Seven research projects from St. Michael’s Hospital have been awarded more than $3.2-million from the Canadian Institutes for Health Research (CIHR) for research that will address the wider impacts of COVID-19 across health in Canada.

CIHR created the ‘Addressing Wider Impacts of COVID-19’ Operating Grant to support scientists aiming to understand the extent and impact of the indirect and wider health consequences of COVID-19 and the resilience of the people of Canada, identify effective interventions and generate evidence related to one or more population experiencing marginalization.

The recently funded projects are tackling important issues including addressing gaps in services for justice-involved persons, understanding the impact of COVID-19 in Sierra Leone’s post-Ebola health system, and learning more about how strains on hospital capacity during the peaks of the pandemic impacted quality of care. Learn more about the projects below.

Demystifying the ‘black box’ of prisoner re-entry and addressing the mental health and substance use needs and service disruptions for people released from custody during the COVID-19 pandemic

People released from correctional facilities face significant mental health and addiction challenges, in addition to poverty, homelessness, poor physical health, and discrimination. The COVID-19 pandemic has made community reentry, including access to mental health and substance use services, more difficult. Particularly affected are Indigenous, African, Caribbean, Black, and 2SLGBTQQIA+ individuals, who are over-represented in the prison system.

“The funding from CIHR will support research that will help us better understand the mental health and addictions needs and service disruptions for justice-involved persons during the pandemic,” said Dr. Flora Matheson, a scientist at the MAP Centre for Urban Health Solutions, who will lead the study. “We will leverage recently collected data from a rapid COVID-19 study that included in-depth qualitative interviews with service providers and people released from correctional facilities, a targeted survey of Ontario-wide service changes, and an Ontario-wide database of service disruptions/adaptations and helpline calls in the COVID-19 service landscape, to explore the wider impacts of COVID-19 for justice-involved persons, including their well-being and emergent coping strategies.”

The study is a collaboration of researchers, community service providers, and knowledge users who support people who face incarceration. Rapid knowledge generation and mobilization will ensure timely and targeted policy, practice, and care responses to ensure people who have incarceration histories are adequately supported. Findings will identify innovative adaptations within the mental health and addiction sectors that can inform the present and future pandemic plans, preparations, and responses to better address the needs of this population.

Disseminating and evaluating ‘best practices’ that promote healthy lifestyle behaviours and mental wellbeing to mitigate the impact of COVID-19 on elementary school children in disadvantaged communities

Dr. Katerina Maximova

Measures implemented to slow the spread of COVID-19, such as school closures and stay-at-home directives, created difficulties for school-aged children. Concerns have emerged about the impact of these measures on children’s health and wellbeing, which may have long-term consequences.

This research, led by Dr. Katerina Maximova, a scientist at the MAP Centre for Urban Health Solutions, will build on a 14-year partnership with a program called APPLE Schools, which promotes healthy living and mental wellbeing for kids experiencing disadvantage and operates in 74 elementary schools.

In response to the pandemic, APPLE Schools developed easy-to-implement practices to support schools during COVID-19. In partnership with APPLE Schools, Dr. Maximova and her team have generated an inventory of health promotion practices designed by APPLE Schools in response to COVID-19, and linked these with students’ lifestyles and wellbeing to identify the most successful practices in APPLE Schools during COVID-19.

“This project will help develop an online toolkit, and promote its dissemination and uptake in all APPLE Schools and all elementary schools across Alberta,” Dr. Maximova said. “We will emphasize promotion of the toolkit in schools in settings experiencing socioeconomic disadvantage to speed up pandemic recovery and alleviate health inequalities.”

The team will evaluate the uptake of the toolkit among school principals and teachers, and assess its impact on students’ lifestyle behaviours and mental wellbeing in APPLE Schools and an equal number of non-APPLE schools. This study aims to yield practical, actionable and scalable solutions.

Testing Resilience:  An evaluation of the health system impact of COVID-19 in Post-Ebola Sierra Leone

Dr. Sharmistha Mishra

In 2014, Sierra Leone was hit with an unprecedented Ebola outbreak with devastating consequences for those directly affected by the virus and through collateral damage across other health sectors. Post-Ebola recovery plans were put into place, centered around strengthening systems-level resiliency to buffer against structural shocks like future pandemics.

When COVID-19 hit the country in 2020, this post-Ebola health system strengthening was tested. Dr. Sharmistha Mishra, a scientist at the MAP Centre for Urban Health Solutions, and her team, which is a partnership between scientists Sierra Leone and Canada, aim to examine the wider impacts of the COVID-19 pandemic on essential health services in Sierra Leone.

“First, we will measure the extent to which the COVID-19 epidemic changed the delivery/uptake of essential services and led to negative health outcomes in infectious diseases, childhood vaccination, and maternal health,” Dr. Mishra said. “We will compare this wider health impact against that of the Ebola epidemic. Second, we will examine how differences in public health measures and SARS-CoV-2 vaccine coverage over time and geography influenced service disruption, and the extent to which adaptive service reconfiguration may have mitigated the wider health impacts of the COVID pandemic.”

Results from this work will be used by stakeholders and service providers, including the National COVID-19 Emergency Operations Center and the Sierra Leone Ministry of Health and Sanitation, to inform ongoing program adaptation in the context of future waves of COVID in a region with limited SARS-CoV-2 vaccine supply to date.

Health equity during the pandemic recovery period: updated knowledge syntheses, policy tracking and health outcome monitoring

Dr. Nav Persaud

Health equity, or fairness in health outcomes, was prominently mentioned during the pandemic.

