Author: Samira Prasad

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By Jennifer Stranges, Unity Health Toronto

Now in our third year of the COVID-19 pandemic, questions about the lessons learned and the path forward are top of mind. When will this pandemic end? How can we prevent future pandemics? What lessons did we learn from not just this pandemic, but the ones that came before it?

These questions and more are addressed in the new book The Invisible Siege: The Rise of Coronaviruses and the Search For a Cure, written by Dr. Dan Werb, a scientist with MAP Centre for Urban Health Solutions in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital. The book was named a named a top 10 science book of the season by Publishers Weekly and will be released by Penguin Random House on March 1.

We spoke with Dr. Werb about the book, the most effective way to end the COVID-19 pandemic, and what he thinks is the “major failure” of the pandemic response.

What is the book about?

The book is an optimistic counter-narrative to all the stories we’ve heard about pandemic failure. There are failures captured in the book, but it’s a story of optimism and hope told through the lives and ideas of scientists who have been studying coronaviruses since the 1980s. It’s also about some scientists who accidentally moved into a space in their careers where they were able to advance a number of the different vaccines and cures that have charted our path through this pandemic and, potentially, future pandemics as well. Really, it’s about scientists as people and the way in which scientific discovery intersects with the real world in very strange and unpredictable ways. Finally, it’s a “family history” of coronaviruses. This viral family itself is a kind of character, and the book charts how that family has evolved for thousands and maybe millions of years.

The book is described as “putting boundaries on our anxiety” by placing COVID-19 in its scientific and historical context. What does this mean and why is it important?

I started writing this book in the early days of the pandemic when nobody knew where it was going to go, how bad it was going to get or how scary it was going to be. Part of what was so brutal about that time was not knowing the depth of the threat and how much our lives would get up-ended.

For the book, I talked to scientists who explained the outer bounds of how bad it could get and the other outer bound of how mild it could be. Science is all about putting ranges on things and if you have that range to work in, that can be incredibly comforting.

We’ve skirted the worst possible scenarios so far – that’s not to minimize how bad it is across the world and how poor the vaccine distribution has been, which is the real major failure of the pandemic – but we avoided the very worst case scenario, and we’re able to understand what exactly that worst case scenario was.

The book feels like a love letter to this small group of scientists who have been studying coronaviruses for decades, and also to the past discoveries that allowed us to learn as much about COVID-19 as quickly as we did. What is the book trying to say about science and scientists?

One of the things that the book does is show how the work that went into creating COVID-19 vaccines started with totally abstract questions about viruses way back in the 1980s. What the book is trying to demonstrate is the need for publicly-funded science to support those big, abstract pursuits. Public-funded science is at threat and what the book describes is how public-funded science – that a lot of the time had nothing to do with coronaviruses at all – got us to a place where we could get through this pandemic.

The more I learned about where all these ideas came from, I started to understand how deliberate all the testing and how rigorous the science is behind it. Misinformation threatens science, and publicly-funded, open-ended science is the only way that we’re going to land on solutions for problems that we have not considered – so that’s what we should be protecting.

One concept explained in the book is the epidemic triangle. What is this and how does it make epidemics “predictable”?

The epidemic triangle is this notion that every single epidemic is driven by the relationship between three factors: the pathogen (or the agent, the virus or bacterium), the host (the animal that harbours that pathogen), and the environment (within which those pathogens and hosts are interacting). Epidemics can always be traced back to a shift in that relationship.

This was where the book started for me. I wrote an op-ed in The New York Times early on in the pandemic outlining the epidemic triangle. It was a concept that comforted me because it outlined that whatever happened in the epidemic, at the very least it was going to obey this basic rubric.

In the case of how coronaviruses fit into the epidemic triangle, I discovered that there has been this movement primarily driven by changes in environment – from climate change, deforestation, from humans moving into areas formerly the homes and habitats of wild animals – which has caused a massive shift in the ways in which humans and animals co-exist. And that has in turn intensified contact between humans and coronaviruses. This is not something that started with SARS-CoV-2, it started decades ago and the first signal of this shift was SARS in 2002, and then MERS in 2012.

The book explains how the “wrong lessons” were learned from SARS. What didn’t the world learn to be able to anticipate and respond to COVID-19?

