Epidemiology, Public Health & Implementation

epidemiology-public-health-implementation, science-brief

| October 3, 2022

Brief on Primary Care Part 3: Lessons Learned for Strengthened Primary Care in the Next Phase of the COVID-19 Pandemic

It is anticipated that future waves of COVID-19 infections and sequelae of prior infections will continue to strain primary care resources in Ontario. This Brief, the final part of a 3-part series, consolidates five lessons learned to date based on the evidence presented in parts 1 and 2 of this Science Brief: Lesson 1: Care provided in formal attachment relationships and through team-based models provides superior support for COVID-19- and non-COVID-19-health issues in the community. Lesson 2: In the absence of additional resources, COVID-19 response results in trade-offs and unmet needs in other areas. Lesson 3: Innovative models and new partnerships supported patients, particularly those from equity-deserving groups, to get needed care, but infrastructure is needed for sustainability, spread, and scale. Lesson 4: The absence of an integrated and inclusive data system compromised the pandemic response in primary care. Lesson 5: Primary care can leverage its longitudinal relationships to improve population health and health system sustainability. Heeding these five lessons would strengthen and support the primary care sector in Ontario to meet expected challenges in pandemic response and recovery.

epidemiology-public-health-implementation, science-brief

| October 3, 2022

Brief on Primary Care Part 2: Factors Affecting Primary Care Capacity in Ontario for Pandemic Response and Recovery

Primary care is a crucial component of pandemic and health emergency preparedness, response, and recovery. It is also essential to continued health system improvement, person-centred care in communities, and optimal population health for Ontarians. A capacity crisis in primary care has deepened during the COVID-19 pandemic. Urgent efforts are needed to address the factors that limit primary care provision. This will include ensuring an infrastructure that supports coordinated and integrated primary care. It will also include ensuring the training, support, and retention of interdisciplinary health human resources (HHR) that comprise teams providing care associated with patient enrolment models (PEMs), so they are equitable and accessible for all Ontarians before, during, and after public health emergencies.

epidemiology-public-health-implementation, science-brief

| October 3, 2022

Brief on Primary Care Part 1: The Roles of Primary Care Clinicians and Practices in the First Two Years of the COVID-19 Pandemic in Ontario

Primary care is a critical entry point into both COVID-19- and non-COVID-19-related care in Ontario. Primary care clinicians (PCCs) played an integral and multi-faceted role in Ontario’s pandemic response. This included a rapid transition to virtual care; participating in testing, treatment, and wraparound services for COVID-19; providing education and support to local communities to increase vaccine uptake; and more recently, catching up with non-COVID care despite fixed resources. COVID-19 care is increasingly being integrated into primary care practices but without added resources or supports. At the same time, PCCs are supporting patients who experienced missed or delayed care through the pandemic. Practices funded to include interprofessional teams have inherently had more flexibility to support both the pandemic response and catch-up of non-COVID-19 care.

epidemiology-public-health-implementation, science-brief

| September 19, 2022

Effective Modalities of Virtual Care to Deliver Mental Health and Addictions Services in Canada

The delivery of virtual mental health care by regulated healthcare professionals has grown substantially since the onset of the COVID-19 pandemic. In the limited research conducted on this modality, virtual mental health care has been found to be efficacious for supporting patients with depression, anxiety, and post-traumatic stress disorder. However, there is limited comparative evidence between in-person and virtual modalities, or for severe mental illnesses such as schizophrenia or bipolar disorder. Thus, despite the surge in the use of virtual care during the pandemic, it is important to recognize that virtual care may not be an adequate substitute for in-person treatment for all populations or conditions. Further, while virtual mental health care has the potential to address barriers to access to care for rural and underserved communities, it may also propagate existing inequities in mental health care for under-resourced populations. Many challenges to the delivery of equitable care through virtual mental health remain. Enhancing technological literacy and access for clinicians and clients, and delivering culturally competent care that aligns with the needs of the local population and community is a largely unaddressed priority for advancing transparency, trust and equity. Deliberate consideration of the specific needs and issues, preferences, culture and values of individual patients and communities is important to deliver culturally-competent virtual mental health models of care for equitable, accessible recovery. This should be done through close engagement and collaborative co-creation with patients, mental health researchers, practitioners and communities.

