Resources

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.
infectious-diseases-clinical-care, science-brief
 | September 7, 2022

Understanding the Post COVID-19 Condition (Long COVID) in Adults and the Expected Burden for Ontario

The post COVID-19 condition is a complex and heterogeneous syndrome that develops in people with prior SARS-CoV-2 infection. More than 100 symptoms have been reported in people with the post COVID-19 condition, and these appear to be associated with reduced quality of life, reduced function, and impairments in people’s ability to work and care for themselves. There remains significant uncertainty in the definition, magnitude of prevalence, causes, risk factors, prevention, and prognosis of the post COVID-19 condition, as well as its impact on people’s quality of life, function, and ability to work. Nonetheless, the reported range of these effects in the published literature suggest that the post COVID-19 condition poses substantial health risks to adults across a diverse range of outcomes that have the potential to impart a considerable burden on individuals and healthcare systems. More contemporary evidence in the era of widespread vaccination and emerging variants resulting in less severe illness than earlier variants suggests that the post COVID-19 condition may now be less frequent following SARS-CoV-2 infection. Still, a proactive and comprehensive strategy to manage the post COVID-19 condition needs to be developed by health systems and policy makers. This strategy should include substantial investments in research and health system resources to mitigate the long-term health, social, and economic impacts of the post COVID-19 condition in Ontario.
public-policy-economic-impact, science-brief
 | August 25, 2022

Infection Prevention and Control Considerations for Schools during the 2022-2023 Academic Year

In-person schooling is essential for children and youth for both academic educational attainment and for the development of social, emotional growth and life skills. Schools are a place where children gain essential academic skills, form friendships, learn social and life skills, and are key settings for physical activity. Schools provide critical services that help to mitigate health disparities, including school nutrition programs, public health services (immunizations, dental screening), health care services (speech and language therapy, occupational therapy), social services and mental health supports. Schools should therefore remain open for in-person learning. Optimizing the health and safety of children and staff in schools requires that certain health and safety measures be in place, irrespective of the COVID-19 pandemic. These “permanent” measures include achieving and maintaining adequate indoor air quality, environmental cleaning and disinfection, hand hygiene, students and staff staying home when sick and up-to-date routine and recommended immunizations for students and staff. Temporary infection-related health and safety measures (e.g., masking, physical distancing, cohorting, active screening, testing) can help reduce the transmission of communicable illnesses in schools. However, some can pose additional challenges to school operations, student learning and student wellness. Furthermore, some of these measures may adversely impact social connectedness, which is of vital importance for children of all ages and of heightened significance in the adolescent years. Therefore, a thoughtful approach based on real-time local level analysis is recommended before reintroducing these temporary measures after careful consideration of the potential benefits and negative consequences. Given that schools are not isolated from communities, implementation of these temporary measures should not be done in isolation of community measures for indoor spaces. These temporary measures are not expected to be required at the start of the 2022 school year.
infectious-diseases-clinical-care, science-brief
 | June 28, 2022

Severe Acute Hepatitis in Children of Unknown Etiology

Public health agencies have raised concern over cases of acute severe hepatitis of unknown etiology in children that have been reported worldwide. Surveillance has been implemented in several jurisdictions to identify cases, investigate etiologies and monitor trends to determine if there is a signal of concern. The relationship between the COVID-19 pandemic and the genesis of these reports is yet to be fully determined. Potential etiological hypotheses have included adenovirus and SARS-CoV-2 infection. However, to date, cases reported in the published literature have had inconsistent and incomplete testing sent, limiting the epidemiological investigation. Clinicians need to be aware of how to recognize severity of acute hepatitis in children, what investigations to perform, and threshold to refer to a pediatric gastroenterologist or a liver transplant center. This document summarizes a pathway for the evaluation of children with severe acute hepatitis of unknown etiology and highlights the importance of immediately consulting with a pediatric gastroenterologist if the INR is elevated (greater or equal to than 1.5) and/or serum direct bilirubin is elevated to prioritize investigations and guide management.
health-equity-social-determinants-of-health, science-brief
 | June 21, 2022

The Impact of Physical Activity on Mental Health Outcomes during the COVID-19 Pandemic

Increasing physical activity and decreasing sedentary behaviour have positive effects on mental well-being and are associated with reduced symptoms of depression and anxiety. These effects were well-established prior to the COVID-19 pandemic. Overall, movement behaviours and mental health status worsened among Canadians during the COVID-19 pandemic. Physical activity in some groups, including children, has been disproportionately affected during the pandemic by measures such as school and recreation closures. Further, a lack of safe, accessible physical activity opportunities for some populations will persist past the pandemic due to structural inequities such as inequities in access to indoor or outdoor recreation spaces, as well as built environment features, which may ultimately negatively impact mental health. Promoting physical activity can help optimize both physical and mental health among Ontarians during and beyond the COVID-19 pandemic. Maintaining and improving emotional well-being through engagement in physical activity may be facilitated by providing publicly accessible and proportionally distributed indoor and outdoor recreation spaces, as well as supporting policies which address the relationship between the built environment and physical activity.
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