Toronto COVID-19 Ditch: Northwest corner of city “system failed”

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“The fascinating thing about COVID-19 is that it has really exposed the health inequalities in the city, in a way that frankly all the reports we have written over the years “haven’t done as effectively,” said Toronto’s medical officer of health, Dr. Eileen de Villa, in an interview.

On Wednesday, the Toronto Public Health Unit announced a proposal to provide alternative housing for residents struggling to isolate themselves in cramped and unsuitable housing, which, according to De Villa and councilor Joe Cressy, would help vulnerable communities to fight the pandemic.

Community advocates say that officials should have acted more quickly on the mountain of evidence already available which suggested that neighborhoods like these would be most vulnerable to COVID, as they had been for many other risks to the health. They fear that the pandemic will have a disproportionate impact on the black community and be yet another spotlight on the pernicious effects of systemic racism: the northwest districts of the city also have the highest proportion of black residents.

De Villa hinted that many of the approaches to tackling the deep roots of these systemic inequalities were beyond the control of his department. Cressy, who is the chair of the Toronto board of health, recognized that the city, the province and Ottawa are all responsible.

“All levels of government are responsible for the persistent health inequities that have plagued some neighborhoods for a long time,” he said, “and all levels of government have not done enough. And COVID has made this painfully visible to everyone. ”

The Toronto Public Health Unit says it is investigating why the northwest neighborhoods have been disproportionately overcrowded by COVID.

The Star reviewed data sets and research and interviewed more than 40 residents, advocates, health workers, experts and government officials to try to better understand. As some warn of a second wave, our results provide clues to how the virus has infiltrated the hardest-hit corner of the city, and how to protect at-risk neighborhoods in the weeks and months to come.

WORK PLACE

For months, the mantra of public health officials has been, “stay home.” But which communities have had the luxury of listening to this advice, wonders Deawuo of Black Creek Community Farm – and which ones don’t?

“Who is homework for? ” she asks. “Who has the ability to do this work from home, or even who has the ability?” ”

In the northwest of the city, the response was “little,” according to census data and community advocates. At the Delta Family Resource Center, which has three locations in northwest neighborhoods, many clients are recent immigrants, refugees, or people without legal status – people who could “live on the edge at the best of times”, a said executive director Kemi Jacobs.

“The people we serve; if they have a job, they don’t have the luxury of not going out. These are the personal support workers, these are the people who work in grocery stores as cashiers, ”she said. “They are the most malnourished and the most vulnerable.”

To better understand the risk of employment in these communities, the Star analyzed the personalized workplace data provided by Statistics Canada for the 16 neighborhoods with the highest COVID rates in Toronto – all grouped in the north corner. west of the city.

In each of these 16 neighborhoods, 26 to 32% of residents work in “sales and services”, in particular in a sub-category that includes cashiers and spreaders. Of the 140 neighborhoods in the city, the five with the highest proportion of cashiers are all in the northwest corner – and all are in the top 10 neighborhoods with the highest COVID levels.

When looking at industry data, the manufacturing sector also stands out; many of the neighborhoods with the highest COVID rates also have the highest proportions of residents working in this sector.

In the 16 districts hardest hit by COVID, between 11 and 25% of the inhabitants work in the manufacturing sector; in comparison, the city average is 8%.

The manufacturing sector is heavily dependent on low-income workers and agency workers, many of whom live in the northwest of the city. And during the pandemic, as the rest of the city closed, factories, such as food processing plants, grew.

In a factory north of Etobicoke in the food service industry, at least a dozen workers have been infected with COVID, according to documents obtained by the Star and an employee of the production line, who asked not to be appointed because of concerns about his work.

According to the worker, the factory has been operating at a breakneck pace since the start of the pandemic; half of the workers on his shifts are new faces who have been recently brought in. But despite the increasing number of worker infections, he said his factory has not yet canceled shifts, closing only a few times for two or three hours so the premises could be cleaned.

“People were crying in the break room,” said the worker. The virus “passed through the plant fairly quickly”.

At Rexdale Community Health Center, nurse practitioner Almut Brenne-Davies also heard alarming stories. She remembers a woman she saw working in a factory and her bosses told her unexpectedly to take a break with half of her colleagues because the inspectors were about to enter.

It was “to make them feel like they were distancing themselves from society,” said Brenne-Davies. “And then they had an epidemic. ”

Although not captured in Statistics Canada data, vulnerable agency workers are common in the northwest of the city, according to Farid Partovi, a community development worker at Jane / Finch Community and Family Center. A report released last year by Jane Finch Action Against Poverty noted that there are up to 100 temp agencies in the region.

