COVID-19 in correctional facilities in Ontario, Canada: a retrospective epidemiological analysis from 15 January 2020 to 31 December 2022.

PURPOSE: The physical environment of correctional facilities promote infectious disease transmission and outbreaks. The purpose of this study is to compare the COVID-19 burden between the correctional facility (incarcerated individuals and staff members) and non-correctional facility population in Ontario during the COVID-19 pandemic. DESIGN/METHODOLOGY/APPROACH: All individuals in Ontario with a laboratory confirmation of SARS-CoV-2 between 15 January 2020 and 31 December 2022 and entered into the provincial COVID-19 data were included. Cases were classified as a correctional facility case (living or working in a correctional facility) or a non-correctional facility case. COVID-19 vaccination status was obtained from the provincial COVID-19 vaccine registry. Statistics Canada census data were used to calculate COVID-19 incidence and hospitalization rates for incarcerated cases and the non-correctional facility population. FINDINGS: Between 15 January 2020 and 31 December 2022, there were 1,550,045 COVID-19 cases in Ontario of which 8,292 (0.53%) cases were reported in correctional (63.8% amongst incarcerated individuals, 18.6% amongst staff and 17.7% amongst an unknown classification) and 1,541,753 (99.47%) were non-correctional facility cases. Most cases in correctional facilities were men (83.8%) and aged 20-59 years (93.1%). COVID-19 incidence and hospitalization rates were generally higher among incarcerated individuals compared to the non-correctional facility population throughout the study period. COVID-19 incidence peaked in January 2022 for both the correctional facility population (21,543.8 per 100,000 population) and the non-correctional facility population (1915.1 per 100,000 population). The rate of COVID-19 hospitalizations peaked for the correctional facility population aged 20-59 in March 2021 (70.7 per 100,000 population) and in April 2021 for the non-correctional facility population aged 20-59 (19.8 per 100,000 population). A greater percentage of incarcerated individuals (73.0%) were unvaccinated at time of their COVID-19 diagnosis compared to the non-correctional facility population (49.3%). Deaths amongst correctional facility cases were rare (0.1%, 6 / 8,292) compared to 1.0% of non-correctional facility cases (n = 15,787 / 1,541,753). ORIGINALITY/VALUE: During the COVID-19 pandemic, individuals incarcerated in correctional facilities in Ontario had higher COVID-19 incidence and hospitalization rates compared to the non-correctional facility population. These results support prioritizing incarcerated individuals for public health interventions to mitigate COVID-19 impacts in correctional facilities.

Perioperative adherence to continuous positive airway pressure and its effect on postoperative nocturnal hypoxemia in obstructive sleep apnea patients: a prospective cohort study.

BACKGROUND: Although continuous positive airway pressure (CPAP) is the first line treatment for obstructive sleep apnea (OSA) patients, the perioperative adherence rate is unclear. The objective of this study was to determine the perioperative adherence rate of patients with OSA with a CPAP prescription and the effect of adherence on nocturnal oxygen saturation. METHODS: This prospective cohort study included adult surgical patients with a diagnosis of OSA with CPAP prescription undergoing elective non-cardiac surgery. Patients were divided into CPAP adherent and non-adherent groups based on duration of usage (≥ 4 h/night). Overnight oximetry was performed preoperatively and on postoperative night 1 and 2 (N1, N2). The primary outcome was adherence rate and the secondary outcome was nocturnal oxygen saturation. RESULTS: One hundred and thirty-two patients completed the study. CPAP adherence was 61% preoperatively, 58% on postoperative N1, and 59% on N2. Forty-nine percent were consistently CPAP adherent pre- and postoperatively. Using a linear fixed effects regression, oxygen desaturation index (ODI) was significantly improved by CPAP adherence (p = 0.0011). The interaction term CPAP x N1 was significant (p = 0.0015), suggesting that the effect of CPAP adherence varied on N1 vs preoperatively. There was no benefit of CPAP adherence on postoperative mean SpO2, minimum SpO2, and percentage of sleep duration with SpO2 < 90%. Use of supplemental oxygen therapy was much lower in the CPAP adherent group vs non-adherent group (9.8% vs 46.5%, p <  0.001). CONCLUSIONS: Among patients with a preoperative CPAP prescription, approximately 50% were consistently adherent. CPAP adherence was associated with improved preoperative ODI and the benefit was maintained on N1. These modest effects may be underestimated by a higher severity of OSA in the CPAP adherent group and a higher rate of oxygen supplementation in the non-adherent group. TRIAL REGISTRATION: ClinicalTrials.Gov registry ( NCT02796846 ).

Identifying gaps in COVID-19 health equity data reporting in Canada using a scorecard approach.

