How a refugee shelter became the home of the worst COVID-19 outbreak in Toronto’s housing system

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In March, staff at the Willowdale Welcome Center, which was to become the site of the largest COVID-19 outbreak in the city’s housing system, became concerned about infection control at the facility.

The refugee center opened in the fall. It housed approximately 200 men and women on separate floors, including many Ugandan and Nigerian professionals looking for a better life in Canada.

It worked quickly and seamlessly, and customers quickly found accommodation and jobs.

“Once the refuge had its roots in place, it was pretty well managed. I was impressed, “said an employee who is not named because he is worried about his future job.

As March progressed, concerns about the transmission of COVID-19 increased – concerns that the employee and others at Homes First Society, the registered charity that operates Willowdale, felt that management did not hear them.

This account is based on interviews with staff from Willowdale and other Homes First shelters; on emails between employees and management and official complaints to the Ministry of Labor, Training and Skills Development.

Shelter staff were told not to wear masks – which is not unusual at the start of the pandemic, when the focus was on preserving supplies for front-line workers and, like the research suggested, masks offered limited defense against the virus outside of healthcare. settings.

Staff were asked to focus on proper hand washing and increased cleaning with disinfectants. But the Lysol wipes, used to clean the cafeteria tables between services, quickly disappeared and were not replaced.

Responding to questions from the Star, Patricia Mueller, Executive Director of Homes First, said that the charity was in compliance at all times with public health guidelines for infection control measures, including personal protective equipment. employees.

Meanwhile, the epidemic is now over at the shelter, said Mueller, as there are no active cases left.

At first, the Willowdale employee said that it was difficult to get shelter clients – most of them 40 years old or younger – to systematically respect the rules of social isolation and to follow the recommendations hand washing and other measures.

“The younger kids said,” I’m not going to die, “said the employee.

Many customers were diligent. Others do not.

The employee had heard, for example, that even after the city had banned gatherings of more than five people, some refugees from the center continued to attend religious services – meeting in private homes.

“We have a guest house that runs it,” one of them told the employee.

It was then that he was watching a New York news program, quickly becoming an international hotspot for the virus, that the employee made his decision.

“It made me realize that we were on the same path and I didn’t want to be part of it,” said the employee. He left shortly after and did not return.

He remains in good health. Meanwhile, more than two dozen former colleagues and more than 180 Willowdale customers have been diagnosed with COVID-19.

“I have very close friends who had it. My heart is breaking for them, ”he said.

The Willowdale epidemic highlights the challenges of fighting COVID-19 in a gathering environment – wherever people are gathered inside – and how a top-down, one-size-fits-all approach can go awry.

The refugee center has become the place with the highest number of infections in the city’s shelter system, which has 72 sites. As of Wednesday, 185 customers tested positive for COVID-19 and more than a dozen employees. No one died.

At one point, the large number of Willowdale customers transferred to COVID-19 recovery sites established by the city raised concerns that there was no room for customers of other recovery center shelters .

Thus, Willowdale was itself transformed into a recovery center and medical staff were brought to the shelter to care for clients, said Mueller.

Four Homes First workers interviewed for the story, including two who worked in Willowdale, say things would not have been so bad if their initial concerns had been addressed in a timely manner.

They are not identified because they are afraid of being fired or of not being rehired.

“Homes First dropped the ball to protect themselves from the disease,” said a statement from Warren (Smokey) Thomas, president of the Ontario Public Service Employees Union.

Homes First Society lists 18 properties on its website, offering shelters ranging from single single rooms to family townhouses.

According to an email exchange provided to The Star, union representatives from Homes First homes began discussing the need to speak to management about safer working conditions on March 15. They spoke to human resources on March 19 and to Mueller on March 23.

Their fears turned out to be prescient: after scouring the news and medical literature to find out what was going on in other parts of the world, they asked for measures that would soon be considered routine, including maintaining a two-meter distance in shelters, ending the practice of allowing staff to work in multiple locations and face masks.

They have attempted to intensify their concerns in some cases by filing their complaints with the Ministry of Labor, Training and Skills Development.

A ministry spokesperson said he had investigated PPE complaints at three Homes First properties in March and April, including Willowdale.

