Discourse on COVID-19 and illicit drug toxicity on social media

This Health System Impact Fellowship is co-funded by ­CIHR Institute of Population and Public Health (CIHR-IPPH), Michael Smith Health Research BC, and the BC Centre for Disease Control (health system partner), to help build BC’s health policy research capacity for the integration of policy research into decision-making.


The illicit drug overdose crisis in North America has had a profound impact on individuals, families and communities, often leading to premature loss of life and lowering of life expectancy. Since 2016, British Columbia (BC) has been experiencing an epidemic of toxic drug supply leading to a large increase in the number of drug overdose events and related deaths. Coronavirus disease 2019 (COVID-19) and measures taken to limit the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, have directly and indirectly disrupted access to healthcare and social services worldwide, including harm reduction and social support services. Since the beginning of the COVID-19 pandemic, BC witnessed large increases in drug overdose related deaths, with 2021 being the deadliest year. This requires scaling up of existing interventions and introducing new, targeted interventions to address the overdose crisis. The level and type of response is also affected by the perception of the population towards health issues and debate on intervention options. The information available on social media could help decision makers understand the public discourse about opioid use and intervention options. In this project, the overall aim is to understand public perceptions and discourse related to overdose in social media using Artificial Intelligence (AI) methods and techniques to inform the overdose response.


Source: CIHR Funding Decisions Database

Impacts of COVID-19 pandemic on diabetes care among South Asian population

This Health System Impact Fellowship is co-funded by CIHR, Michael Smith Health Research BC, and the BC Centre for Disease Control (health system partner), to help build BC’s health policy research capacity for the integration of policy research into decision-making.


COVID-19 and pandemic response measures implemented to limit its spread have resulted in various indirect health impacts due to the disruption of many preventative, diagnostic, and management services. The extent of their impacts on the diabetes care cascade are not known. South Asians, representing 25 percent of the visible minorities have highest burden of Type 2 diabetes. Higher incidence of COVID-19 was reported in neighborhood areas with higher density of South Asian population in British Columbia (BC) and Ontario. However, it is not known if diabetes care cascade among South Asians was impacted more than other population groups.


We aim to assess: a) The impact of COVID-19 pandemic on the diabetes care cascade, b) Differential impact in South Asians vs other population groups; c) Patient/provider perceptions of disruption of services.


We will use BC COVID-19 Cohort which integrates daily COVID-19 lab tests, case follow-up data, COVID-19 immunizations, hospital and ICU admissions, with demographic, healthcare utilization datasets (medical visits, hospital admissions, emergency room visits, dispensed prescription drugs) Chronic Disease Registry and socioeconomic data and data from BC SPEAK Survey. We will construct care cascade in pre-pandemic years and pandemic/post pandemic years and apply a combination of epidemiological and statistical techniques to investigate the stated aims. We will gather qualitative data based on interviews with diabetes patients and care providers to provide context and inform interventions to prevent further disruptions and optimize care.


This project will characterize the extent of disruption in services across diabetes care cascade and will identify characteristics of population most affected. We will provide evidence on disparities experienced by South Asians and identify strategies to mitigate the impacts of the COVID-19 pandemic or future similar health emergencies for individuals with diabetes.


Source: CIHR Funding Decisions Database

Developing a risk index for multimorbidity surveillance in British Columbia

This Health System Impact Fellowship is co-funded by CIHR, Michael Smith Health Research BC, and the BC Centre for Disease Control (health system partner), to help build BC’s health policy research capacity for the integration of policy research into decision-making.


Multimorbidity is when an individual has two or more chronic diseases. But, behind this simple definition lies a complex phenomenon. Chronic diseases interact, and their combined health impacts can be greater than predicted by their individual impacts. Multimorbidity accumulates with age and affects the majority of senior citizens in Canada. For these seniors, multimorbidity increases health complications; including dementia, severe complications from COVID-19, and susceptibility to heat and climate events.


The BC Centre for Disease Control’s mandate is to provide accurate, timely and actionable health intelligence about population well-being and its determinants to decision makers in BC. This project follows this mandate, to improve knowledge of multimorbidity across BC. Multimorbidity is a huge challenge for our health care system because of its complexity. There are countless possible disease combinations, each with unique interactive effects on health. For this reason, most previous research has indexed multimorbidity by a simple count of the number of co-occurring diseases. But this approach loses granularity in understanding the nature of disease combinations.


Our goal is to use data clustering analyses to identify patterns of co-occurring diseases across the BC population and create a multimorbidity disease cluster index. We will apply this cluster index to measure how common different clustered disease combinations are across BC, and how different disease clusters relate to negative health outcomes. Finally, we will measure how disease clusters vary by sociodemographic variables like age, sex and gender, and socioeconomic status.


