Testing "the science": A comparative analysis of COVID-19 testing policy across four Canadian provinces

Following the COVID-19 pandemic, scholarship has focused on the intersection of politics and scientific evidence in the development, distribution and uptake of vaccines; border closures; and interventions such as public space closures or masking. But there is a significant gap in the examination of the political choices which informed how discrete jurisdictions chose to undertake and support COVID-19 testing. Using a qualitative, multiple-case study nested in a larger comparative, mixed-method explanatory case study, this research addresses this gap in the literature through a qualitative analysis based on 103 key stakeholder interviews to inform the narrative of testing strategy across four Canadian provinces. Despite the perception that testing is a largely "scientific" process relatively insulated from political choices and pressures, this study shows that jurisdictions had to address an array of variables, often specific to their region, which strongly influenced policy choices in this area. Testing policy, rather than a simple and straightforward clinical exercise, is a highly complex and nuanced process that must take into account a wide variety of non-clinical variables.

Early COVID-19 Pandemic Preparedness: Informing Public Health Interventions and Hospital Capacity Planning Through Participatory Hybrid Simulation Modeling

We engaged with health sector stakeholders and public health professionals within the health system through a participatory modeling approach to support policy-making in the early COVID-19 pandemic in Saskatchewan, Canada. The objective was to use simulation modeling to guide the implementation of public health measures and short-term hospital capacity planning to mitigate the disease burden from March to June 2020. We developed a hybrid simulation model combining System Dynamics (SD), discrete-event simulation (DES), and agent-based modeling (ABM). SD models the population-level transmission of COVID-19, ABM simulates individual-level disease progression and contact tracing intervention, and DES captures COVID-19-related hospital patient flow. We examined the impact of mixed mitigation strategies-physical distancing, testing, conventional and digital contact tracing-on COVID-19 transmission and hospital capacity for a worst-case scenario. Modeling results showed that enhanced contact tracing with mass testing in the early pandemic could significantly reduce transmission, mortality, and the peak census of hospital beds and intensive care beds. Using a participatory modeling approach, we not only directly informed policy-making on contact tracing interventions and hospital surge capacity planning for COVID-19 but also helped validate the effectiveness of the interventions adopted by the provincial government. We conclude with a discussion on lessons learned and the novelty of our hybrid approach.

TAS2R38 haplotypes, COVID-19 infection, and symptomatology: a cross-sectional analysis of data from the Canadian Longitudinal Study on Aging

The TAS2R38 gene is well known for its function in bitter taste sensitivity, but evidence also suggests a role in innate immunity. TAS2R38 may be relevant in coronavirus disease 2019 (COVID-19), but research findings are inconsistent. The objective of this study was to explore whether common TAS2R38 haplotypes are associated with COVID-19 infection and symptomatology in the Canadian Longitudinal Study on Aging (CLSA). Data from the CLSA COVID-19 Questionnaire and Seroprevalence sub-studies were utilized with CLSA genetic data for common TAS2R38 haplotypes related to bitter taste sensitivity. Haplotypes were categorized into three diplotype groups: [P]AV homozygotes, [P]AV/[A]VI heterozygotes, and [A]VI homozygotes. No significant differences were observed between diplotypes and COVID-19 infection frequency. Among self-reported COVID-19 cases (n = 76), and in uncorrected exploratory analyses, heterozygotes were less likely to report experiencing sinus pain compared to [P]AV homozygotes. Among seroprevalence-confirmed cases (n = 177), [A]VI homozygotes were less likely to report experiencing a sore/scratchy throat compared to [P]AV homozygotes. However, both observations were non-significant upon correction for multiple testing. In this study, TAS2R38 haplotypes were not significantly associated with COVID-19 infection or symptomatology. Nevertheless, in light of some exploratory patterns and conflicting evidence, additional research is warranted to evaluate links between TAS2R38 and innate immunity.

Prevalence of Unmet Rehabilitation Needs Among Canadians Living With Long-term Conditions or Disabilities During the First Wave of the COVID-19 Pandemic

OBJECTIVE

We aimed to describe the prevalence of unmet rehabilitation needs among a sample of Canadians living with long-term conditions or disabilities during the first wave of the COVID-19 pandemic.

