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

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.

But how do medications actually perform when they’re used by thousands of people with varying backgrounds and health profiles?

Analyzing health data to reveal drugs’ real-world results – such as side effects, drug interactions and different responses based on users’ age or genetics – is a growing scientific field.

Scientists with an interest in pharmacoepidemiology – the study of the use, safety and effectiveness of drugs in large groups of people – have new opportunities at UM. This fall, the College of Pharmacy has launched a new concentration in pharmacoepidemiology, allowing students to earn master’s and PhD degrees in this specialty for the first time.

The degrees are open not only to pharmacists, but to scientists who have completed their undergraduate work in other fields.    

Dr. Silvia Alessi-Severini

“Before medications reach the public, they’re tested in small, controlled, generally short-term trials, which adequately determine safety and efficacy,” says pharmacy professor Dr. Silvia Alessi-Severini.

“But only well-conducted pharmacoepidemiological studies – a type of observational study – can assess the effects of medications in larger populations. Regulatory agencies and pharmaceutical manufacturers are increasingly interested in using real-world research to confirm and follow the use and effectiveness of medications.” 

Alessi-Severini says other Canadian universities that offer graduate degrees in pharmacoepidemiology can’t keep up with the demand for trained professionals in the field. Her own population-level research has explored topics such as dose escalation in patients who take certain sedating medications.

Dr. Joseph Delaney

Dr. Joseph (Chris) Delaney, an associate professor who joined UM in 2019, is one of five other faculty members at the College of Pharmacy with expertise in pharmacoepidemiology.

“Understanding the long-term side effects of medications and detecting rare-but-serious side effects will always require observational research,” says Delaney.

“The tools used by pharmacoepidemiologists have improved drug safety. Now, in the era of COVID-19, the same techniques we’re teaching will be used to look at issues like vaccine safety and effectiveness in large populations.”

Delaney has extensive experience in computer-based analysis of health data. By running complex statistical comparisons within large datasets, he can reveal, for example, that a drug taken for one disease increases the risk of another disease. In one study, he showed that proton pump inhibitors (drugs to reduce stomach acid) increase the risk of C. difficile infection.

The two faculty members say Manitoba is one of the best places in Canada to pursue pharmacoepidemiology because of the world-class data repository housed at the Manitoba Centre for Health Policy (MCHP) in the Rady Faculty of Health Sciences.

“It gives us access to extremely rich, high-quality health data that covers a long time period,” says Delaney. “And because we have the ability to link Manitoba datasets together, we can study connections between the health-care system and the education, social service and justice systems. This is a key advantage of our program.”

PhD student Sai Krishna Gudi

Sai Krishna Gudi, a PhD student in the new pharmacoepidemiology program of study, is using the MCHP data repository to investigate the effectiveness of new antiviral drugs for hepatitis C.

“Specializing in pharmacoepidemiology is giving me a strong methodological foundation for conceiving, designing and conducting population-level research,” Gudi says. “It’s allowing me to explore innovative ideas and potential collaborations focused on unique research questions.”

The professors say they look forward to further collaboration with MCHP, the department of community health sciences in the Max Rady College of Medicine, and national and international research partners.

“The Rady Faculty of Health Sciences is already known for expertise in epidemiology, biostatistics, health services and pharmacy services,” Alessi-Severini says. “Now that we’ve introduced these new graduate degrees, the Rady Faculty is positioned to become a leading site for training experts in pharmacoepidemiology.”

“I come from a family of teachers,” says Alessi-Severini. “My grandfather was an excellent teacher. Other members of my family were teachers. It’s just this call that came to me.”

Alessi-Severini is an associate professor in the College of Pharmacy and a scientist at the Manitoba Centre for Health Policy. She received the award from the Health Sciences Graduate Student Association council, which recognizes excellence and distinction in mentorship, teaching and research. 

The students who nominated her say she has supported them in numerous ways, such as helping them find them office space, serving as an advisor for their student club and giving them opportunities to gain teaching experience by teaching in her course.

