Author: Samira Prasad

From the CBC News article

Ontario’s chief coroner is investigating several cold-related deaths among Toronto’s homeless population and evaluating whether to hold an inquest on the issue.

An advocacy group has requested an inquest, Dr. Dirk Huyer said. At least two homeless people have died as a direct result of the cold in Toronto this winter, but advocates believe there are more.

“The inquest request is being evaluated by our regional supervising coroner,” Huyer said in an interview.

Health experts and advocates say there’s a lack of centralized data on homeless cold-related deaths and injuries, which they say makes it harder to push for changes to support those who live outside.

Those deaths and cold-related injuries don’t currently go into any central repository, said Dr. Stephen Hwang, a physician and researcher at the MAP Centre for Urban Health Solutions at the Unity Health Toronto hospital network.

There’s also currently no legislation that mandates systematic reporting of hypothermic injuries, unlike COVID-19 or tuberculosis cases, he said.

“I’m not sure if the problem of hypothermic injuries and deaths has got better or worse over the last year compared to previous years,” he said.

Hwang sought to get a better sense of hypothermic injuries and deaths in Toronto on his own several years ago. He had to comb through records of emergency departments and coroner records between 2005 and 2015.

He found 79 hypothermic injuries, such as severe frostbite, and 18 deaths in Toronto during that stretch.

MAPmaking brings you Canada’s leading voices on the health equity issues that affect us all.

Together, we will discuss and explore the scientific evidence and real-world solutions that we believe have the potential to transform our country. Our vision is a Canada where everyone has the opportunity to thrive.

In this first season of MAPmaking, we are exploring the recommendations from MAP’s Equity Roadmap Report, a set of 13 recommendations for a more equitable COVID-19 pandemic recovery in Canada.

Episode one features Gautam Mukherjee, Executive Director of Houselink and Mainstay Community Housing. Gautam has worked in the housing and homelessness sector for 20 years and is a passionate advocate for social justice, inclusion and housing for all. In this episode, Gautam and MAP Director Stephen Hwang discuss and explore a recommendation from MAP’s Equity Roadmap Report: the expansion of permanent supportive housing programs with high fidelity to the Housing First approach.

Dr. Tara Kiran speaks with CBC White Coat, Black Art’s podcast The Dose

Listen to the podcast episode here.

The pandemic interrupted routines for health, work and family — including regular checkups.

So if you haven’t been to see your family doctor since before March 2020, now may be the time. 

“There’s a lot of diseases still going on,” Dr. Peter Lin, a Toronto-based family doctor and a director at the Canadian Heart Research Centre, told CBC podcast The Dose.

“If you have diabetes, high blood pressure, all of those things need some fine-tuning.”

Those who have a chronic illness or new pain should see their health-care provider right away, he said.

And if you’re overdue for an age-related cancer screening test, like a Pap smear, colonoscopy or a mammogram, get in touch with your family doctor.

If you’re unsure whether you need a checkup, several physicians told The Dose about what to consider before making an appointment. 

Who should book an appointment?

Contrary to its name, an annual checkup isn’t something most people need every year, said Dr. Tara Kiran, a family physician at St. Michael’s Hospital.

“That’s a little bit of a misnomer.”

Instead, most practitioners and their staff look at several factors before seeing someone. 

“What we do is really try and target preventive care based on people’s health history and their age, sex and the [medical] history of their family,” said Kiran, who is also the Fidani Chair for improvement and innovation at University of Toronto’s department of family and community medicine.

From the CBC News article

Health-care practitioners say this is the second difficult winter in a row for those who live outside. Pandemic pressures on an already-stretched shelter system as well as restrictions prohibiting eating — and getting warm — in fast-food restaurants have left many with nowhere to go on cold nights.

Toronto’s shelter system has been full or near capacity for years. This winter, Harrison and others say they have often called the city’s central intake office only to be told no beds are available.

Emergency departments have become ad hoc warming centres, says Dr. Stephen Hwang, a physician and researcher at the MAP Centre for Urban Health Solutions at the Unity Health Toronto hospital network. 

He says the network has an outreach worker who calls intake on cold nights in an effort to find spots inside shelters.