epidemiology-public-health-implementation, science-brief

| April 28, 2022

The COVID-19 Pandemic's Impact on Long-Term Care Homes: Five Lessons Learned

Older adults living in Ontario’s long-term care (LTC) homes have experienced some of the most devastating impacts of the COVID-19 pandemic, including disproportionate deaths, prolonged isolation from family and essential caregivers and reduced quality of life. In response, national and provincial associations and organizations have launched inquiries, issued expert reports, and offered recommendations. This brief summarizes and consolidates key recommendations from five reports and identifies opportunities to strengthen and integrate these recommendations into the Ontario policy environment. We identified five critical lessons learned: 1) Enhance the entry and retention of LTC home staff through the creation of more full-time positions, adequate staffing levels, and improvement of working conditions, 2) Reduce crowding through the elimination of three and four bed ward rooms and creation of more private rooms with dedicated bathrooms, 3) Maintain the ability for essential caregivers to have in-person access to the resident, 4) Ensure residents have access to timely and high-quality palliative care that promotes both quality and length of life, and 5) Build and maintain infection prevention and control (IPAC) expertise within LTC homes. These five lessons learned offer opportunities for significant improvement for Ontario’s LTC homes and can optimize safety, quality of life and outcomes for residents and improve the LTC home environment for staff and essential caregivers.

epidemiology-public-health-implementation, science-brief

| April 14, 2022

Update on COVID-19 Projections

epidemiology-public-health-implementation, science-brief

| April 12, 2022

Increased Screen Time for Children and Youth During the COVID-19 Pandemic

Screen time has substantially increased for children and youth in Ontario and globally during the COVID-19 pandemic. Emergency measures introduced during the pandemic such as closures of schools and recreation contributed to increased screen time. There is a growing body of evidence associating increased screen time with harms to physical (e.g., decreased physical activity, eye strain and headaches), cognitive (e.g., attentiveness) and mental (e.g., reported symptoms of depression and anxiety) health in children and youth. There are evidence-based strategies to promote healthy screen habits for children and their families which offer an approach to encourage healthier screen use in the home setting and mitigate potential harms. However, the burden to reduce screen time cannot fall to parents and families alone. Policies are needed to avoid closures of school and recreation, and ensure alternatives to screen time for children and youth of all ages that promote socialization and physical activity. In addition, there are key equity considerations when it comes to accessibility of alternatives to screen time such as child care and community recreation.

epidemiology-public-health-implementation, science-brief

| March 17, 2022

Update on COVID-19 Projections

epidemiology-public-health-implementation, science-brief

| February 10, 2022

Supporting Long-term Care Home Residents during Omicron

epidemiology-public-health-implementation, science-brief

| February 10, 2022

Use of Rapid Antigen Tests during the Omicron Wave

The emergence of the now provincially and globally dominant SARS-CoV-2 Omicron variant demands a reassessment of the diagnostic performance of rapid antigen tests. Rapid antigen tests are less sensitive for the Omicron variant compared to the Delta variant in nasal samples, especially in the first 1-2 days after infection. However, rapid antigen tests can more reliably detect infectious cases of the Omicron variant in combined oral-nasal samples. Individuals can collect these samples by initially swabbing both cheeks, followed by the back of the tongue or throat, and then both nostrils. In light of currently very high SARS-CoV-2 transmission rates in Ontario and the limited sensitivity of rapid antigen tests for the Omicron variant, a single negative rapid antigen test result cannot reliably rule out infection; a single negative test result is not conclusive and should not be used as a green light for abandoning or reducing precautions. Conversely, in this context, an individual with a positive rapid test result should be considered and managed as a case of COVID-19 and should immediately isolate; additional confirmation by polymerase chain reaction (PCR) is not necessary in most settings. If asymptomatic testing strategies are considered, rapid antigen tests need to be performed frequently to be effective. When using ‘Test-to-Stay’ strategies as an alternative to large-scale isolation, asymptomatic close contacts of a positive case need to do rapid antigen testing daily. When using ‘Voluntary Asymptomatic Screen Testing’ strategies, asymptomatic individuals should do rapid antigen testing 3-5 times per week.

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