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- OPEN ACCESS
- Carole A. Estabrooks,
- Sharon E. Straus,
- Colleen M. Flood,
- Janice Keefe,
- Pat Armstrong,
- Gail J. Donner,
- Véronique Boscart,
- Francine Ducharme,
- James L. Silvius, and
- Michael C. Wolfson
The Royal Society of Canada Task Force on COVID-19 was formed in April 2020 to provide evidence-informed perspectives on major societal challenges in response to and recovery from COVID-19. The Task Force established a series of working groups to rapidly develop policy briefings, with the objective of supporting policy makers with evidence to inform their decisions. This paper reports the findings of the COVID-19 Long-Term Care (LTC) working group addressing a preferred future for LTC in Canada, with a specific focus on COVID-19 and the LTC workforce. First, the report addresses the research context and policy environment in Canada’s LTC sector before COVID-19 and then summarizes the existing knowledge base for integrated solutions to challenges that exist in the LTC sector. Second, the report outlines vulnerabilities exposed because of COVID-19, including deficiencies in the LTC sector that contributed to the magnitude of the COVID-19 crisis. This section focuses especially on the characteristics of older adults living in nursing homes, their caregivers, and the physical environment of nursing homes as important contributors to the COVID-19 crisis. Finally, the report articulates principles for action and nine recommendations for action to help solve the workforce crisis in nursing homes. - OPEN ACCESSThe COVID-19 pandemic has highlighted the challenges governments face in balancing civil liberties against the exigencies of public health amid the chaos of a public health emergency. Current and emerging pandemic response strategies may engage diverse rights grounded in civil liberties, including mobility rights, freedom of assembly, freedom of religion, and the right to liberty and security of the person. As traditionally conceived, the discourses of civil rights and public health rest on opposite assumptions about the burden of proof. In the discourse of civil and political rights of the sort guaranteed under the Canadian Charter of Rights and Freedoms, the onus rests on government to show that any limitation on rights is justified. By contrast, public health discourse centers on the precautionary principle, which holds that intrusive measures may be taken—lockdowns, for example—even in the absence of complete evidence of the benefits of the intervention or of the nature of the risk. In this article, we argue that the two principles are not so oppositional in practice. In testing for proportionality, courts recognize the need to defer to governments on complex policy matters, especially where the interests of vulnerable populations are at stake. For their part, public health experts have incorporated ideas of proportionality in their evolving understanding of the precautionary principle. Synthesizing these perspectives, we emphasize the importance of policy agility in the COVID-19 response, ensuring that measures taken are continually supported by the best evidence and continually recalibrated to avoid unnecessary interference with civil liberties.
- OPEN ACCESS
- Tania Bubela,
- E. Richard Gold,
- Vivek Goel,
- Max Morgan,
- Karen Mossman,
- Jason Nickerson,
- David Patrick, and
- Aled Edwards
In the event of the current COVID-19 pandemic and in preparation for future pandemics, open science can support mission-oriented research and development, as well as commercialization. Open science shares skills and resources across sectors; avoids duplication and provides the basis for rapid and effective validation due to full transparency. It is a strategy that can adjust quickly to reflect changing incentives and priorities, because it does not rely on any one actor or sector. While eschewing patents, it can ensure high-quality drugs, low pricing, and access through existing regulatory mechanisms. Open science practices and partnerships decrease transaction costs, increase diversity of actors, reduce overall costs, open new, higher-risk/higher-impact approaches to research, and provide entrepreneurs freedom to operate and freedom to innovate. We argue that it is time to re-open science, not only in its now restricted arena of fundamental research, but throughout clinical translation. Our model and attendant recommendations map onto a strategy to accelerate discovery of novel broad-spectrum anti-viral drugs and clinical trials of those drugs, from first-in-human safety-focused trials to late stage trials for efficacy. The goal is to ensure low-cost and rapid access, globally, and to ensure that Canadians do not pay a premium for drugs developed from Canadian science. - OPEN ACCESSCOVID-19 presents an opportunity to preserve a rich and diverse historical record—one intended to honour all experiences and voices and in recognition of ongoing systemic inequalities shaping the pandemic. But policy changes are necessary in three key areas: how memory institutions are funded and supported, the gaps in our capacity to preserve the digital records that reflect how we communicate with one another today, and how to preserve and make accessible valuable scholarly research into the societal impact of COVID-19. Our goal is to begin a conversation about priorities for archival preservation, the need for greater equity and justice in our preservation practices, and ways to safeguard the existence of historical records that will allow us in future to bear witness, with fairness and truth and in a spirit of reconciliation, to our society’s response to COVID-19.