The thing about SARS is that it was essentially an unfit virus. It wasn’t able to transmit itself efficiently enough to remain replicating in human bodies and infecting human population. That wasn’t really a result of a human response, it was more the result of the virus just not being fit enough to survive.

Unfortunately, we took two wrong lessons from that. The first was that coronavirus pathogens don’t emerge frequently, and if they do, they aren’t terribly deadly or efficient when they do gain purchase in human populations. The second was that we can control coronavirus epidemics pretty easily when they emerge in human populations – and we can do that without vaccines, mainly with quarantines and public health restrictions. These were obviously wrong.

How can we blunt the threat of future pandemics?

It all comes back to the epidemic triangle. We know epidemics are driven by a shift in the relationship between pathogens, hosts and the environment they live in. Humans are not becoming more physiologically vulnerable to pathogens. It’s also not necessarily that the pathogens are becoming more pathogenic or becoming more effective at transmitting across species – that threat has always been there.

It’s really the environment – it’s the intensification of the frequency with which pathogens are able to engage with human populations. And that is driven by climate change on the one hand, by the wildlife trade, and also mass global production of meat for eating, which requires so much land and habitat, and ultimately ends up bringing humans into places where they’re displacing animals.

If the system continues this way we will see more of these pathogens emerge. More pandemic-potential pathogens emerged in the first 20 years of the 21^st century than emerged across the entire 20^th century. So there’s an acceleration of pathogens making their way into human populations, and it’s all related to the way that our food chains work, the way we use land for meat production and our ongoing conquest of natural spaces.

How do you describe how vaccines work and their purpose?

Ultimately, if a vaccine was meant to protect a single person, there would be no reason to invent one. Yes, vaccines are effective at preventing you from becoming very ill and offer some protection against infection, but they are primarily a population health tool. They are meant to be deployed across an entire population to achieve herd immunity – in a funny way, they’re actually designed to protect the people who don’t have vaccines.

In the book, I liken vaccines to a scenario wherein, if I bought a pair of glasses, your vision would get better. And for every additional person who got glasses, your vision would just keep improving. Once you remove yourself from the equation, it’s a lot easier to understand what the utility of vaccines is and why it’s so important for as many people as possible to get vaccinated.

How do you feel as there’s a real transition towards “living with COVID”?

My greatest sadness and frustration comes from the lack of global vaccine distribution. It makes me sad because it’s one of the few times in the system we live in where the ethically correct response is also the most selfish response.

As long as there are populations that are vulnerable to infection, and within which SARS-CoV-2 can replicate freely, there will be ongoing variants that will emerge. Inevitably, variants will emerge that will undercut the effectiveness of vaccines – and that’s bad for everyone.

If we want to stop new variants from emerging, and thereby stop the weakening of vaccines, we need to get vaccines out to everyone in the world, and right now access to the vaccines is completely lopsided for rich countries versus low and middle income countries.

As long as that inequity exists, this thing will not end. It will transform, yes, and maybe we’ll find a way to live with it. But it will constantly be there, we will constantly be adapting our defenses, and almost certainly requiring new boosters, and the production of new treatments. When really the fastest, most effective way to end the pandemic is to get the vaccine to people who do not currently have it.

The book is dedicated “to those who science could not save.” Why was that important to you?

There’s a lot of reasons why people were not saved by science. It was timing, it was which countries they lived in, and it’s also people that did not believe the science. It felt important for me to acknowledge that in the book, and to have the grounding as I wrote the book to make sure what I was writing was not too salacious of hyperbolic, that it was honouring the stark reality of what’s happened. I want to make sure it honours people who have lost something or those people who were lost.

You can order The Invisible Siege: The Rise of Coronaviruses and the Search For a Cure here, and subscribe to Dr. Werb’s newsletter here.

Entretien avec le Dr Dan Werb sur les coronavirus et la prévisibilité des pandémies

Par Jennifer Stranges, Unity Health Toronto

Alors que nous sommes dans la troisième année de la pandémie de COVID-19, les questions sur les leçons apprises et sur la voie à suivre sont au cœur des préoccupations. Quand cette pandémie prendra-t-elle fin? Comment pouvons-nous empêcher de futures pandémies? Quelles leçons avons-nous tirées non seulement de cette pandémie, mais aussi de celles qui l’ont précédée?