OBJECTIVE: To assess health equity-oriented COVID-19 reporting across Canadian provinces and territories, using a scorecard approach. METHODS: A scan was performed of provincial and territorial reporting of five data elements (cumulative totals of tests, cases, hospitalizations, deaths, and population size) across three units of aggregation (province or territory level, health regions, and local areas) (15 "overall" indicators), and for four vulnerable settings (long-term care and detention facilities, schools, and homeless shelters) and eight social markers (age, sex, immigration status, race/ethnicity, healthcare worker status, occupational sector, income, and education) (180 "equity-related" indicators) as of December 31, 2020. Per indicator, one point was awarded if case-delimited data were released, 0.7 points if only summary statistics were reported, and 0 if neither was provided. Results were presented using a scorecard approach. RESULTS: Overall, information was more complete for cases and deaths than for tests, hospitalizations, and population size denominators needed for rate estimation. Information provided on jurisdictions and their regions, overall, tended to be more available (average score of 58%, "D") than that for equity-related indicators (average score of 17%, "F"). Only British Columbia, Alberta, and Ontario provided case-delimited data, with Ontario and Alberta providing case information for local areas. No jurisdiction reported on outcomes according to patients' immigration status, race/ethnicity, income, or education. Though several provinces reported on cases in long-term care facilities, only Ontario and Quebec provided detailed information for detention facilities and schools, and only Ontario reported on cases within homeless shelters and across occupational sectors. CONCLUSION: One year into the pandemic, socially stratified reporting for COVID-19 outcomes remains sparse in Canada. However, several "best practices" in health equity-oriented reporting were observed and set a relevant precedent for all jurisdictions to follow for this pandemic and future ones.

RéSUMé: OBJECTIF: Évaluer les pratiques de déclaration des données de surveillance de la COVID-19 axée sur l'équité en matière de santé dans les provinces et territoires canadiens, en utilisant une fiche de pointage. MéTHODES: Les sites webs et rapports officiels des provinces et territoires ont été analysés pour identifier la présence de cinq éléments de données sur la COVID-19 (totaux cumulatifs des tests, cas, hospitalisations et décès ainsi que la taille de la population évaluée, nécessaire pour l'estimation de taux), déclarées au niveau de trois unités d'agrégation populationnelle (de la province/du territoire, des régions socio-sanitaires, et des localités/quartiers) (15 indicateurs de données « globales ¼); ainsi qu'au niveau de quatre milieux à risque d'éclosions (les établissements de soins de longue durée et de détention, les écoles, et les refuges pour personnes en situation d'itinérance) et de huit marqueurs sociaux (l'âge, le sexe, le statut d'immigration, la race/ethnicité, le statut de travailleur de santé, le revenu, le niveau d'éducation, et le secteur de travail) (180 indicateurs d'équité en matière de santé) à compter du 31 décembre 2020. Pour chaque indicateur, un point a été attribué si des données délimitées par cas ont été publiées, 0,7 points si seules les statistiques sommaires ont été communiquées, et 0 si aucune information n'a été fournie. Les résultats sont présentés sous la forme d'une fiche de pointage. RéSULTATS: Dans l'ensemble, les informations sur les cas et les décès étaient plus complètes que celles pour les tests, les hospitalisations et les tailles de population. Les éléments de données étaient plus disponibles au niveau global des provinces et territoires et de leurs régions socio-sanitaires (note moyenne de 58 % ou « D ¼) que pour les indicateurs liés à l'équité en matière de santé (note moyenne de 17 % ou « F ¼). Seuls la Colombie-Britannique, l'Alberta et l'Ontario ont fourni des données délimitées par cas, et seuls l'Alberta et l'Ontario ont fourni des données au niveau local. Aucune juridiction n'a fait état de données en fonction du statut d'immigration, de la race/l'ethnicité, du revenu ou du niveau d'éducation des patients. Plusieurs juridictions ont fourni des informations au sujet des cas au sein des établissements de soins de longue durée, mais seuls l'Ontario et le Québec ont fourni des informations détaillées au sujet des établissements de détention et des écoles. L'Ontario était unique en rapportant sur les cas par secteur occupationnel et pour les refuges pour les personnes en situation d'itinérance. CONCLUSION: Un an après le début de la pandémie, la disponibilité des données sur la COVID-19, stratifiées par marqueurs sociaux, reste très limitée au Canada. Cependant, plusieurs « bonnes pratiques ¼ en matière de déclaration axée sur l'équité en matière de santé ont été observées, ce qui constitue un précédent pertinent que les juridictions pourront suivre pendant cette pandémie et celles à venir.