- OPEN ACCESS
- Victoria Esses,
- Jean McRae,
- Naomi Alboim,
- Natalya Brown,
- Chris Friesen,
- Leah Hamilton,
- Aurélie Lacassagne,
- Audrey Macklin, and
- Margaret Walton-Roberts
Canada has been seen globally as a leader in immigration and integration policies and programs and as an attractive and welcoming country for immigrants, refugees, temporary foreign workers, and international students. The COVID-19 pandemic has revealed some of the strengths of Canada’s immigration system, as well as some of the fault lines that have been developing over the last few years. In this article we provide an overview of Canada’s immigration system prior to the pandemic, discuss the system’s weaknesses and vulnerabilities revealed by the pandemic, and explore a post-COVID-19 immigration vision. Over the next three years, the Government of Canada intends to bring over 1.2 million new permanent residents to Canada. In addition, Canada will continue to accept many international students, refugee claimants, and temporary foreign workers for temporary residence here. The importance of immigration for Canada will continue to grow and be an integral component of the country’s post-COVID-19 recovery. To succeed, it is essential to take stock, to re-evaluate Canada’s immigration and integration policies and programs, and to expand Canada’s global leadership in this area. The authors offer insights and over 80 recommendations to reinvigorate and optimize Canada’s immigration program over the next decade and beyond. - OPEN ACCESS
The need for a federal Basic Income feature within any coherent post-COVID-19 economic recovery plan
COVID-19 has shone a harsh light on the extent of poverty in Canada. When normal economic activity was interrupted by the exigencies of public health driven lockdowns, the shutdown disproportionately affected people who, before the pandemic, were living on incomes beneath the poverty line or dependent upon low-paying hourly remunerated jobs, usually part time and without appropriate benefits. Those living beneath the poverty line in Canada, three million of welfare poor and working poor, include a disproportionately large population of Black and Indigenous people and people of colour. This paper addresses the challenge of inclusive economic recovery. In particular, we propose that the federal government introduce a Basic Income guarantee for all residents of Canada as part of a comprehensive social safety net that includes access to housing, child care, mental and physical health care, disability supports, education, and the many other public services essential to life in a high-income country. Residents with no other income would receive the full benefit that would be sufficient to ensure that no one lives in poverty, while those with low incomes would receive a reduced amount. - OPEN ACCESS
- Annette Majnemer,
- Patrick J. McGrath,
- Jennifer Baumbusch,
- Chantal Camden,
- Barbara Fallon,
- Yona Lunsky,
- Steven P. Miller,
- Genevieve Sansone,
- Tim Stainton,
- John Sumarah,
- Donna Thomson, and
- Jennifer Zwicker
The COVID-19 pandemic has impacted the lives and well-being of all people globally, with consequences being observed across all domains from physical and mental health, to education and employment outcomes, to access to community supports and services. However, the disproportionate impact of the COVID-19 pandemic and its associated public health restrictions on individuals with intellectual and developmental disabilities (IDD) has largely been overlooked. Not only do people with IDD have a greater risk of severe complications and death from the virus as shown in large-scale studies, but they also face significant short- and long-term consequences of COVID-related public health measures on their mental health and well-being. At a time when this vulnerable population is already feeling undervalued, ignored, and forgotten, it is imperative that the risks facing adults and children with IDD—as well as their families and caregivers—are recognized, valued, and addressed through a disability-inclusive approach to Canada’s pandemic policy response planning. This requires both a mainstreaming of disability inclusion into all COVID-19 response and recovery policies as well as disability-specific policies to address the unique barriers and challenges encountered by people with IDD during the pandemic. The recommendations in this policy briefing aim to achieve a more inclusive, accessible, and sustainable Canada for people with IDD both during and after the pandemic—an approach that will result in benefits for all of society. - OPEN ACCESS
- Samira Mubareka,
- John Amuasi,
- Arinjay Banerjee,
- Hélène Carabin,
- Joe Copper Jack,
- Claire Jardine,
- Bogdan Jaroszewicz,
- Greg Keefe,
- Jonathon Kotwa,
- Susan Kutz,
- Deborah McGregor,
- Anne Mease,
- Lily Nicholson,
- Katarzyna Nowak,
- Brad Pickering,
- Maureen G. Reed,
- Johanne Saint-Charles,
- Katarzyna Simonienko,
- Trevor Smith,
- J. Scott Weese, and
- E. Jane Parmley
Given the enormous global impact of the COVID-19 pandemic, outbreaks of highly pathogenic avian influenza in Canada, and manifold other zoonotic pathogen activity, there is a pressing need for a deeper understanding of the human-animal-environment interface and the intersecting biological, ecological, and societal factors contributing to the emergence, spread, and impact of zoonotic diseases. We aim to apply a One Health approach to pressing issues related to emerging zoonoses, and propose a functional framework of interconnected but distinct groups of recommendations around strategy and governance, technical leadership (operations), equity, education and research for a One Health approach and Action Plan for Canada. Change is desperately needed, beginning by reorienting our approach to health and recalibrating our perspectives to restore balance with the natural world in a rapid and sustainable fashion. In Canada, a major paradigm shift in how we think about health is required. All of society must recognize the intrinsic value of all living species and the importance of the health of humans, other animals, and ecosystems to health for all. - OPEN ACCESS
