LOOKING UPSTREAM FOR SOLUTIONS TO HEALTH SYSTEM CHALLENGES

By Elaine Smith

Dr. Andrew Pinto, an Associate Professor in the Department of Family and Community Medicine at the University of Toronto, wears many hats: family physician, public health specialist and scientist. He also holds an Applied Public Health Chair from the Canadian Institutes of Health Research and is the only family physician among the seven researchers nationwide who received this honour.

The award, worth $1.15 million, provides mid-career researchers with an opportunity to collaborate with policy makers to support evidence-informed decision-making that improves health and health equity. Dr. Pinto attributes the recognition to the work being done by his Upstream Lab based at MAP Centre for Urban Health Solutions, St. Michael’s Hospital, one of the University of Toronto teaching hospital partners.

He created the lab in 2016 as a way to make medicine more effective by looking upstream to the social determinants of health and the interventions that could create change at an individual, organizational or policy level.

“My selection speaks to the fact that the Upstream Lab is recognized in Canada and elsewhere for showing leadership in a challenging area,” he says of the five-year Applied Public Health Chair. “I see the lab as a resource for the community to use to create change and innovative solutions. We have a social justice focus and we seek to both describe and solve problems.

“It’s something I can’t do by myself, but I have a fantastic team of 26 staff and a dozen graduate students and post-doctoral fellows. We’re also starting to be the home for other research scientists,” says Dr. Pinto.

Dr. Archna Gupta, PhD is a member of the Upstream team. The family physician is finishing her post-doctoral fellowship in the lab and will soon become one of its scientists.

“The fact that Dr. Pinto started this lab well before others recognized the problem is impressive and the dedication he puts into pushing the envelope is amazing,” Dr. Gupta says. “The growth of the lab is a testament to his leadership and his ability to get grants for projects that aren’t traditionally funded.”

With his new appointment, he hopes to establish a repository of evidence around what works in terms of upstream actions; determine what works to help health organizations look at the external factors that could be addressed to prevent various health problems; create a network of upstream clinics across Canada; and examine policy and opportunities for policy change through the Upstream Policy Observatory.

His CIHR chair and the Upstream Lab aren’t the only balls Dr. Pinto is juggling when it comes to research. In 2022, he was awarded $10 million in federal funding for CanTreatCOVID, which stands for Canadian Adaptive Platform Trial of Treatments for COVID in Community Settings. The trial is a national study of the effectiveness of current and future oral COVID-19 therapies to reduce symptoms faster and prevent long COVID. It is designed to identify useful and affordable medications so they can be made readily available in community settings.

“People needed better evidence about whether these treatments work, especially in a highly vaccinated population,” says Dr. Pinto. “They are expensive and we need to know if it’s a good use of public money. It’s a great way to identify what works and test it in a continuous way.”

The team comprises primary care researchers and infectious disease and public health specialists. The goal is to attract 3,000 people to the study for each treatment, starting with Paxlovid and adding more therapeutics as they emerge. Participant recruitment is happening through primary care physicians, emergency rooms, pharmacies, COVID assessment centres and appeals to the public. Provincial hubs in British Columbia, Alberta, Manitoba, Quebec, Newfoundland and Ontario will help connect patients to treatments.

The researchers hope to have feedback within six months and are looking at ways to disseminate the findings quickly, while continuing to assess other treatments. They are working in conjunction with colleagues in the United Kingdom who are doing a similar study, looking for ways to collaborate and pool their data.

“We’ll follow the patients over the course of their treatment and for six months afterward,” Dr. Pinto says. “Our main question is whether any of these treatments reduces hospitalization, emergency room visits or deaths. We will also look at recovery times and whether these medications reduce the chances of getting long COVID and its side effects.”

The study has been approved by Health Canada and supported by the Canadian Institutes of Health Research and Public Health Agency of Canada. It features more than 90 investigators, staff and patient partners, something he calls “a real team effort.” The team has a communications plan to disseminate pre-prints of their findings as quickly as possible.

Dr. Pinto wants the platform to be accessible to people beyond the research who have treatment ideas and there will be a committee who studies their proposals. Over the long term, he hopes that CanTreatCOVID will grow into a platform that encompasses other respiratory conditions such as influenza and respiratory syncytial virus, becoming CanTreatResp and helping public health prepare for future pandemics.

Dr. Gupta, his colleague, doesn’t doubt the future success and growth of CanTreatCOVID after seeing how he has assembled the team at the lab.

“We’ve grown over time and his ability to manage that speaks to his capacity as a leader,” she says. “He’s trying to develop a sustainable system of researchers so that the lab is bigger than one person—an organism that can perpetuate. It’s not a one-man-show. We’re all part of a team working toward a common vision. He’s developing a living entity.”