DESIGN

Cross-sectional survey.

SETTING

Individuals residing in Canada during the first wave of the COVID-19 pandemic.

PARTICIPANTS

Eligible participants were Canadians living with long-term conditions or disabilities, 15 years or older living in 1 of the 10 provinces or 3 territories (n=13,487).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

We defined unmet rehabilitation needs as those who reported needing rehabilitation (ie, physiotherapy/massage therapy/chiropractic, speech, or occupational therapy, counseling services, support groups) but did not receive it because of the COVID-19 pandemic. We calculated the national, age, gender, and province/territory-specific prevalence and 95% confidence interval of unmet rehabilitation needs.

RESULTS

During the first wave of the pandemic, the prevalence of unmet rehabilitation needs among Canadians with long-term conditions or disabilities was 49.3% (95% confidence interval [CI]; 48.3, 50.3]). The age-specific prevalence was higher among individuals 15-49 years old (55.6%; 95% CI [54.2, 57.1]) than those 50 years and older (46.0%; 95% CI [44.5, 47.4]). Females (53.7%; 95% CI [52.6, 54.9]) had higher unmet needs than males (44.1%; 95% CI [42.3, 45.9]). Unmet rehabilitation needs varied across provinces and territories.

CONCLUSIONS

In this sample, almost 50% of Canadians living with long-term conditions or disabilities had unmet rehabilitation needs during the first wave of the COVID-19 pandemic. This suggests that a significant gap between the needs for and delivery of rehabilitation care existed during the early phase of the pandemic.

Personal protective equipment during COVID-19: A natural history of dental and dental hygiene regulatory guidance in Canada

BACKGROUND

Due to the evolving nature of COVID-19, there is evidence that COVID-19-specific infection prevention and control guideline (IPCG) documents formulated for oral health care settings are also changing rapidly. To better inform future policies, a comprehensive review of all IPCG documents across different phases of restrictions for oral health care practitioners is required.

TYPES OF STUDIES REVIEWED

A search was performed for documents shared from March 2020 through January 2022 on websites of oral health regulatory authorities in Canada's 10 provinces and 3 territories. The authors performed a narrative review of the identified IPCG documents for dentists (n = 78) and dental hygienists (n = 57).

RESULTS

Overall findings from more than 100 IPCG documents distributed during a period of 23 months revealed that the frequency of these updates differed among jurisdictions and between the 2 oral health care practitioners (ie, dentists and dental hygienists) within the same jurisdiction. The most notable observation was the different face-covering recommendations for dentists and dental hygienists within the same jurisdiction during the same timeframe. A common document was sometimes observed for dentists and dental hygienists, however, most jurisdictions had separate IPCG documents.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

The different approaches could have been justified on the basis of prevalence of COVID-19 and availability of personal protective equipment; however, there was a risk of creating confusion about IPCG best practices. The findings of this review will support decision makers when planning future development and dissemination of regulations for all oral health care practitioners.

Newcomer perceptions of COVID-19 countermeasures in Canada

Newcomers to Canada have been disproportionally affected by COVID-19, with higher rates of infection and severity of illness. Determinants of higher rates may relate to social and structural inequities that impact newcomers' capacity to follow countermeasures. Our aim was to describe and document factors shaping newcomers' acceptance of COVID-19 countermeasures. Semi-structured qualitative interviews were conducted with individuals living in Canada for <5 years. Participants were asked to discuss their pandemic experiences, and perceptions and acceptance of measures. Five themes were identified: (i) belief in the necessity and efficacy of countermeasures; (ii) negative impact of measures on health/wellbeing; (iii) existing barriers to newcomer settlement exacerbated by pandemic measures; (iv) countermeasure adherence related to immigration status and (v) past experiences shaping countermeasure acceptance. Government should continue to provide messaging regarding the importance of measures for individual and population heath and continue to demonstrate a commitment to the interests of citizens. Importantly, newcomer trust in government should not be taken for granted, as this trust is critical for the acceptance of government interventions now and moving forward. It will be important to ensure that newcomers are given support to overcome challenges to settlement that were intensified during the pandemic.