Ces questions et plusieurs autres sont abordées dans le nouveau livre The Invisible Siege : The Rise of Coronaviruses and the Search For a Cure du Dr Dan Werb, scientifique du Centre MAP pour des solutions de santé urbaine du Li Ka Shing Knowledge Institute de l’hôpital St. Michael. Le livre a été désigné comme l’un des dix meilleurs ouvrages scientifiques de la saison par Publishers Weekly et il sera publié par Penguin Random House le 1^er mars.

Nous nous sommes entretenus avec le Dr Werb au sujet de son livre, de la manière la plus efficace de mettre fin à la pandémie de COVID-19 et de ce qu’il pense être le « grand échec » de notre réponse à la pandémie.

De quoi traite ce livre?

Ce livre est une contre-narration optimiste de toutes les histoires que nous avons entendues à propos des erreurs commises en temps de pandémie. Le livre fait état des échecs, mais il relate une histoire d’optimisme et d’espoir à travers la vie et les réflexions de scientifiques qui étudient les coronavirus depuis les années 1980. L’ouvrage traite également de scientifiques qui, par hasard, sont arrivés à un moment de leur carrière où ils ont pu faire progresser un certain nombre de vaccins et de traitements différents qui nous ont permis de traverser cette pandémie et, possiblement, d’autres pandémies à venir. On y découvre les scientifiques en tant que personnes et la façon dont les percées scientifiques s’entrecroisent avec le monde réel de manière tout aussi étrange qu’imprévisible. En d’autres mots, on y raconte l’« histoire familiale » des coronavirus. Cette famille virale constitue elle-même une forme de personnage, et le livre relate l’évolution de cette famille depuis des milliers, voire des millions d’années.

From Unity Health Toronto

New research has found an Ontario provincial guidance change during the early days of the COVID-19 pandemic that recommended that individuals receive rapid access to take-home doses of medication for their opioid use disorder helped people stay on their treatment without increasing their risk of overdose in the subsequent six months.

The research, published in JAMA and led by researchers at St. Michael’s Hospital of Unity Health Toronto, suggests that providing people with more flexible access to their medication for opioid use disorder could be a successful strategy to keep patients in treatment and while not increasing the risk of overdose.

New guidance recommending low barrier access to take-home doses of opioid agonist therapies (OAT) was introduced on March 22, 2020 to accommodate COVID-19 public health measures, including limiting trips outside one’s place of residence, distancing requirements and isolation requirements.

People receiving OAT, such as methadone, are typically required to go to a pharmacy each day to consume their dose under medical supervision. Once they are stabilized on treatment and with agreement from their clinician, they are able to begin receiving doses to consume at home, typically beginning with one observed dose, followed by one take-home dose, and increasing over time. With the changing guidance in March 2020, the goal was to more quickly provide people with multiple take-home doses based on their clinician’s assessment of their social stability and ability to store doses safely.

“For a long time, people with opioid use disorder have been asking for more flexible access to OAT,” said Dr. Tara Gomes, lead author of the study, a Scientist at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital and ICES, and a Principal Investigator of the Ontario Drug Policy Research Network (ODPRN).

“It can be hard to hold down a job, go on vacation, or maintain some degree of autonomy and freedom on a day-to-day basis when accessing opioid agonist therapies because you are so tied to visiting a pharmacy on a daily basis. This pandemic-related change in guidance allowed us to see what would happen if these rigid rules were changed, and the findings suggest that more flexible treatment is actually safe and helps keep people in OAT programs.”

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From the New Scientist article

Diabetes and obesity rates can be reduced by transforming towns and cities into places where it is safe and convenient to walk, cycle or take public transport rather than drive.

Gillian Booth at the University of Toronto and her colleagues scoured more than 170 previous studies and discovered consistent evidence that people who live in areas where walking and cycling are practical options are more active and less likely to have diabetes or obesity.

One large study that Booth’s team considered involved 32,767 people and found that the prevalence of obesity among adults living in pedestrian-friendly towns and cities was 43 per cent, compared with 53 per cent of those living in areas where walking was a less practical option.

Another study that involved analysing the blood of 1.1 million adults also demonstrated the benefits of pedestrian-friendly areas. People with normal blood sugar levels at the beginning of the study were 20 per cent more likely to show symptoms of pre-diabetes eight years later if they lived in areas judged less friendly for pedestrians.