Hamad (centre) with Alessi-Severini (L)

Dr. Amani Hamad, a postdoctoral fellow at the George & Fay Yee Centre for Healthcare Innovation, was advised by Alessi-Severini as a PhD student.

“She is a strong student advocate,” says Hamad. “She guided me through manuscript submissions and was there to review and edit and encourage me when I was faced with rejections. She always attended our presentations to give us feedback and cheer us on.”

Alessi-Severini says she tailors her approach to mentoring students depending on their personality and level of experience.

“If the student is just starting out, you need to be a coach. As they progress to be more independent, you are a motivator, a facilitator, then a delegator.” she says.

The students say Alessi-Severini celebrates their successes, hosting social events at her home to celebrate milestones such as student defences and graduations or to welcome new faculty members.

Janzen (R) with Alessi-Severini

“She mentors not only grad students but junior faculty members. She really helps set a good work environment, very collaborative, and she made graduate school a very positive experience all around,” says PhD candidate Donica Janzen, who is supervised by Alessi-Severini.

Master’s student Olasumbo Ojo says that while Alessi-Severini is not her advisor, she takes the time to chat and answer questions and her passion for pharmacoepidemiology rubs off on those around her.

“It’s inspiring because she’s so passionately involved with pharmacoepidemiology. It makes me want to do and learn more. It’s now my focus,” says Ojo.

Janzen says she was a key person in growing pharmacoepidemiology as a research area at the University of Manitoba.

“For me she’s a very good example to look to when considering a career in academia. She is very committed to service in the university and to teaching. She has very high standards for research, doing it with integrity and making sure the methods are rigorous and our research is well-designed,” says Janzen.

Alessi-Severini credits her own mentors at the College of Pharmacy with helping her to build her skills and lending her support, including Dr. Colleen Metge and Dr. Keith Simons.

“I don’t think I have a natural way of being a mentor, I just imitate what my mentors did with me,” she says.

In turn she encourages senior students to mentor younger students.

“As a mentor, you can see the talents of some students, some have the qualities to be natural leaders.”

One thing that Alessi-Severini feels strongly about is helping students secure financial support by writing letters of recommendation and encouraging them to apply for awards, saying the support available for students, particularly international students, is very limited.

“We should support graduate students more, and not only from the academic perspective. It’s an important aspect that we need to address,” she says.

Alessi-Severini says she was surprised when she found out about the award and that her students didn’t tell her they had nominated her.

“I felt really humbled and honoured. You don’t expect it, since this is my job, but when it comes from your students, it’s very rewarding as a teacher. I would like to thank the students, it’s been a privilege to work with them and they share this with me.”

The Ed Kroeger Mentorship Award is named in honour of Dr Edwin Kroeger, professor of physiology and pathophysiology, Max Rady College of Medicine, who chairs the annual national Canadian Student Health Research Forum at UM, Canada’s premier event for graduate student researchers in the health sciences. The forum provides a venue for health research trainees from across the country to present their work, network, attend presentations on innovative research, and be recognized for their scientific accomplishments.

Nearly two-thirds of Canadians 65 years of age and older are receiving five or more different prescription drugs, which can increase the risk of side effects and interactions, leading to patient burden, morbidity and hospitalizations.

Join us on Oct. 29 to learn about the latest research on the use of medication and potential harm, while we discuss how research can drive advancement of clinical knowledge and improve patient care of older adults.

Café Scientifique – Polypharmacy: Are we overmedicating older Canadians?

Oct. 29  – 7 p.m.
McNally Robinson Booksellers, 1120 Grant Avenue, Winnipeg

Moderator: Dr. I fan Kuo
Assistant Professor, College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba

Panelists:

Dr. Silvia Alessi-Severini
Associate Professor, College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba

Dr. Jamie Falk
Assistant Professor, College of Pharmacy; Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba

Dr. Christine Leong
Assistant Professor, College of Pharmacy; Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Clinical Pharmacist, Family Medical Centre

To assist in planning seating, RSVP to: Research_Communications@umanitoba.ca or call 204-474-6689.