This project will enhance the ability of BC health authorities to identify opportunities for public health planning around multimorbidity, with knowledge of specific disease combinations and their sociodemographic context. Our project output will lay the foundation for enhanced population health surveillance and monitoring in BC.


Source: CIHR Funding Decisions Database

Tailoring antibiotic audit and feedback according to dentists’ needs

Twelve percent of all dental antibiotic prescriptions in BC are for clindamycin, a drug with considerable risk of adverse effects compared with alternatives. Good dental outcomes are achieved with much lower use of that drug in Australia (5 percent), and the UK (0.5 percent). Prescribing clindamycin endangers patient safety due to higher rates of Clostridium difficile infections, increases the risk of resistance, and should only be used when no better option is available. Audit and feedback interventions have decreased antibiotic prescribing rates in various settings, but experience with its use in dental prescribing is limited. Further, there is growing evidence that strategies informed by behavioral theory may be more effective and should be explored. Focus groups will provide an understanding of the current challenges in dental prescribing and test the responses on audit and feedback as well as the planned and alternative behavioral interventions. This would enable tailoring the audit and feedback according to the dentists’ needs making the intervention more relevant to the receivers and more effective.

Team members: Sade Stenlund (BCCDC); Fawziah Lalji (UBC – Faculty of Pharmaceutical Sciences); Clifford Pau (UBC – Faculty of Dentistry); Mamun Abdullah (BCCDC); Nick Smith (BCCDC); Max Xie (BCCDC); Lynsey Hamilton (BCCDC); Kirstin Appelt (Sauder School of Business); Dana Stanley (UBC – Therapeutics Initiative); Anat Fisher (UBC Therapeutics Initiative); Sophie Y. Wang (University of Hamburg).

Building capacity to reduce overdose among formerly incarcerated people in British Columbia

BC is facing dual public health emergencies of COVID-19 and a public health emergency of overdose, first declared in 2016. New interventions have been introduced to reduce overdose in BC, including efforts to decriminalize drug possession and the introduction of pharmaceutical alternatives to the toxic drug supply, known as “Risk Mitigation Guidance” (RMG) prescribing. RMG allows physicians to prescribe pharmaceutical medications (e.g. opioids, stimulants) to people at risk of overdose. While provincial evaluations of pharmaceutical alternatives are ongoing, little is known about the impact of these interventions on people who have been incarcerated, who face a disproportionate burden of overdose risk and mortality in BC, particularly in the weeks immediately following release from correctional institutions.

We aim to address this knowledge gap by convening a Peer Advisory Group of people with lived and living experience of substance use and incarceration. The group will advise on how data sources created in response to the 2016 public health emergency (BC-ODC) can be used to investigate interventions to reduce overdose, with attention to the unique and context-specific overdose risks faced by people who have been incarcerated.

Team members: Ana Becerra (BC Centre for Disease Control); Helen Brown (UBC); Jane Buxton (BC Centre for Disease Control); Ruth Elwood Martin (UBC); Kurt Lock (BC Centre for Disease Control); Tonia Nicholls (UBC); Erin Wilson (University of Northern British Columbia); Chloe Xavier (BC Centre for Disease Control); Sofia Bartlett (BC Centre for Disease Control); Cameron Geddes (UBC); Heather Palis (BC Centre for Disease Control); Marnie Scow (UBC); Chas Coutlee (Indian Residential School Survivors Society); Nicholas Crier (UBC’s Transformative Health and Justice Cluster); Jade Hoffman (Prince George Urban Aboriginal Justice Society); Patrick Keating (UBC’s Transformative Health and Justice Cluster ); Jenny McDougall (BC Centre for Disease Control); Rick Meier (Coalition of Substance Users of the North); Elder Roberta Price (UBC’s Transformative Health and Justice Cluster); Glenn Young (Unlocking the Gates Services Society); Pam Young (Unlocking the Gates Services Society); Andrew Ivsins (Ministry of Mental Health and Addictions); Carrie McCully (BC Corrections); Angus Monaghan (BC Mental Health and Substance Use Services); Justine Patterson (BC Mental Health and Substance Use Services); Kathryn Proudfoot (BC Mental Health and Substance Use Services); Vijay Seethpathy (BC Mental Health and Substance Use Services)

Evaluating the impact of pharmaceutical interventions to reduce overdose among people with criminal justice system involvement in British Columbia

People with criminal justice system involvement (i.e. who have been to prison for a criminal offence) are more likely to use drugs like heroin and methamphetamine compared to the general population. People who use drugs also are at higher risk of negative outcomes like overdose and more rapid or frequent return to prison. Efforts to address overdose, both in prisons and in the community, have been focused on providing treatment for people who use opioids (e.g. heroin, fentanyl). This alone may not be sufficient to reduce overdose risk, particularly among people who use other substances (e.g. cocaine, alcohol) in addition to opioids. In March 2020, in the context of COVID-19, the British Columbia (BC) Ministry of Health provided new Risk Mitigation Guidance (RMG) for doctors, permitting them to prescribe opioids, stimulants, benzodiazepines, and alcohol withdrawal management medications to people at risk of overdose. In this study, I will evaluate whether the RMG has reduced overdose and return to prison among people with criminal justice system involvement in BC. This study will highlight gaps in substance use services in BC, and will inform evidence-based services that can help to reduce overdose in prison and community.