Les villes privilégiant les piétons présentent des taux plus faibles de diabète et d’obésité

Extrait de l’article tiré de la revue New Scientist

Il est possible de faire chuter les taux de diabète et d’obésité en transformant les villes en lieux où il est sécuritaire et pratique de marcher, de faire du vélo ou de prendre les transports en commun plutôt que sa voiture.

Gillian Booth, de l’Université de Toronto, ainsi que ses collègues ont passé en revue plus de 170 études antérieures et découvert des preuves démontrant que les personnes qui vivent dans des zones où la marche et le vélo sont des options privilégiées sont plus actives et moins susceptibles de souffrir de diabète ou d’obésité.

Une vaste étude examinée par l’équipe de Mme Booth menée auprès de 32 767 personnes a révélé que la prévalence de l’obésité chez les adultes vivant dans des villes adaptées aux piétons était de 43 %, contre 53 % chez ceux vivant dans des zones où la marche est une option moins pratique.

Une autre étude, qui a consisté à analyser le sang de 1,1 million d’adultes, a également démontré les bienfaits des zones piétonnes. Les personnes dont la glycémie était normale au début de l’étude étaient 20 % plus susceptibles de présenter des symptômes de prédiabète huit ans plus tard si elles vivaient dans des zones jugées moins favorables aux piétons.

Op-ed by Dr. Dan Werb in The Globe & Mail

When a cluster of unexplainable pneumonia cases emerged in Hong Kong and the nearby Chinese city of Guangzhou in November, 2002, the world stood rapt. From a few dozen cases, the epidemic grew to include hundreds; as the numbers mounted, so did the deaths. The new pathogen had all the hallmarks of being pandemic-ready: It could transmit itself efficiently across human populations, it killed more than 10 per cent of those that were infected and it was a virus the world had never seen before.

That virus was severe acute respiratory syndrome, or SARS, the first pathogenic human coronavirus ever detected – and a close relative of SARS-CoV-2, the cause of the COVID-19 pandemic. When SARS first spread to Canada in the spring of 2003, Bob Brunham, a vaccinologist and the director of the BC Centre for Disease Control, helped lead a team that first mapped its genome. But after having seen the virus spread unchecked to every global hemisphere in a matter of months, he decided mapping it wasn’t enough.

If humanity was to ever keep up with emerging pathogenic abominations such as SARS, a leap in vaccine development was urgently needed. It was an audacious gambit because, at the time, the timeline for getting a vaccine to market was measured in decades, not years – making them a poor strategy for fast-moving epidemics. Vaccine production was also totally cornered by pharmaceutical companies, which were the only ones with the estimated US$100-million that was the minimum amount needed to get a viable product to market.

From the Healthy Debate article

The “shadow epidemic” lurking in the COVID-19 background is leaving another group of front-line workers battered and bruised. And Ontario’s opioid crisis is expected to get worse over the next six months, according to the latest data.

But unlike mainstream health-care providers, harm reduction workers do not have benefits like danger pay or strong unions to support them. With jobs characterized by low wages, stigma and political red-tape, overworked harm reduction professionals are seeing burnout on the front lines.

“I have watched harm reduction workers over the past two years, from the first wave, where they really quickly pivoted because they realized if supervised consumption sites closed, tons of people who were relying on their services would die,” says Gillian Kolla, postdoctoral fellow at the MAP Centre for Urban Health Solutions at St. Michael’s Hospital. “They literally moved mountains heroically from day to day, to still provide services in the midst of COVID. They did this with zero funding, they did this by begging and borrowing (personal protective equipment) in the initial wave. It was an absolutely heroic effort that went largely unrecognized.”

News release by Canadian Medical Association Journal

A new study shows hotspots of SARS-CoV-2 infections in Canadian cities across four provinces, linked to occupation, income, housing and proxies for structural racism. The study, which looked at infections in 16 urban centres in British Columbia, Manitoba, Ontario and Quebec, is published in CMAJ (Canadian Medical Association Journal.)

The COVID-19 pandemic has had variable impacts across provinces and within cities, with some regions more affected than others. To better understand the factors contributing to the concentration of SARS-CoV-2 infections in geographic areas, researchers analyzed provincial surveillance data from January 2020 to February 2021.