While TTC ridership dropped during the pandemic, some of the city’s busiest bus routes are located in the northwest of the city. Many workers are moving to industrial jobs in the 905 region, said Partovi. According to Statistics Canada data, the neighborhoods with the highest COVID levels in the city all have Vaughan or Mississauga as one of their top three workplaces.

The public health units in York and Peel both began to identify an increase in workplace outbreaks in their area very early on. York reported 475 work place clusters, Peel investigated 17. In both health regions, a significant proportion of these outbreaks occurred in food manufacturing and processing plants.

The Toronto Public Health Unit has not released figures for workplace outbreaks, saying it “is still developing a process to post clusters of COVID-19 on our website.”

HOUSING

When Deawuo, who lives in Jane and Sheppard, discovered that her neighborhood was among the hardest hit by COVID-19, she thought of a chain of distressing events she imagined would take place all around her – workers frontline infected and “going home to their communities and taking the virus with them.” ”

“It is a little scary to think and try to figure out how we can protect each other and survive this pandemic,” said Deawuo, a single mother of two, 17 and 8 years old.

Residents, community advocates and experts say overcrowding and poor housing conditions that have plagued these areas for a long time could play a role in the transmission of the virus.

De Villa told The Star that “close household contact is a major risk factor” and that public health officials are investigating cases to find out more about how it affects transmission in games of the city hard hit by COVID-19. . Toronto public health has also started to collect individual household size data to better understand this phenomenon.

Space is essential to stop the spread of COVID-19. Public health officials are urging people on the streets and in the grocery store to stay at least two meters apart. At home, people infected with COVID-19 must isolate themselves, far from their families, in a separate room and use a separate bathroom.

Forties is a “luxury item,” say experts like Jim Dunn, chairman of the Department of Health, Aging and Society at McMaster University.

“You just have to go up to Jane and Finch’s, Jane and Sheppard’s, and see the buildings, see the dwellings that virtually prevent people from practicing physical distance,” said Charles-Fridal.

Cramped living has long been rampant in aging towers in low-income areas of the city, including the northwest corner.

In Toronto, about 12% of homes do not have enough rooms to accommodate the size and composition of the households that live in them, according to 2016 census data. This measure is nicknamed “adequacy of housing”. It is a good way to measure overcrowding and quantify risks during the pandemic.

In Mount Olive, which has been hardest hit by the virus, 30% of homes are considered unsuitable. Other neighborhoods in the northwest corner with a disproportionate COVID-19 burden also score poorly on this measure, including Black Creek (26%), Glenfield-Jane Heights (23%) and Kingsview Village-The Westway (20 %).

Although the need to set up COVID recovery centers for homeless people is “flagrantly obvious”, it is also a concern for those living in overcrowded conditions or in multigenerational households and who cannot isolate themselves safely, said Dr. Stephen Hwang, director of the MAP Center for Urban Health Solutions at St. Michael’s Hospital.

Councilor Cressy said work has been going on for about six weeks on a plan to provide free hotel rooms for people who don’t have enough space to isolate themselves at home – a first in Canada, did he declare.

“This work is urgent,” he said. “And being the first country to implement such a program does not mean that you are patting yourself on the back. That means it’s a good thing, now do more, “he said.

Toronto public health said it had not reported an outbreak in an apartment building. But COVID-19 has increased the anxiety of some residents, who fear unmet maintenance issues and cleanliness issues could put them at risk.

Angie Toussaint, 65, who lives on the 23rd floor of a skyscraper near Jane and Finch, said she “was trying to stay safe.” But her building did not provide hand sanitizer in the common areas, she said, despite directives issued by the city. These guidelines also invited owners to regularly clean common areas and shared surfaces.

Toussaint, who is co-chair of the York West section of ACORN Canada, which advocates for low and moderate income families, also complained that the broken elevators in the building were causing overcrowding – “a pile of people downstairs in the hall.”

At the request of ACORN and the Federation of Metro Tenants Associations, whose members reported that more than half of the landlords do not comply with the guidelines, Councilor Josh Matlow will present a motion on June 29 to make these rules mandatory. .

“When we are in the middle of a public health emergency, why on earth, even with extra caution, would we not tell the owners that we are expecting the basics? Said Matlow.

HEALTH CARE

Even before the pandemic broke out, the corrosive effects of poverty and other systemic ills had already degraded the health of these communities. The maps of many chronic diseases in Toronto – hospitalizations for cardiovascular disease, diabetes rates – look like a donut, with a healthy and affluent nucleus and a circle of sicker communities surrounding it.

“We can’t talk about COVID until we talk about what we have historically seen in this community when it comes to access to health care,” said Michelle Westin, Senior Planning, Quality and Risk Analyst at the Black Creek Community Health Center.

Food insecurity, lack of affordable and safe housing, high unemployment rates – these have already had “a huge impact” on the overall health of the community, she said.

