By Maria Sarrouh
(November 16, 2020) – Can we track COVID-19 through our province’s waste water? This is one of the many questions on the minds of the experts on Ontario’s COVID-19 Science Advisory Table.
Every week, a team of nearly 40 scientists with diverse backgrounds gather to discuss questions pertaining to the pandemic that you may have never considered. The Science Table provides weekly summaries of the best global evidence to the Province of Ontario’s Health Coordination Table, and recaps findings for the public in the form of Science Briefs. Through sharing their expertise, Dr. Peter Jüni, director of the Science Table, along with his Unity Health colleagues Drs. Arthur Slutsky, Janet Smylie, Fahad Razak and Pavlos Bobos are playing an essential role in guiding the government’s decision-making.
Each member of the table draws on a unique research background. For example, the sickest COVID-19 patients will sometimes develop Acute Respiratory Distress Syndrome (ARDS), experience acute lung failure and require mechanical ventilation. These topics are Dr. Slutsky’s areas of expertise as a researcher at the Keenan Research Centre for Biomedical Science, and he has published over 20 articles on COVID-19 since the pandemic began.
Dr. Slutsky said he hopes the Science Table can support the province in more clinical trials on patients being treated for COVID-19. He used the example of the RECOVERY Trial conducted by the United Kingdom’s National Health Service, where COVID-19 treatments are being tested on over 14,000 patients across the country.
“We’re a single health-care system. We could be doing more things like that,” Dr. Slutsky said. “And six months from now, we’ll have more answers than we do now, because of work done in Ontario.”
What he thinks is particularly notable about the Science Table is its size and diversity.
“We have members with different backgrounds: epidemiology, virology, clinical trials, mathematical modeling…everything you need for this kind of thing,” Dr. Slutsky said. “Ontario should know this.”
For example, when it came to identifying populations at risk, Dr. Janet Smylie, a global leader in Indigenous health research based at St. Michael’s, added multi-generational households to the conversation — something that was originally missing from the dialogue. Three generations or more may live in the same household in First Nations, Inuit and Métis communities, which strengthens cultural continuity, but presents a challenge during the pandemic.
“People think that only happens in rural and remote communities, but it’s happening right here in Toronto,” Dr. Smylie said.
She has two major priorities in her role on the Science table. The first is to contribute her expertise in Indigenous health sciences, social epidemiology and health promotion. The other is to learn everything she can about what’s happening related to COVID-19 across different disciplines in order to apply it to her day job: mitigating the spread of the pandemic among First Nations, Inuit and Métis people.
“There’s huge infrastructure gaps. We don’t have the kind of surveillance systems that most Canadians take for granted,” Dr. Smylie said, explaining that for the most part, COVID-19 tracking is unable to detect infection in Toronto’s Indigenous community.
“Some of the topics we’re working on related to COVID-19 expose health inequities. They expose issues in our society,” she said.
Although Indigenous public health is a growing workforce, there’s a shortage of Indigenous epidemiologists, or clinician researchers who are focused on infectious disease response, Dr. Smylie said. She often uses the metaphor of a wildfire to describe the urgency of responding to the COVID-19 pandemic.
“If I was trained as a firefighter, this would probably be the biggest wildfire I would ever see,” Dr. Smylie said.
Drawing on his frontline experience with COVID-19 care, Dr. Fahad Razak, a Scientist at the Li Ka Shing Knowledge Institute and General Internal Medicine Physician at St. Michael’s, is providing the Science Table with a perspective on hospital care efficiency, quality and capacity. He said that hospitals are currently filled to the brink with non-COVID patients.
“The majority of patients admitted to hospitals with COVID-19 go to general medical wards first,” said Dr. Razak, who helped lead St. Michael’s COVID-19 wards for several weeks when the pandemic first began. “If there’s a significant increase in the number of COVID-19 patients requiring hospitalizations, it’s going to become important to figure out how to safely provide care for everyone.”
Part of the mandate of the Science Table is to help clinicians deliver the highest-quality COVID-19 care possible through Science Briefs. He hopes to contribute to those briefs by presenting rapidly generated evidence from research groups across the world.
Dr. Razak explained that insights from the General Medicine Inpatient Initiative (GEMINI) — a big data network across hospitals which he co-leads – will help inform decision making related to COVID-19 care in the province. GEMINI analyzes routinely collected electronic data of patients who are admitted to 30 hospitals across the province.
“Our first cut of data from all these hospitals will be ready soon,” Dr. Razak said. “We’re hoping that we can take all of that evidence and provide something meaningful and actionable for the government.”
Dr. Jüni meets with the provincial government’s Health Coordination Table typically once a week to bring forward the table’s findings and ideas. He helps support the province’s COVID-19 initiatives, like making sure a province-wide project on wastewater detection of the virus — for which the Ford government has dedicated $12 million — stays on track and begins activities this fall.
The Science Table meets twice a week, where members present scientific reports, peer-reviewed papers and pre-print stories related to the COVID-19 pandemic. Helping Dr. Jüni sort information presented at the meetings is Dr. Pavlos Bobos, a Postdoctoral Fellow at the Li Ka Shing Knowledge Institute and a member of the secretariat of the Science Advisory Table.
“After each weekly meeting, we untangle every piece of information, and gather the evidence we’re going to present to the Health Coordination table,” Dr. Bobos said. “And we try to write the Science Briefs in layman’s terms, so everyone can understand them.”
When Dr. Jüni was first approached about becoming the Director of the Science Table, he hesitated to take on the role, calling it an “equally scary and interesting proposition.”
Nevertheless, he stepped up to the plate, bringing with him a research background that covers clinical medicine, public health, epidemiology and statistics, as well as experience as the Director of the Applied Health Research Centre (AHRC) at St. Michael’s Li Ka Shing Knowledge Institute.
Achieving as much transparency as possible is a priority for Dr. Jüni. He wants the public to know which topics are being discussed with the Health Coordination table. He also wants the public to know who the members of the Science Table are, their backgrounds and any potential conflicts of interest they may have.
“What is most important from my perspective is to be completely honest with everybody about what we know and don’t know, and the mistakes we make,” he said. “We’re still building this up. We’re riding the bike while we build it.”