Identifying leverage points for strengthening coordinated intersectoral action for health promotion in British Columbia

This Health System Impact Fellowship is co-funded by CIHR, Michael Smith Health Research BC, and the BC Centre for Disease Control (health system partner), to help build BC’s health policy research capacity for the integration of policy research into decision-making.


Health promotion (HP) enables people to increase control over health and reduce health inequities through action on the determinants of health. HP actions include developing personal skills, creating supportive environments, strengthening community action, building healthy public policy, and reorienting health services to improve population health and wellness.The COVID-19 pandemic has emphasized the need for more coordinated, integrated and intersectoral HP action. The focus and value-add of the project is the development of co-created (with research, policy, and practice stakeholders) recommendations for enhanced HP and the innovative application of a complex systems approach to support this work. Using physical activity as a starting point, this project will to map (inventory) HP initiatives targeting physical activity at the provincial, regional, and local levels and identify areas to enhance coordination and integration to build healthier communities. The anticipated impacts and value of achieving this goal include:


  • Shared leadership, governance, and accountability for HP.
  • Increased collaborative capacity to align HP.
  • Enhanced focus among stakeholders on reducing health equities.
  • Shared resources (human, financial, infrastructure) to implement HP.
  • Improved information (knowledge exchange, research and evaluation, monitoring and surveillance).
  • Shared learning and understanding among stakeholders of new approaches to HP identified through the lens of a complex systems paradigm.


There are three objectives:


  1. Describe and map existing physical activity HP initiatives and systems in BC.
  2. Assess systems to identify facilitating and hindering factors and key feedback mechanisms that influence implementation, coordination and integration.
  3. Strengthen systems through identification of priority leverage points and recommendations for more synergistic implementation of coordinated intersectoral HP in BC.


Source: CIHR Funding Decisions Database

Novel metabolomics approach for the diagnosis of infectious diseases

Tests to determine whether an individual has a disease or not are often expensive and performed on complex instruments in laboratories. As such, there is currently an important unmet need for tests to diagnose infectious diseases with highly accurate, inexpensive and simple methods that could be performed nearer to the patient.

We have developed a method that can identify the metabolites (small molecules) that change in response to infection. As a proof-of-concept, we demonstrated its successful use for the highly accurate detection of respiratory viruses directly from swabs taken from the nasopharynx (upper part of the throat behind the nose).

We now aim to expand this method to a new testing instrument at the BC Centre for Disease Control and assess its test performance for the detection of other infectious diseases like human papillomavirus (HPV) and tuberculosis (TB). Identification of a limited set of metabolites for each condition will enable the adaptation of the method to a simpler, near-patient diagnostic test. Such a test has the potential to reduce the time it takes to obtain an accurate diagnosis and improve clinical outcomes at a population level.

Population-based Study of Coronavirus Antibody Cross-Reactivity to Inform SARS-CoV-2 Seroprevalence Surveys, Severity Profiles, and Vaccine Strategies

Most people have had one or more colds due to seasonal coronaviruses (CoV) with the number of prior infections increasing with age. SARS-CoV-2 entered the human population in late 2019, causing the COVID-19 pandemic. Before that no one had immunity yet older males are at higher risk of severe COVID-19 illness. One explanation is that prior antibodies to seasonal CoVs may enhance SARS-CoV-2 risk through a process called antibody dependent enhancement. To assess that hypothesis we first need to know if seasonal CoV antibodies interact with SARS-CoV-2, how common those antibodies are, and if older men have more of them. We will develop a pan-CoV assay to compare prevalence of all human CoVs by age and sex. Findings will inform SARS-CoV-2 sero-surveys, severity profiles and vaccine strategies.

Measuring the Impact of Physical Distancing Measures and Creating Paths for Monitoring during the Relaxation Phase of the COVID-19 Pandemic

As of April 30, 2020, Coronavirus disease 2019 (COVID-19) has caused over 3.2 million cases and 230,000 deaths, globally. The SARS-COV-2 virus causes COVID-19 and is spread by close contact. To reduce its spread, physical distancing measures have been implemented in British Columbia (BC). These measures will be relaxed once transmission is low, but this could increase transmission.

This project will establish a system to measure physical distancing behaviours in BC with:

  1. ongoing surveys to monitor local contact patterns; and
  2. analysis of mobility data from multiple sources, such as TransLink, traffic data, and mobility indices from Google, Citymapper and Apple. This system will inform education and communication needs and policy decisions related to physical distancing measures in BC.