“There’s just been not enough space for people,” he says.

The city says it has added 400 new shelter spaces and 165 spots in warming centres this winter. It has also kept warming centres open since Jan. 7, instead of only during extreme cold weather alerts.

Advocates say that’s not enough. 

At least two homeless people have died as a direct result of the cold, although data on the subject is hard to come by.

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Op-ed in The Globe and Mail by Zoe Dodd, Eris Nyx, Corey Ranger, and Mark Tyndall

In December, the Alberta government set up a committee to consider the merits of providing access to a regulated supply of pharmaceutical-grade drugs, also called safe supply, in response to the continuing drug-poisoning crisis.

This crisis has killed more than 27,000 Canadians since 2015, and there is no end in sight. The introduction of fentanyl, unpredictable drug combinations and other deadly contaminants into the drug supply has resulted in a protracted massacre of people who were already being left behind.

As a group, we have declined the invitation to appear before the Alberta government’s committee. We feel that this is a deeply flawed process and that the conclusions have been predetermined. While we remain committed to saving lives through providing access to a safer drug supply, we refuse to lend any credibility to the process.

While governments across Canada have largely been sitting on the sidelines as this crisis has unfolded, Alberta’s United Conservative Party has taken an aggressive stance against people who use drugs by actively opposing harm-reduction interventions, targeting both evidence-based supervised injection sites and injectable opioid agonist treatment programs. The government has instead promoted abstinence-based treatment programs and tougher law enforcement.

Further, its safe-supply committee clearly lacks impartiality: It consists of only MLAs from the UCP. Members of the Opposition NDP walked away from the legislative committee. The party’s mental-health and addictions critic, Lori Sigurdson, described it as a “rigged process” after reviewing the list of more than 20 “experts” who were invited to present.

Le comité d’approvisionnement sûr de l’Alberta rate une occasion de protéger la population

Article d’opinion publié dans le Globe and Mail par Zoe Dodd, Eris Nyx, Corey Ranger et Mark Tyndall

En décembre, le gouvernement de l’Alberta a mis sur pied un comité chargé d’examiner les avantages d’un accès à un approvisionnement réglementé en médicaments de qualité pharmaceutique, également appelé approvisionnement sûr, en réponse au problème persistant des intoxications médicamenteuses.

Cette crise a tué plus de 27 000 Canadiens depuis 2015, sans que la fin ne soit en vue. L’introduction du fentanyl, de combinaisons de médicaments imprévisibles et d’autres contaminants mortels dans l’approvisionnement en médicaments a provoqué un carnage chez des personnes qui étaient déjà marginalisées.

En tant que groupe, nous avons décliné l’invitation à comparaître devant le comité du gouvernement de l’Alberta. Nous pensons que ce processus est profondément déficient et que les conclusions ont été préalablement établies. Alors que nous restons déterminés à sauver des vies en donnant accès à un approvisionnement en médicaments plus sûrs, nous refusons d’accorder une quelconque crédibilité à ce processus.

Alors que les gouvernements de tout le Canada sont restés en retrait face à cette crise, le Parti conservateur uni de l’Alberta (PCU) a adopté une position ferme à l’encontre des personnes qui consomment des drogues en s’opposant activement aux interventions de réduction des risques, ciblant à la fois les sites d’injection supervisés fondés sur des données probantes et les programmes de traitement des agonistes opioïdes injectables. Le gouvernement a plutôt encouragé les programmes de traitement fondés sur l’abstinence et l’application plus stricte de la loi.

De surcroît, son comité d’approvisionnement sûr manque manifestement d’impartialité : il est composé uniquement de députés du PCU. Les membres de l’opposition du NPD ont quitté le comité législatif. La porte-parole du parti en matière de santé mentale et de toxicomanie, Lori Sigurdson, a qualifié le processus de « truqué » après avoir examiné la liste de plus de 20 « experts » invités à faire une présentation.

MAP scientists Drs. Aisha Lofters and Nav Persaud are forming a citizen panel that will make recommendations to promote equitable access to preventative care interventions – including cancer screening and screening for cardiovascular disease – during the pandemic recovery period.

