the MAP Values in Practice (MVP) Award, an award to recognize an individual who exemplifies and advocates for MAP values in their work and interactions. Members of Jemal’s team note that, “Jemal is fiercely dedicated to making meaningful and much needed change within their program and the organization to ensure systemic barriers are dismantled. They continuously demonstrates the upmost courage in vocalizing inequities in many practices… While many are willing to raise concerns, Jemal often stands out as often being first to raise their hand and asks “what can I do to help make this happen?” and to follow through.”

Genevieve Blais, who is First Nations from Oneida Nation of the Thames, and a Research Coordinator at the Well Living House, is the winner of the Community Partnership Award, awarded to an individual who consistently models exemplary community partnership practices and integration of the perspectives of community and people with lived expertise into their research. Her colleagues note that “Gen is incredibly kind, thoughtful, and committed—every project she supports benefitting from her involvement. Her ability to establish trusting relationships quickly and effectively with organizations, Indigenous knowledge keepers and community research partners is consistently demonstrated. Gen brings an understanding of community data governance systems which informs her way of working and interacting that uphold the role of Indigenous community partners.”

Pearl Buhariwala, Research Coordinator on Dr. Pat O’Campo’s team, is the winner of the Peer Mentor Award, an award to honour an individual who works hard to help colleagues learn, feel valued, and do well at work. Pearl’s colleagues shared several anecdotes about how she practices these values in her work. “Pearl has thrived at MAP in part because her own values align so well with those of MAP—equity, social justice, anti-racism, and equitable engagement with community. Pearl works with many different stakeholders, bringing them up to speed on a variety of projects and research methods and always does so with grace and respect, ensuring to build on each person’s unique strengths.”

Congratulations to the winners, and to all of the 2021 MAP Award nominees!

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From the Toronto Star article

They’re making a list and checking it twice. A team of health researchers have put together a short list that would put Canada on the path to a more equitable pandemic recovery.

Written by 11 researchers from St. Michael’s Hospital’s MAP Centre for Urban Health Solutions, the guidelines pull blueprints from trials, policies and other examples from Canada, the U.S. and around the world to show what is possible and effective to help people struggling to meet their basic needs.

The result is 13 clear recommendations that would help solve problems related to income, housing, intimate partner violence, children’s well-being, racism and access to health care. The recommendations were published Monday by the Canadian Medical Association Journal. Some could be put into place in a matter of weeks or months — paid sick leave, pharmacare and eviction interventions are things that already have infrastructure around them — what governments need is the will, researchers said.

“I hope that part of what this document shows is that the inequities we’re seeing today and suffering from today, are a result of choices that we’ve made,” Dr. Nav Persaud, co-author and scientist at St. Michael’s Hospital told the Star in an interview. “If we choose different policies, if we make different decisions, we could have a more equitable society, and we could have more equitable health outcomes.”

Treize façons de rendre plus équitable la reprise en réponse à la crise de la COVID-19 au Canada

Extrait de l’article du Toronto Star :

Comme le dit la chanson, « They’re making a list and checking it twice ». Une équipe de chercheurs du domaine de la santé a dressé une liste restreinte de solutions qui mettraient le Canada sur la voie d’une reprise plus équitable en situation de pandémie.

Rédigées par 11 chercheurs du Centre MAP pour des solutions de santé urbaine de l’hôpital St. Michael, les lignes directrices s’inspirent d’essais, de politiques et d’autres exemples provenant du Canada, des États-Unis et du monde entier qui présentent des solutions possibles et efficaces dans le but d’aider les personnes qui ont du mal à satisfaire leurs besoins fondamentaux.

Il en résulte 13 recommandations claires qui permettraient de remédier aux problèmes liés aux revenus, au logement, à la violence entre conjoints, au bien-être des enfants, au racisme et à l’accès aux soins de santé. Les recommandations ont été publiées lundi par le Journal de l’Association médicale canadienne. Certaines de ces mesures pourraient être mises en place en quelques semaines ou quelques mois; les congés de maladie payés, l’assurance médicaments et les interventions en cas d’expulsion sont des mesures qui disposent déjà d’une infrastructure. Selon les chercheurs, il ne manque aux gouvernements que la volonté nécessaire pour y arriver. « Je souhaite que ce document puisse démontrer que les inégalités que nous constatons et dont nous souffrons aujourd’hui sont le résultat de choix que nous avons faits, a déclaré dans une entrevue au Star le D^r Nav Persaud, co-auteur et scientifique à l’hôpital St. Michael. Si nous choisissions des politiques et des décisions différentes, nous pourrions avoir une société plus équitable, ainsi que des résultats plus uniformes en matière de santé. »