- Gail Tomblin Murphy,
- Tara Sampalli,
- Lisa Bourque Bearskin,
- Nancy Cashen,
- Greta Cummings,
- Annette Elliott Rose,
- Josephine Etowa,
- Doris Grinspun,
- Esyllt W. Jones,
- Mélanie Lavoie-Tremblay,
- Kathleen MacMillan,
- Cindy MacQuarrie,
- Ruth Martin-Misener,
- Judith Oulton,
- Rosemary Ricciardelli,
- Linda Silas,
- Sally Thorne, and
- Michael Villeneuve
Nurses represent the highest proportion of healthcare workers globally and have played a vital role during the COVID-19 pandemic. The pandemic has shed light on multiple vulnerabilities that have impacted the nursing workforce including critical levels of staffing shortages in Canada. A review sponsored by the Royal Society of Canada investigated the impact of the pandemic on the nursing workforce in Canada to inform planning and implementation of sustainable nursing workforce strategies. The review methods included a trend analysis of peer-reviewed articles, a jurisdictional scan of policies and strategies, analyses of published surveys and interviews of nurses in Canada, and a targeted case study from Nova Scotia and Saskatchewan. Findings from the review have identified longstanding and COVID-specific impacts, gaps, and opportunities to strengthen the nursing workforce. These findings were integrated with expert perspectives from national nursing leaders involved in guiding the review to arrive at recommendations and actions that are presented in this policy brief. The findings and recommendations from this policy brief are meant to inform a national and sustained focus on retention and recruitment efforts in Canada. - OPEN ACCESS
- R.T. Noel Gibney,
- Cynthia Blackman,
- Melanie Gauthier,
- Eddy Fan,
- Robert Fowler,
- Curtis Johnston,
- R. Jeremy Katulka,
- Samuel Marcushamer,
- Kusum Menon,
- Tracey Miller,
- Bojan Paunovic, and
- Teddie Tanguay
The COVID-19 pandemic has exposed the precarious demand-capacity balance in Canadian hospitals, including critical care where there is an urgent need for trained health care professionals to dramatically increase ICU capacity.The impact of the pandemic on ICUs varied significantly across the country with provinces that implemented public health measures later and relaxed them sooner being impacted more severely. Pediatric ICUs routinely admitted adult patients. Non-ICU areas were converted to ICUs and staff were redeployed from other essential service areas. Faced with a lack of critical care capacity, triage plans for ICU admission were developed and nearly implemented in some provinces.Twenty eight percent of patients in Canadian ICUs who required mechanical ventilation died. Surviving patients have required prolonged ICU admission, hospitalization and extensive ongoing rehabilitation. Family members of patients were not permitted to visit, resulting in additional psychological stresses to patients, families, and healthcare teams. ICU professionals also experienced extreme psychological stresses from caring for such large numbers of critically ill patients, often in sub-standard conditions. This resulted in large numbers of health workers leaving their professions.This pandemic is not yet over, and it is likely that new pandemics will follow. A review and recommendations for the future are provided. - OPEN ACCESS
- Steve E. Hrudey,
- Heather N. Bischel,
- Jeff Charrois,
- Alex H. S. Chik,
- Bernadette Conant,
- Rob Delatolla,
- Sarah Dorner,
- Tyson E. Graber,
- Casey Hubert,
- Judy Isaac-Renton,
- Wendy Pons,
- Hannah Safford,
- Mark Servos, and
- Christopher Sikora
Wastewater surveillance for SARS-CoV-2 RNA is a relatively recent adaptation of long-standing wastewater surveillance for infectious and other harmful agents. Individuals infected with COVID-19 were found to shed SARS-CoV-2 in their faeces. Researchers around the world confirmed that SARS-CoV-2 RNA fragments could be detected and quantified in community wastewater. Canadian academic researchers, largely as volunteer initiatives, reported proof-of-concept by April 2020. National collaboration was initially facilitated by the Canadian Water Network.Many public health officials were initially skeptical about actionable information being provided by wastewater surveillance even though experience has shown that public health surveillance for a pandemic has no single, perfect approach. Rather, different approaches provide different insights, each with its own strengths and limitations. Public health science must triangulate among different forms of evidence to maximize understanding of what is happening or may be expected. Well-conceived, resourced, and implemented wastewater-based platforms can provide a cost-effective approach to support other conventional lines of evidence. Sustaining wastewater monitoring platforms for future surveillance of other disease targets and health states is a challenge. Canada can benefit from taking lessons learned from the COVID-19 pandemic to develop forward-looking interpretive frameworks and capacity to implement, adapt, and expand such public health surveillance capabilities.