“Understanding the factors associated with geographic patterns of transmission within cities can help identify the populations and, specifically, the contexts with the greatest risks,” write Yiqing Xia, McGill University, Montréal, Quebec, and Huiting Ma, Unity Health Toronto, Toronto, Ontario, with coauthors. “Geographic analyses can enable better allocation of resources, tailoring of policies and implementation of context-specific strategies to more effectively and efficiently curb local transmission.”

There were 62 709 SARS-CoV-2 cases in BC, 15 089 in Manitoba, 239 160 in Ontario and 215 928 in Quebec recorded in the 16 census metropolitan areas that were included in the study. They accounted for 81%, 57%, 83% and 80% of all confirmed cases in each province, respectively. Researchers observed concentrations of cases according to social determinants of health, such as income, housing, essential work, visible minority status and more. They found that visible minority status was the social determinant of health that was important across all cities, with variations in the others.

“This study provides comprehensive and robust evidence of high geographic concentration of SARS-CoV-2 cases within Canadian cities in BC, Manitoba, Ontario and Quebec,” write senior authors Dr. Mathieu Maheu-Giroux, McGill University, and Dr. Sharmistha Mishra, Unity Health Toronto, with coauthors. “These hotspots are largely defined along social determinants related to occupation, income, housing and proxies for structural racism.”

The 16 regions included:

• British Columbia – Vancouver, Kelowna and Abbotsford–Mission
• Manitoba – Winnipeg
• Ontario – Toronto, Ottawa, Hamilton, Kitchener–Cambridge–Waterloo, St. Catharines–Niagara and Windsor
• Quebec – Montréal, Québec City, Gatineau, Sherbrooke, Saguenay, Trois-Rivières

These findings are consistent with those of other studies from Canada as well as Sweden, the United States and other countries showing higher rates of SARS-CoV-2 in racialized communities or diverse neighbourhoods.

The authors call for city-specific public health supports like geographic hot-spot initiatives, such as vaccination rollouts and access to mobile and outreach testing with wrap-around support for quarantine and isolation, that are tailored to effectively reach and meet the prevention and care needs of communities at disproportionate risk of COVID-19.

“Geographically prioritized allocation of resources and services that are tailored to the local drivers of inequalities in acquisition and transmission risk offer a path forward in the public health response to SARS-CoV-2,” they conclude.

Interview by Marlene Leung, Unity Health Toronto with Dr. Nav Persaud

Dr. Alexander Augusta was a Black physician who studied medicine in Toronto in the mid-1800s after being refused admission to medical schools in the United States because of racism. Although he completed his medical training in Canada and practiced for a brief period in Toronto, he returned to America to fight for the Union in the Civil War, becoming the first African-American surgeon in the Union army. He went on to hold many distinguished and groundbreaking positions as a medical educator in the States, and, with full military honours, was buried at Arlington National Cemetery.

Dr. Nav Persaud, family physician at Unity Health Toronto and Canada Research Chair in Health Justice, recently co-authored a new paper about the remarkable life and career of Dr. Augusta. We spoke with Dr. Persaud about his interest in researching Augusta’s life in Canada and what his story can teach us about racism and the disparities that exist today in Canadian medicine.

Q: What initially sparked your interest in researching Dr. Alexander Augusta?  

Dr. Persaud: It started when I was thinking about how the history of medicine is pretty homogenous and focuses largely on the accomplishments of white men. I wondered if there were other important stories out there that had been overlooked, and that’s when I came across a book by Dr. Heather Butts (who co-authored the paper) that looked at healthcare in the U.S. during the Civil War era. That’s where I learned about Dr. Augusta.

Most of what’s written about him focuses on his time in America. Augusta’s remarkable time in Canada hadn’t been carefully examined, so that’s why we chose to focus on his decade here.

Q: This paper was published in the Canadian Medical Education Journal, why do you feel Augusta’s story is important for medical and healthcare students to know?

Dr. Persaud: Augusta’s experience here in Canada can help us understand the disparities that exist today in Canadian medicine. Even today, medical schools don’t represent the populations that they serve, and if you want to understand why, part of that means going back to Augusta’s time.

Augusta had some pretty good reasons to stay in Canada, he was barred from getting into U.S. medical schools, and people were still being enslaved in the U.S. But he decided to go back to the States and put his life at risk fighting for the Union, rather than staying in Canada. Fighting against the Confederates in the Civil War was obviously very important to him, but things weren’t easy for him here.