Canadian COVID-19 Outbreak Surveillance System: implementation of national surveillance during a global pandemic

SETTING

Early in the SARS-CoV-2 pandemic, the need to develop systematic outbreak surveillance at the national level to monitor trends in SARS-CoV-2 outbreaks was identified as a priority for the Public Health Agency of Canada (PHAC). The Canadian COVID-19 Outbreak Surveillance System (CCOSS) was established to monitor the frequency and severity of SARS-CoV-2 outbreaks across various community settings.

INTERVENTION

PHAC engaged with provincial/territorial partners in May 2020 to develop goals and key data elements for CCOSS. In January 2021, provincial/territorial partners began submitting cumulative outbreak line lists on a weekly basis.

OUTCOMES

Eight provincial and territorial partners, representing 93% of the population, submit outbreak data on the number of cases and severity indicators (hospitalizations and deaths) for 24 outbreak settings to CCOSS. Outbreak data can be integrated with national case data to supply information on case demographics, clinical outcomes, vaccination status, and variant lineages. Data aggregated to the national level are used to conduct analyses and report on outbreak trends. Evidence from CCOSS analyses has been useful in supporting provincial/territorial outbreak investigations, informing policy recommendations, and monitoring the impact of public health measures (vaccination, closures) in specific outbreak settings.

IMPLICATIONS

The development of a SARS-CoV-2 outbreak surveillance system complemented case-based surveillance and furthered the understanding of epidemiological trends. Further efforts are required to better understand SARS-CoV-2 outbreaks for Indigenous populations and other priority populations, as well as create linkages between genomic and epidemiological data. As SARS-CoV-2 outbreak surveillance enhanced case surveillance, outbreak surveillance should be a priority for emerging public health threats.

Healthcare utilization and adverse outcomes stratified by sex, age and long-term care residency using the Alberta COVID-19 Analytics and Research Database (ACARD): a population-based descriptive study

BACKGROUND

Understanding the epidemiology of Coronavirus Disease of 2019 (COVID-19) in a local context is valuable for both future pandemic preparedness and potential increases in COVID-19 case volume, particularly due to variant strains.

METHODS

Our work allowed us to complete a population-based study on patients who tested positive for COVID-19 in Alberta from March 1, 2020 to December 15, 2021. We completed a multi-centre, retrospective population-based descriptive study using secondary data sources in Alberta, Canada. We identified all adult patients (≥ 18 years of age) tested and subsequently positive for COVID-19 (including only the first incident case of COVID-19) on a laboratory test. We determined positive COVID-19 tests, gender, age, comorbidities, residency in a long-term care (LTC) facility, time to hospitalization, length of stay (LOS) in hospital, and mortality. Patients were followed for 60 days from a COVID-19 positive test.

RESULTS

Between March 1, 2020 and December 15, 2021, 255,037 adults were identified with COVID-19 in Alberta. Most confirmed cases occurred among those less than 60 years of age (84.3%); however, most deaths (89.3%) occurred among those older than 60 years. Overall hospitalization rate among those who tested positive was 5.9%. Being a resident of LTC was associated with substantial mortality of 24.6% within 60 days of a positive COVID-19 test. The most common comorbidity among those with COVID-19 was depression. Across all patients 17.3% of males and 18.6% of females had an unplanned ambulatory visit subsequent to their positive COVID-19 test.

CONCLUSIONS

COVID-19 is associated with extensive healthcare utilization. Residents of LTC were substantially impacted during the COVID-19 pandemic with high associated mortality. Further work should be done to better understand the economic burden associated with related healthcare utilization following a COVID-19 infection to inform healthcare system resource allocation, planning, and forecasting.

An equitable vaccine delivery system: Lessons from the COVID-19 vaccine rollout in Canada

BACKGROUND

The COVID-19 pandemic exacerbated existing health disparities and disproportionately affected vulnerable individuals and communities (e.g., low-income, precariously housed or in institutional settings, racialized, migrant, refugee, 2SLBGTQ+). Despite their higher risk of infection and sub-optimal access to healthcare, Canada's COVID-19 vaccination strategy focused primarily on age, as well as medical and occupational risk factors.