Racialized people, women, people with a low income, people experiencing homelessness, people who use substances and people who are incarcerated were disproportionately affected during the pandemic. Disparities in who died from COVID-19, and who was getting vaccinated were widely reported in national media and in national reports such as from the Public Health Agency of Canada. There was also some attention paid to the disproportionate effect of pandemic-related restrictions on people experiencing disadvantages.

Interventions and policy changes that can address the inequities exposed during the pandemic have been well studied and described. These include changes to governmental income supports, housing policies, supports for victims of intimate partner violence, supports for children, access to preventative health care, and comprehensive changes to address racism.

This study, led by Dr. Nav Persaud, a scientist at the MAP Centre for Urban Health Solutions, aims to translate the recent attention to inequities into lasting improvements including policy changes and clinical practice changes.

“This timely funding will allow us to provide more recommendations aimed at promoting health equity during the pandemic recovery period,” Dr. Persaud said. “We hope to inform policy changes and preventive care such as cancer screening programs that help those worst affected during the pandemic. The pandemic recovery period is a unique opportunity to advance health equity to protect health after the pandemic and before the next one.”

Approaches For ThE pRioritization of patients in priMAry care post-COVID To reduce Health inequities (AFTERMATH)

Dr. Andrew Pinto

High quality primary care is the cornerstone of strong health systems. The COVID-19 pandemic has significantly altered primary care across Canada. Most offices and clinics rapidly shifted to virtual care, restricted in-person visits or closed their offices, and delayed routine monitoring and lab testing. It is likely health inequities in preventive care activities and chronic disease management widened, but the extent is unknown.

AFTERMATH consists of two parts that will occur in tandem. In Part 1, the team, led by Dr. Andrew Pinto, scientist the MAP Centre for Urban Health Solutions, will use electronic medical record (EMR) data from all seven primary care Practice-Based Research Networks (PBRNs) in Ontario from more than 1.6 million patients to examine the impact of the COVID-19 pandemic on gaps in preventive care activities and chronic disease management, and examine inequities by demographics and chronic disease status.

In Part 2, the team will conduct a trial at the largest PBRN, focused on a population expected to have significant gaps in preventive care activities: adults living with mental illness and at least one additional chronic disease.

“Our goal is to improve quality of life, reduce gaps in preventive care activities and improve chronic disease management by supporting physicians with a newly developed EMR data driven dashboard plus tailored supports,” Dr. Pinto said. “Our project will result in new evidence on strategies to improve access to and reduce inequities in preventive care.”

Findings will inform future efforts to use EMR data to drive improvements in primary care beyond the COVID-19 pandemic. If this intervention works, the team plans to rapidly disseminate and scale it up in Canadian primary care, building on advances in processing and integrating EMR data into the workflow of clinicians and health organizations.

Understanding the effects of hospital capacity strain on quality of hospital care for patients admitted to medical and ICU wards during the pandemic and evaluating interventions to mitigate hospital capacity strain

Dr. Fahad Razak and Dr. Amol Verma

COVID-19 placed significant strain on hospital capacity in Canada. This research team, led by Dr. Amol Verma and Dr. Fahad Razak, scientists at the Li Ka Shing Knowledge Institute, will study the effect of this strain on the quality of acute care for adult medical and intensive care unit (ICU) admissions, the two main locations of COVID-19 care and subsequent hospital strain.

“This CIHR funding is critical for us to be able to study how Ontario responded to one of the greatest crises faced by our healthcare system,” Dr. Razak said. “During peak pressures from the COVID-19 pandemic, more than 3,000 patients were transferred between facilities to mitigate capacity strain – a number that is unprecedented in our healthcare system’s history. We don’t know if this intervention was safe or effective for transferred patients and especially for critically ill patients. Little is known about how hospital strain, or the transfer of patients impacted populations experiencing marginalization.”

During periods of limited capacity, ICU care was also extended onto medical wards. This research will investigate how hospital strain, and the two major capacity-mitigating interventions, affected quality of acute care for hospitalized medical and ICU patients.

Support from this grant will allow the team to work with critical knowledge users to facilitate translation of the research to support Canada’s pandemic response going forward.

“Our results will help us understand how we can mitigate wider health consequences of hospital strain, promote equity, and increase the resilience of Canada’s healthcare system,” Dr. Verma said.

What are the wider health impacts of COVID-19 on fracture patients served through Ontario’s province-wide Fracture Screening and Prevention Program? 

Dr. Joanna Sale

Every year, over 131,000 Canadians have a fragility fracture, which is a fracture resulting from a slip, trip, or fall from standing height or less. This type of fracture predicts future fractures, such as devastating hip fractures. 

Fractures generally happen in women and older individuals with other chronic health conditions.  The Fracture Screening and Prevention Program is a program that runs in 34 Ontario fracture clinics. Through the program, coordinators screen 8,000 patients per year. Coordinators arrange for patients to get a bone mineral density test, referral to a specialist, and treatment that may include medication.

COVID-19 has disrupted fracture patients’ access to health care worldwide but little is known how it has affected Canadian fracture patients.

“This grant contributes to years of research by our team in the area of fracture prevention,” said Dr. Joanna Sale, a scientist at the Li Ka Shing Knowledge Institute. “We want to understand how COVID-19 has affected fracture patients in Ontario so that we can develop interventions to improve preparedness for future health emergencies and pandemics.”

The evidence generated by this proposal will facilitate timely diagnoses and treatment for fracture patients experiencing health inequity, including individuals who are older, have comorbid conditions, and those who experience the gendered impacts of the pandemic.

By: Ana Gajic