During his brief time here, Augusta spoke out against racism and discrimination in Canada. When there was a proposal to create a segregated colony for Black people on Ontario’s Manitoulin Island, he advocated against it, drawing parallels to the American south. He also was president of the Association for the Education of Coloured People in Canada, a group that helped ensure Black children had the necessary supplies and supports to succeed at school. It appears he never worked at a large hospital in Toronto, but after the Civil War he headed a hospital in the United States.

His story counters the very simplistic narrative of America being bad, and Canada being good. Sometimes there is this idea of Canadian exceptionalism in comparison to America, and people assume that racism wasn’t a problem in Canada and isn’t a problem today. Augusta’s life shows that it’s a much-more nuanced story than that. Obviously there was a good reason for him to come here, and racism in America was a big part of that. But there was also good reasons for him to leave Canada, and racism was one of them.

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From Unity Health Toronto

A study of emergency department (ED) visits for drug overdoses in Ontario during the COVID-19 pandemic reveals that overdoses were disproportionately higher among people experiencing homelessness.

The findings, published in Addiction, show that in Ontario from June to September 2020, when the province was reopening after wave 1 lockdown measures, weekly rates of ED visits for drug overdoses more than doubled among homeless individuals compared to the same time the year prior. Increases of this magnitude were not observed among the stably housed or those living in low-income neighborhoods.

The study shows that the impacts of the pandemic have disproportionately harmed individuals experiencing homelessness, and suggests that greater supports are needed to address the intersection of homelessness and drug use.

“These findings confirm one shameful truism of this pandemic – that vulnerable populations have been time and time again disproportionately impacted by the COVID-19 pandemic,” said Michael Liu, lead author of the study, a research coordinator at St. Michael’s MAP Centre for Urban Health Solutions, and visiting scholar at ICES.

“This is a population that already contends with immeasurable difficulties, and we have failed to protect them during the pandemic. There are clear policies and interventions that need to be put in place to support and protect the most vulnerable within our cities and neighborhoods,” said Mr. Liu, who is also a medical student at Harvard University and a Rhodes Scholar.

Researchers at St. Michael’s Hospital of Unity Health Toronto used data from ICES, the not-for-profit research institute, to categorize over 15.2 million Ontarians into three groups based on their housing status: individuals with a recent history of homelessness, all housed individuals, and individuals living in low-income neighborhoods.

To understand how the pandemic impacted overdoses for the people within these groups, researchers retrospectively analyzed ED data during three stages: pre-pandemic (January 5 to March 16, 2020), peak (March 17 to June 16, 2020), and re-opening periods (June 17 to September 26, 2020). The researchers used corresponding weeks in 2019 as a benchmark to measure against. They found:

• There was an overall increase in ED visits for overdoses among all three housing groups from 2019 to 2020.
• The increase was most pronounced in individuals with a recent history of homelessness. There was a 56 percent increase in ED visits for overdoses during the re-opening period of 2020 compared to the same weeks in 2019.
• Looking just at 2020, rates of ED visits per 100,000 people for drug overdoses among recently homeless individuals were 148 times higher than that of all housed individuals and 22 times higher than that of low-income housed individuals.
• ED visits for drug overdoses decreased across all groups by approximately 20 percent during the peak period compared with corresponding weeks in 2019.

“Our study shows the enormous toll that drug overdoses have taken on people experiencing homelessness during the pandemic,” said Dr. Stephen Hwang, senior author of the study and Director of MAP Centre for Urban Health Solutions at St. Michael’s Hospital.

“We need to act right now to prevent overdoses, which all too often end up causing tragic and preventable deaths,” said Dr. Hwang, who is also an internal medicine physician and Chair in Homelessness, Housing and Health at St. Michael’s Hospital.

The authors are calling for urgent public health and policy interventions to reduce the burden of drug overdoses and substance-related problems in this population, including greater access to supervised consumption facilities, fentanyl testing strips, naloxone, low-barrier opioid agonist therapies, and tailored office-based addiction treatments. The authors say the services need to be brought directly to people experiencing homelessness through mobile street teams, community-based agencies, and shelter services.

“Difficulties with substance use and homelessness are inextricably linked. Stable housing is necessary – although not sufficient – to address the unacceptably high rates of morbidity and mortality in the homeless population,” said Mr. Liu.