METHODS

We conducted a mixed-methods constant comparative qualitative analysis of epidemiological data from a national database of COVID-19 cases and vaccine coverage in four Canadian jurisdictions. Jurisdictional policies, policy updates, and associated press releases were collected from government websites, and qualitative data were collected through 34 semi-structured interviews of key informants from nine Canadian jurisdictions. Interviews were coded and analyzed for themes and patterns.

RESULTS

COVID-19 vaccines were rolled out in Canada in three phases, each accompanied by specific challenges. Vaccine delivery systems typically featured large-venue mass immunization sites that presented a variety of barriers for those from vulnerable communities. The engagement and targeted outreach that featured in the later phases were driven predominantly by the efforts of community organizations and primary care providers, with limited support from provincial governments.

CONCLUSIONS

While COVID-19 vaccine rollout in Canada is largely considered a success, such an interpretation is shaped by the metrics chosen. Vaccine delivery systems across Canada need substantial improvements to ensure optimal uptake and equitable access for all. Our findings suggest a more equitable model for vaccine delivery featuring early establishment of local barrier-free clinics, culturally safe and representative environment, as well as multi-lingual assistance, among other vulnerability-sensitive elements.

Examining the barriers, facilitators and attitudes towards COVID-19 vaccine and public health measures for black communities in Canada: a qualitative study protocol

INTRODUCTION

Black communities claim the highest number of cases and deaths due to COVID-19 in Canada. Generating culturally/contextually appropriate public health measures and strategies for vaccine uptake in black communities within Canada can better support the disproportionate impact of this pandemic. This study explores the barriers and enablers to public health measures limited to mask-wearing, disinfection, sanitation, social distancing and handwashing, as well as the barriers and attitudes towards COVID-19 vaccines among the black community.

METHODS AND ANALYSIS

We will use qualitative approaches informed by the widely accepted Consolidated Framework for Implementation Research (CFIR) to aid our investigation. We will conduct 120 semistructured interviews and five focus groups with black populations across the major provinces of Canada to understand the barriers and facilitators to public health measures, including barriers and attitudes towards COVID-19 vaccines. Data will be organised and analysed based on the CFIR. Facilitators and barriers to COVID-19 preventative measures and the barriers, facilitators and attitudes towards COVID-19 vaccines will be organised to explore relationships across the data.

ETHICS AND DISSEMINATION

This study was approved by the Social Sciences, Humanities and Education Research Ethics Board at the University of Toronto (41585). All participants are given information about the study and will sign a consent form in order to be included; participants are informed of their right to withdraw from the study. Research material will be accessible to all researchers involved in this study as no personal identifiable information will be collected during the key informant semistructured interviews and focus groups. The study results will be provided to participants and published in peer-reviewed journals.

Understanding the Associations among Social Vulnerabilities, Indigenous Peoples, and COVID-19 Cases within Canadian Health Regions

Indigenous Peoples are at an increased risk for infectious disease, including COVID-19, due to the historically embedded deleterious social determinants of health. Furthermore, structural limitations in Canadian federal government data contribute to the lack of comparative rates of COVID-19 between Indigenous and non-Indigenous people. To make visible Indigenous Peoples' experiences in the public health discourse in the midst of COVID-19, this paper aims to answer the following interrelated research questions: (1) What are the associations of key social determinants of health and COVID-19 cases among Canadian health regions? and (2) How do these relationships relate to Indigenous communities? As both proximal and distal social determinants of health conjointly contribute to COVID-19 impacts on Indigenous health, this study used a unique dataset assembled from multiple sources to examine the associations among key social determinants of health characteristics and health with a focus on Indigenous Peoples. We highlight key social vulnerabilities that stem from systemic racism and that place Indigenous populations at increased risk for COVID-19. Many Indigenous health issues are rooted in the historical impacts of colonization, and partially invisible due to systemic federal underfunding in Indigenous communities. The Canadian government must invest in collecting accurate, reliable, and disaggregated data on COVID-19 case counts for Indigenous Peoples, as well as in improving Indigenous community infrastructure and services.