And when people in the northwest corner of Toronto get sick, they’re less likely to see a family doctor. This corner of the city has always been a “primary care wilderness,” experts say.

When Ontario researchers looked at the geography of primary care gaps in the province, they found that the areas of the province with the highest need received the lowest levels of care. In Toronto, these areas have clustered in the northwest corner of the city and south of Scarborough.

“You have a great poverty of opportunities and services, and part of (that) is the lack of health care,” said Dr. Rick Glazier, senior scientist at ICES and lead author of the 2018 report.

Access to a family doctor was vital during the pandemic, Glazier noted – especially in the first few months when it was difficult to get tested. Primary care physicians and nurses have played a crucial role in providing advice on how to get screened, self-isolate or go to the emergency room.

The northwest has strong community health centers, which offer a unique model of care and have deep roots in these neighborhoods. CHCs like Rexdale and Black Creek have a mandate to care for community health and the social determinants of health, and to serve anyone who needs care, even if they are uninsured.

“I can’t say enough wonderful things about them,” said Glazier, a family doctor himself. But he added that they cover a small proportion of the population and that underserved areas need more.

At the Rexdale Community Health Center earlier this month, staff noted that there were only a few CHCs covering a large geographic area.

“What are the resources?” Look at it – let’s break it down and see where all the resources are, ”said Linda Akuamoah-Boateng, diabetes educator.

“Even north and south of Etobicoke – it’s like going from one world to another. ”

In Rexdale, concerns about the health center pandemic go far beyond the virus. Their list of food insecure customers has grown from around 50 in late March to over 900 in early June, and continues to grow. The impacts on mental health have become a serious concern.

But their virus problems are also unique compared to richer and better endowed areas. Although this area of ​​the city has generally high test rates, staff suggested that their clients had difficulty accessing assessment centers: not everyone drives or owns a car, and travel by TTC when symptoms are strongly discouraged.

In Thorncliffe Park, a neighborhood across the city where rates of newcomers, low-income residents and inadequate housing are also high, a partnership between health care providers removes similar barriers to screening.

At Michael Garron Hospital, which operates the nearest assessment center, doctors have noted high rates of test positivity in some areas of the community. Infectious disease doctor Jeff Powis said the hospital’s close relationship with other community health partners was essential to establishing a response.

“I was able to rely on my colleagues who are already integrated into the community, and already know the intricacies of connections in the community … fortunately, I was able to work with them and put this piece back together.”

These partners – Health Access Thorncliffe Park and East Toronto Family Practice Network – have collaborated with the hospital to set up a low barrier context test site in a currently vacant community center near some of the residential areas that tested positive. higher. rates.

Two “community ambassadors” are always present, helping to gather information and guide patients. Information documents are available in several languages. Community workers publicized the site’s opening via WhatsApp, and when they didn’t see the diversity on the test site they could expect, they worked harder. The masks, sewn by hand by volunteers, are stacked in boxes and available for a gift.

In the northwest, no mobile test available to the community has materialized, even though they are the hardest hit by COVID-19.

The Star asked the nearest hospitals operating mobile testing assessment centers in these communities; they redirected inquiries to public health. City officials suggested that planning for mobile testing, however, was the responsibility of the province’s local health integration networks, which either did not respond or referred the Star to public health.

De Villa said mobile testing in these neighborhoods was “definitely a topic of conversation and soon an action, I would like to think about. But she reiterated that while Toronto Public Health is a partner in screening efforts, “we are not the testers,” and added that mass testing in the hardest-hit communities can stigmatize them.

But several community agencies and health centers have said they want mobile testing in the region.

“We know people face barriers to accessing test sites,” said Cheryl Prescod, Executive Director of the Black Creek Community Health Center. “Mobile testing in our community would be incredibly beneficial – going to community spaces, apartment buildings, places of worship – will help us reach the people we know need the most testing.”

As different levels of government find an answer, local organizations continue to work hard to protect their communities, as they have done since the start of the pandemic.

“Residents and organizations are really engaging,” said Ruth Crammond of the United Way of Greater Toronto, who has worked with a group of community organizations in the northwest corner that have responded to the pandemic. “It’s not that people are just sitting around and waiting for someone to save them. ”

But the northwest neighborhoods also need what the more privileged Toronto communities already have.

“We need the resources to make these changes,” said Butterfly Sabrina GoPaul, a community health worker who lives in Jane and Finch. “But the systemic reality is so deep that it won’t happen with, you know, pixie dust and curry powder.

“We really need to break down what was broken and stop trying to fix and create dressing solutions. Because it does not work for communities like ours. ”

Graphics by Nathan Pilla, Andres Plana and Cameron Tulk

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