Did COVID-19 skip Vancouver's poorest neighbourhood? Antibody testing might have the answer

When the COVID-19 pandemic hit Canada mid-March, health experts feared Vancouver's impoverished Downtown Eastside would be decimated — the coronavirus expected to tear through its vulnerable population.

That didn't happen, and now a B.C. medical sleuth is trying to find out why only a handful of residents have tested positive for the virus in one of Canada's poorest neighbourhoods. 

It's a medical mystery given there are an estimated 15,000 people crammed into 30 square blocks around Vancouver's infamous Main and Hastings intersection.

Many residents have mental health issues, are infected with HIV or hepatitis C, and have compromised immune systems.

The answer to the apparent low infection count could benefit all Canadians in the fight against the spread of the coronavirus, says Dr. Brian Conway, medical director of the Vancouver Infectious Diseases Centre.

"The thrill of the chase is exciting," says Conway. "The more we learn, the more we will be able to help."

'Pop-up clinics' test for antibodies

Conway has launched a series of free community "pop-up clinics" to test blood for telltale coronavirus antibodies among Downtown Eastside (DTES) residents. 

Antibodies are formed when a person's body attempts to fight off infection.

They are an indication that the individual was, at some point, infected with the virus, even if there were no symptoms of illness or only mild symptoms. 

Conway says if antibodies are found in a large percentage of volunteer test subjects, that would mean the virus has been more common in the Downtown Eastside than previously thought.

Symptoms of COVID-19, the illness caused by the virus, could have been masked by underlying health and addiction issues.

"It is possible that certain cases were missed since opioid withdrawal might look a little bit like an acute [coronavirus] infection," Conway said. "So we want to just make sure that we understand exactly what happened in that community since the middle of March."

'Is there something here ... protecting them?'

If antibodies aren't found, Conway says, that could mean the coronavirus has skipped over an easy target, perhaps due to the community's social isolation from the rest of the Vancouver area.

There's another intriguing possibility: that Downtown Eastside residents have some form of resistance to the potentially deadly virus.

"Is there something here that is protecting them against becoming infected?" Conway said. "This is a thing that we need to learn."

Conway says the clinics have been approved by Health Canada, and are staffed and funded by his non-profit centre, independent from local health authorities.The centre's stated mission is to provide expert diagnosis and treatment of chronic infectious diseases in Vancouver. Conway says that now includes COVID-19.

He hopes to test approximately 20 DTES residents at each pop-up, to be held once a week throughout the summer. Conway says the blood samples taken at the clinics will be analyzed for coronavirus antibodies in the weeks ahead, likely by the B.C. Centre for Disease Control (BCCDC).

The presence or absence of antibodies against coronavirus could help researchers understand infection rates as compared to illness rates. But, Health Canada cautions, it's not yet clear how long antibodies stay in the body, and it's not yet know whether people with antibodies are immune to re-infection or if they are still infectious to others.

There is also research suggesting that antibody tests may not be reliable. 

COVID-19 recovery facility had just 3 patients

Social advocates on Vancouver's Downtown Eastside say they, too, have been baffled by the lack of reported COVID-19 cases.

"It may be that the people who live in the Downtown Eastside tend not to travel outside of the country," says Janice Abbott, CEO of Atira, which operates social housing in the neighbourhood. "Many of them spend all of their time [here], so maybe there's a protective factor in geography — I don't know."

In April, Atira joined forces with the B.C. government and Vancouver Coastal Health to convert a local hotel into a 60- room recovery facility for local residents who become sick with COVID-19.

It was quietly closed in June — after housing just three patients.

'I don't think it should have taken this long'

Downtown Eastsiders who spoke with CBC News welcome the antibody testing. 

They, too, want answers.

Randy Hyman describes himself as a former resident and frequent visitor to the neighbourhood.

"It's great that it's finally arrived that the testing will be done," said Hyman, 40. "Despite the fact that some people may not feel they have a voice and cannot advocate for their own health ... I'm sure they would appreciate the opportunity to be tested."

Selling plastic jewellery from her central spot on East Hastings Street, Edith Delmo wonders why the apparent absence of COVID-19 on the Downtown Eastside wasn't investigated sooner.

"I don't think it should have taken this long," said Delmo, 60.

Through his pop-up clinics — building on similar testing he's done for HIV and hepatitis C on the Downtown Eastside since the 1980s — Conway hopes to find out why COVID-19 seems to have passed over this community, and how that information could help fight the pandemic in the rest of the country.

"I think we need to understand exactly how much the virus has penetrated in the [DTES] population," says Conway. 

"That's going to help us plan better on how to deal with this going forward ... [and] that's going to be very useful to the general public."