Who is encouraged to apply?

• People who have experience with primary care (as a provider, administrator, and/or patient).
• Racialized women and others who are typically underrepresented in clinical practice planning are especially welcome.
• No research experience is needed, and panel members will be supported with opportunities for learning about relevant health care terms, practices, and concepts.

We strive to create a supportive environment for this work focused on health equity. Panel members will be compensated at a rate of $100 per hour using funding for this project from the Canadian Institutes of Health Research. We estimate that over the coming year, panel members will spend approximately 10 hours reviewing materials and approximately 10 hours participating in meetings that will take place during normal working hours (usually from 1 to 3 pm EST). Panel members will be co-authors of the resulting article presenting the recommendations aimed at promoting health equity through preventative health care during the pandemic recovery period.

Questions? Please contact Dr. Nav Persaud at nav.persaud@utoronto.ca

Op-ed in the Toronto Star by Dr. Sloane Freeman, Dr. Ripudaman Minhas and Dr. Kevin Schwartz

The COVID-19 vaccine is safe, effective, and recommended for children aged 5 years and older, yet, nationwide, COVID-19 vaccine uptake has been low in children 5-11 years of age. To date, only 28 per cent have received two doses.

Increasing vaccination rates in this age group must be our priority. Some provinces have mandatory immunization programs for school-aged children, and questions have been raised about the suitability of this approach for the COVID-19 vaccine.

As pediatricians and child health advocates, our considerations surrounding COVID-19 vaccine mandates in children include: Will they prevent serious disease in the individual? Will they protect the community by decreasing transmission? Will they address the root cause of low uptake in children? There is much debate as to whether mandating the COVID-19 vaccine for school attendance is an ethical and equitable way to increase uptake in this age group.

A key benefit of a mandatory COVID-19 child vaccination policy would be its effectiveness in increasing vaccination rates and preventing serious illness in children. With more children exposed to Omicron each day, increasing vaccination in this age group is essential, especially for children with medical and developmental complexity.

Furthermore, COVID-19 has disproportionately impacted marginalized and racialized communities in Canada, with higher rates of hospitalization in children. Requiring the COVID-19 vaccine for school attendance could increase protection of children in hard-hit communities and accelerate the pace of vaccination in all school-aged children.

A mandate would also improve parents’ perception of the importance of the COVID-19 vaccine. Historically, vaccines that were mandated have been viewed as essential by the public.

Many advocates have suggested that mandating COVID-19 vaccination to increase uptake would reduce transmission. A recent preprint study from Ontario demonstrated that two or three vaccine doses were very effective at preventing hospitalizations and death from Omicron in adults. However, two doses provided only 40 per cent protection from mild infection within two months and no protection after six months.

From the CTV News article

A new study tracking patients receiving treatment for opioid addiction in Ontario has found that a recommendation change in March 2020 which allowed for more take-home treatments during the pandemic resulted in less overdoses and in more patients staying in the program.

Researchers followed more than 21,000 people who were receiving opioid agonist therapy (OAT) in 2020, and found that among those who were receiving daily doses of methadone, those who moved to take-home doses were actually 27-per-cent less likely to have an opioid-related overdose.

Study authors believe this could support giving more flexible access to treatments in the future – an important step given Canada’s opioid crisis has worsened during the pandemic.

“Allowing people to have that agency over treatment and given that opportunity is really important in independence and in confidence building,” Charlotte Munro, one of the study’s co-authors and a member of the Ontario Drug Policy Research Network’s (ODPRN) lived experienced advisory board, told CTVNews.ca in a phone interview.

The gold standard in treating opioid addiction is OAT, in which patients take regular doses of either methadone or buprenorphine, also called Suboxone, which are both long-acting opioid drugs. 

“They’re oral medications that are taken that replace opioids that people might have taken instead and help people prevent themselves from going into withdrawal and maintain a steady state of opioid in their system,” said Dr. Tara Gomes, a Principal Investigator of ODPRN and lead author of the study published Tuesday in the journal JAMA.