TORONTO, December 13, 2021 – A task force of scientists at MAP Centre for Urban Health Solutions has published the Equity Roadmap: Recommendations for equitable COVID-19 pandemic recovery in Canada. Published in CMAJ (Canadian Medical Association Journal) Dec. 13, these recommendations look to address long-standing health inequities that were exposed and exacerbated by COVID-19, which will continue to threaten health outcomes in Canada after the pandemic.

Based on research conducted throughout the pandemic, MAP recommends governments at all levels across Canada consider the policy changes covered in this report. Implementing these proven interventions and recommendations in the areas of income, housing, intimate partner violence, childhood, access to health care, and systemic racism would help to ensure a healthier future for everyone in Canada, while putting Canada in a better spot to respond to the next pandemic. The task force is led by MAP scientist and Canada Research Chair in Health Justice Dr. Nav Persaud, and includes MAP’s leading experts on interventions to address homelessness, income-related health inequities, gender-based violence, childhood health inequities; barriers to health care; and systemic racism.

“Coordinated pandemic responses include efforts to return life to “normal” after the immediate threat, but the COVID-19 pandemic has underscored the need to address inequities rather than resume the unfair status quo,” write the authors.

As Canada begins to consider a post-COVID-19 future, there is a tremendous opportunity to address long-standing health inequities and ensure that no one in our society is left behind. The recommendations in this report look to guide those efforts, making them as efficient and effective as possible.

The authors define the pandemic recovery period as the stage when the direct harms of COVID-19 abate but their recommendations might be needed for months, years or as permanent solutions.

Read the report

Endorsements:

This guideline is endorsed by Black Physicians of Canada, Canadian Doctors for Medicare and the Canadian Medical Association. The College of Family Physicians of Canada supports these recommendations.

About MAP

MAP Centre for Urban Health Solutions is a world-leading research centre dedicated to creating a healthier future for all.

Through big-picture research and street-level solutions, our scientists tackle complex community health issues – many at the intersection of health and equity. MAP is changing the way the world understands the health consequences of social inequality in Canada.

Together with our community and policy partners, we are charting the way to the world’s healthiest cities: places where people, communities, and the political, economic, social, environmental, and health infrastructures come together so that everyone can thrive.

MAP is part of the Li Ka Shing Knowledge Institute of St. Michael’s Hospital and is fully affiliated with the University of Toronto. St. Michael’s is a site of Unity Health Toronto, which also includes Providence Healthcare and St. Joseph’s Health Centre.

Learn more at www.maphealth.ca

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From the Toronto Star article:

Family doctor and MAP scientist Dr. Tara Kiran looked at how thousands of patients in Toronto feel about virtual care. In a survey of more than 7,000 patients in the city, more than 90 per cent said they were comfortable receiving care by phone, email or video. But those who weren’t were primarily low-income, with poorer health, and came to Canada in the last 10 years.

In the findings, Kiran said health-care providers need to consider how to best incorporate virtual care in their practice to ensure equity of access.

“I don’t think that standalone virtual care can meet the standard of care,” Kiran said.

La pandémie a favorisé les visites virtuelles chez les médecins de famille. Sont-elles là pour de bon?

Extrait de l’article du Toronto Star :

La D^re Tara Kiran, médecin de famille et scientifique spécialiste du MAP, s’est penchée sur la perception qu’ont des milliers de patients de Toronto des soins virtuels. Un sondage réalisé auprès de plus de 7 000 patients de la ville a révélé que plus de 90 % d’entre eux étaient à l’aise avec le fait de recevoir des soins par téléphone, par courriel ou par vidéo. Mais ceux qui ne l’étaient pas étaient principalement des personnes ayant de faibles revenus, en moins bonne santé et arrivées au Canada au cours des dix dernières années.

Dans ses conclusions, la D^re Kiran a déclaré que les prestataires de soins de santé doivent réfléchir à la meilleure façon d’intégrer les soins virtuels dans leur pratique afin de garantir l’équité d’accès.

« Je ne pense pas que des soins virtuels à eux seuls puissent répondre à la norme de soins », a déclaré la D^re Kiran.