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Preventing unintended disaster

March 1, 2021 — 

A light rain fell on the morning of July 24, 1915, as the final passengers boarded the Eastland in Chicago, eager to enjoy a Saturday picnic at a park across Lake Michigan. The ship prepared to leave with its 2,573 passengers, and crucially, 11 lifeboats and 37 life rafts. The ship, however, was designed to carry only six lifeboats. An extra 40,000-pound burden of life rafts now hung from its decks because U.S. President Woodrow Wilson recently signed an act requiring more lifeboats on every ship to prevent another disaster akin to the Titanic, where many perished from a lack of them.

And before the Eastland even left the wharf, the lifeboats caused it to list, and then it capsized so quickly that one reporter said it rolled over like “a dead jungle monster shot through the heart.” Eight hundred and forty-four passengers died, a passenger death toll higher than the Titanic’s.

What was meant to save lives, ended up harming and killing many others. Indeed, in 1638, scientist Galileo Galilei warned in his final book that cautionary measures can in turn cause disaster.

When the COVID-19 virus first moved across the globe, governments quickly implemented lockdowns and social distancing rules. As supply chains broke, they worried about material shortages, including prescriptions drugs, and so enacted precautionary measures. In Canada, for instance, some patients received a one-month refill rather than the usual three-month extension. Factors such as this, and the general fear people have of contracting the virus in medical facilities, has changed how people are using the health care system, but we don’t know exactly who is being affected, or how. That, however, is about to change.

“A UM team led by assistant professor Christine Leong in the College of Pharmacy is starting a novel study to see if our cautionary measures are enabling a disaster somewhere else.”

Thanks to the anonymized administrative health data held in the Manitoba Centre for Health Policy (MCHP) at the University of Manitoba (UM), a UM team led by assistant professor Christine Leong in the College of Pharmacy, is starting a novel study to see if our cautionary measures are enabling a disaster somewhere else. We need to know because more pandemics are inevitable.

Christine Leong.

Christine Leong

Leong and her collaborators received $100,000 in funding from the Research Manitoba COVID-19 Rapid Response Grant to study the changes in med­ication dispensation, health service use (physician visits, hospital visits, emergency department visits), and death rates before—and during—the COVID-19 pandemic in the general population, and in those with a history of mental illness. And in Manitoba, the latter category holds a lot of people: A past UM study found that 28 per cent of our population (or roughly 300,000 individuals) has been diagnosed with a mental disorder within the last five years. So, the potential impact of these restrictions on our society is enormous.

“Obviously a lot of things have changed since COVID happened, and the ways in which people can access in-person health care has shifted, and visits to the Crisis Response Centre for example has gone down. Where are these individuals going? I felt like these changes are a very important area that needed to be looked at,” Leong says.

“I’ve done research in the past looking at health service use and psychotropic medication use in the general population. I was also a primary care pharmacist, working at the Family Medical Centre from 2014 up until it closed in 2019. And I’ve encountered many patients struggling with mental illness, and sometimes the resources available to them are quite limited. So when COVID-19 happened, I was quite interested in studying this further,” she says.

Leong and her team will use the rich data contained within MCHP to see the real-world effects the pandemic has had on those with a psychiatric diagnosis, and the general population.

A key aspect of this study is that it focuses on data from the past five years, including the four years leading up to the pandemic. This enables the research team to establish a solid baseline pattern—which is helpful to policy-makers concerned with everyday planning—and then see how things change during the pandemic, which is key information we need to prepare for the next pandemic. We need to know where to direct resources, both during, and after pandemics: when restrictions lift, people may flood into the system again, potentially creating new resource problems.

James Bolton, a professor of psychiatry at UM, has used MCHP data in other studies and is excited to be collaborating on this specific project.

“I think there’s huge potential for this study to really uncover a lot of important information about how the pandemic is influencing mental health,” he says. “The early signs are that people with mental illnesses are facing unique challenges during the pandemic. And so I think this study is extremely important to take a look at what happens with people’s medication use and their connections with services, to really see what the impacts of COVID are on mental health. And it’s hard to anticipate which direction things will go.”

“I think there’s huge potential for this study to really uncover a lot of important information about how the pandemic is influencing mental health.”

It’s possible the distress caused by social isolation is leading to more people seeking help. Or, the opposite: Because of COVID restricting our ability to connect, people might be avoiding treatments and not renewing prescriptions.

“I think this study will give us a story as to where vulnerable people are going and how they are impacted,” Leong says. “Even before the pandemic, how were they doing? I think this study is going to give us a clearer idea of how we can better care for these patients. This data will let us dig deeper into seeing how can we actually support these patients, whether we are in a pandemic or not.”

Population-level effects

The coronavirus disease 2019 (COVID-19) pandemic is anticipated to have both short-and long-term effects on the mental health and wellbeing of individuals at a population level. Physical distancing, changes in financial circumstances and fears associated with the virus itself can impact mental health. Understanding the psychiatric effects of COVID-19 has become an important research priority. Many shifts in the way individuals access care have occurred.

Using health data from Manitoba, Leong and her team are studying changes in medication adherence, health service use and death rates before and during the COVID-19 pandemic in the general population and in those with a history of mental illness. This study will help us under­stand how the healthcare system can help individuals living with mental illness.

Leong’s team includes collaborators at the Rady Faculty of Health Sciences: Silvia Alessi-Severini, James Bolton, Daniel Chateau, Joseph Delaney, Sherif Eltonsy, Murray Enns, Jamison Falk, Kaarina Kowalec and Jitender Sareen.

Preventing Unintended Disaster is one of the feature stories in the Winter 2021 issue of ResearchLIFE magazine.

Research at the University of Manitoba is partially supported by funding from the Government of Canada Research Support Fund.

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