A departmental inspector investigated by telephone and no orders or requirements were issued.

“It has been determined that all appropriate directives are being followed and no orders have been issued,” the ministry said.

A Willowdale employee who spoke to the Star was diagnosed with COVID-19 and became so ill that she thought she was going to die.

At the start of the pandemic, she said that management told her that she could wear a mask if she wanted to, but that she had to provide it herself – and at that time, the masks were impossible to buy in stores.

Initially, there were Lysol wipes on lunch tables to keep surfaces clean between shifts, but they were removed because management said they were stolen.

After that, the wipes were locked in offices, the employee said.

There were sinks with soap and paper towels, where people could wash their hands before sitting down to eat, but they sometimes ran out of paper towels, she added.

Staying two meters from customers was difficult because of the layout of the shelter, she added. The lobby is where the front desk and security desk is, and this is where people line up for the cafeteria. People constantly crossed paths.

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“It’s a fairly small bottleneck,” she said.

Mueller agrees there were problems with supplies, including Lysol and paper towels – in some cases they were stolen, in some cases overused, she said, and it took a while to find a solution.

A third concern for staff at Homes First was the high turnover of staff between homes, according to a third employee, who asked to remain anonymous.

Homes First employs approximately 300 people, including approximately 175 rescue personnel who moved between facilities, said Mueller.

She said that after the staff-management meeting on March 23, Homes First started taking steps to end the practice, but it took several weeks.

“I’m with them, I wish it could have been done faster,” said Mueller. She added that it was simply not possible to manage change faster.

Before the pandemic began, there were more than 7,000 people in Toronto’s shelter system, including nearly 3,000 in hotels and families, according to the city’s Shelter, Support and Housing Administration.

The city operates 11 shelters and places of respite; 61 are operated by non-profit community organizations like Homes First.

In order to increase social distancing, SSHA began moving people into existing programs on March 18, according to SSHA executive director Mary-Anne Bedard.

By the end of April, 1,400 shelter clients had been displaced. The figure now exceeds 2,000, Bedard said in an interview.

Activists have criticized the city for not moving enough clients quickly enough and for moving some to community centers, which does not provide enough opportunities for social distancing or isolation of people who begin to show symptoms.

A group of activists sued the city which, as part of a provisional settlement, agreed to meet targets for physical distance in all homeless shelters.

Bedard said community centers were chosen because they were easy to convert quickly.

“I know there are critics, but I am confident that we did everything as quickly as possible,” said Bedard.

Although masks were provided to shelter staff in March, the availability of PPE was of great concern and pressure was placed on not using precious stock if it was not to be used, he said. -she adds.

She said that ASIS does not yet understand why there have been outbreaks in some shelters and not in others.

She warned that the number of infected people in the shelters would continue to increase.

“There is a good reason for this – because we are doing more testing,” she said.

If all the recommendations made by Willowdale staff at the start of the pandemic had been implemented, would the outcome have been different?

Dr. Isaac Bogoch, an infectious disease specialist at the University of Toronto and the Toronto General Hospital, who also worked with Willowdale, said the masks may have made a small difference.

“The masks are not perfect – it’s not like you are secretions leaving your face – they are porous masks and you can still contaminate the surfaces around you. Masks are useful in these settings, but they are not the savior, ”he said.

Listening to front-line workers is essential, says Tiziana Casciaro, professor of organizational behavior at the University of Toronto, Rotman School of Management.

While top-down policy making – like the public health policies that informed decisions in Willowdale and other institutions – is the most effective way to meet the challenges, it has drawbacks.

“It allows top-down directives to take control of the life of an organization without any possibility of closing the bottom-up loop. This is something that I think is applied in this particular case, “said Casciaro.

Bedard and Mueller, meanwhile, say they have done their best with the information available.

“There will always be, in retrospect, things that you look back and say that I wish, I could have, and we will learn from that for sure, but I don’t think we can guess the things that we do,” a declared Bedard.

Francine Kopun
Francine Kopun is a Toronto journalist who covers the town hall and the Star’s municipal policy. Follow her on Twitter: @KopunF



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