Les visites aux urgences dues à des surdoses de drogue sont disproportionnellement plus nombreuses dans la population des personnes sans-abri en période de pandémie : étude

Par Unity Health Toronto

Une étude portant sur les visites dans les salles d’urgence causées par des surdoses de drogues en Ontario pendant la pandémie de COVID-19 révèle que les surdoses étaient proportionnellement beaucoup plus nombreuses chez les populations de personnes sans-abri.

Les conclusions, publiées dans la revue Addiction, révèlent qu’en Ontario, de juin à septembre 2020, au moment où la province se déconfinait après la première vague de mesures de confinement, les taux hebdomadaires de visites aux urgences en raison de surdoses de drogues ont plus que doublé chez les sans-abris par rapport à la même période l’année précédente. Des augmentations de cette ampleur n’ont pas été observées chez les personnes ayant un logement stable ou vivant dans des quartiers à faibles revenus.

L’étude révèle que les répercussions de la pandémie ont nui de manière disproportionnée aux personnes sans domicile fixe et elle indique que des mesures de soutien plus importantes sont nécessaires pour faire face aux conséquences de la réciprocité entre les personnes sans domicile fixe et la consommation de drogues.

« Ces résultats confirment un triste cliché de cette pandémie, à savoir que les populations vulnérables ont été à maintes reprises touchées de manière disproportionnée par la pandémie de COVID-19 », a déclaré Michael Liu, auteur principal de l’étude, coordonnateur de recherche au Centre MAP pour des solutions de santé urbaine de l’hôpital St. Michael et chercheur invité à l’ICES.

« Il s’agit d’une population qui doit déjà faire face à des difficultés incommensurables, et nous n’avons pas su la protéger pendant la pandémie. Il existe des politiques et des interventions concrètes qui doivent être mises en place pour soutenir et protéger les plus vulnérables dans nos villes et nos quartiers » a déclaré M. Liu, également étudiant en médecine à l’Université de Harvard et boursier Rhodes.

From the Toronto Star article

Toronto’s supervised drug consumption sites are seeing a record number of overdoses, while the city’s paramedics responded to more fatal overdoses in 2021 than any other recorded year — all signs that experts say point to a worsening opioid crisis both in Ontario and elsewhere.

The toll comes as front-line staff struggle with burnout and grief while navigating the unpredictability of COVID-19 and the latest Omicron wave. And a lack of swift action on the part of policy-makers to reduce opioid-related harms, some critics say, has exacerbated an already dire situation.

“The drug poisoning crisis is not getting better,” said Shaun Hopkins, manager of The Works, a supervised consumption site run by the city of Toronto. “We’re continuing to see records being set in terms of paramedic calls, deaths, overdose numbers.”

The Works saw a record 165 overdoses in December, accounting for 8.8 per cent of all visits to the site that month. It is a marked increase from December 2019, where the rate of overdoses hovered around 1.4 per cent. In January 2022, the rate of overdoses remained high at 5.6 per cent.

Paramedics in Toronto also saw a record number of opioid deaths in 2021, responding to a total of 357 fatal suspected overdose calls. In 2020, paramedics responded to 268 fatal calls. Because paramedics aren’t involved in every opioid fatality, the numbers for opioid-related deaths in 2021 may be higher, said Gillian Kolla, a post-doctoral fellow at St. Michael’s Hospital with expertise in drug policy.

Due to a data lag in Ontario, preliminary numbers of opioid-related fatalities for 2021 are only available up until June, but they hover at 1,415 deaths. In all of 2020, the province saw 2,431 deaths. British Columbia, which released its 2021 data on Monday, saw its deadliest year yet for opioid-related deaths, with 2,224 fatalities.

Op-ed by Dr. Tara Kiran published on Healthy Debate

Every day, thousands of Canadians are infected with COVID. But this isn’t March 2020. As a result of high rates of vaccination and the particulars of Omicron, the overwhelming majority of those getting COVID currently will not need hospital care. What Canadians do need to be able to ride out this wave is information, support at home and timely access to primary care.

And what primary care teams need is reliable resources to help guide us through the ever-changing thicket of research, public health guidance and tools for prevention and treatment. We need to support most people to manage on their own while also identifying and helping people who need timely interventions to keep them from becoming seriously sick.

On the ground and at the front line, it seems that information – our most valuable asset in the Omicron wave – isn’t getting through clearly.