However, because OAT involves controlled substances that could pose a risk of overdose, particularly methadone, the treatment is delivered in-person every day in a pharmacy for a period of time until a physician decides to slowly prescribe more doses to take at home.

From Unity Health Toronto

People experiencing homelessness had more than twice the odds of testing positive for COVID-19 than those not experiencing homelessness in the first wave of the pandemic, according to new research led by Unity Health Toronto.

The study, published in Healthcare Policy, analyzed data from over 2,000 patients who visited the COVID-19 testing centre at St. Michael’s Hospital in downtown Toronto from March to April 2020 and found the higher positivity among the homeless population was present even after researchers adjusted the data to account for differences in age, sex and comorbidities.

The data also showed that approximately 10 per cent of people seeking a test were experiencing homelessness – far higher than the estimated proportion of the city’s homeless population, which is an estimated 8,715 of nearly 3 million people. People at the COVID-19 assessment centre were classified as homeless if the checkboxes for “shelter” or “unhoused” were marked in their records, or if the address field indicated no fixed address or listed the name or address of a shelter.

The study shows that people experiencing homelessness are at high risk of contracting COVID-19 and suggests that better strategies are needed to control COVID-19 transmission among people experiencing homelessness, particularly at shelters.

“Unfortunately, we still have a long way to go to make shelters a safe space and protect residents from infections that spread from droplets and air,” said Dr. Tara Kiran, first author of the study and a scientist at the MAP Centre for Urban Health Solutions at St. Michael’s Hospital. 

“Shelters are a stop-gap measure that we have unfortunately continued to rely on. They don’t meet people’s needs and this has just become more apparent during the pandemic. The findings are a reminder that we need to address the core issue of not enough affordable housing,” said Dr. Kiran, who is also a family physician at St. Michael’s Hospital.

The study builds off of the authors’ previously published research that suggested a more robust testing strategy was needed to prevent COVID-19 outbreaks in shelter settings. The authors say in addition to increased PCR and rapid antigen testing, this new study points to the need for improved ventilation in shelters and a full series of vaccination for people experiencing homelessness and those who work at shelters, including third doses.

“Our study shows that residents of homeless shelters had twice the odds of testing positive for COVID compared to those with stable housing,” said Dr. Joel Lockwood, co-author of the study and co-lead physician at the COVID-19 Assessment Centre at St. Michael’s Hospital.

“A lack of safe housing makes it difficult to practice physical distancing, mask-wearing, and other preventative measures. This is especially important since people experiencing homelessness are at a higher risk of severe COVID due to a higher rate of chronic medical conditions than the general population,” said Dr. Lockwood, who is also an emergency physician at St. Michael’s Hospital.

From The Conversation

Forty per cent of COVID-19 deaths in Ontario have taken place in long-term care homes. Chronic and in some cases devastating outbreaks have also been reported in shelters, detention centres and group homes for adults with disabilities. Residents and workers have died, and thousands more have been infected.

In these group facilities, termed “congregate settings” in Ontario, people eat together, and bedrooms and bathrooms are often shared. Because of this, they are very high-risk for acquiring airborne diseases.

It is imperative that congregate settings receive the best, most rigorous guidance available from Public Health Ontario (PHO). But that is not what is happening. A key aspect of infection prevention and control — indoor air quality — has been omitted from PHO’s public, written COVID-19 guidance specifically designed for these types of facilities.

Sub-standard guidance for congregate settings

Our team, which includes researchers with expertise in indoor air quality, engineering, epidemiology, public health and knowledge translation, conducted a detailed study of the public, written guidance PHO has produced specifically for institutions such as long-term care homes, shelters, group homes and correctional facilities. (The study is shared here as a pre-print, and has been submitted to a journal for peer review.)

We found no references to ventilation, HVAC (heating, ventilation and air conditioning) systems, portable air filters, bathroom exhaust fans or even opening windows. This includes PHO’s COVID-19 checklists for long-term care homes and congregate settings, which target those who are responsible for facility health and safety.

While our formal study concluded at the end of October 2021, we’ve continued to explore guidance on PHO’s website. Even as outbreaks continue in facilities such as long-term care homes and shelters, nothing much has changed, almost two years into the COVID-19 pandemic.