COVID-19's devastating toll on families in Montreal's poorest neighbourhoods
'Anyone who sees these health inequalities emerge is completely unsurprised,' says public health ethicist
Over the phone, the voice of Marie Missoule Michaud's two-year-old son rings out in the background: "Papa, papa."
"He still asks for him. He looks for him all over," Michaud says.
Her son's father, Sony Innocent, 39, died two weeks ago from what Michaud believes were complications of the coronavirus, though he was never tested.
Michaud says it started with a fever Innocent attributed at first to the bouts of malaria he'd experienced since he was a child in Haiti. But when the fever went away, he got a bad cough.
Then, on April 30, his lungs started hurting, and he had trouble breathing.
Michaud called 911, but Innocent died as paramedics were putting on their protective equipment outside the couple's Montréal-Nord apartment complex.
"I was screaming, and I could see police officers running so fast toward the house," said Michaud. "But it was too late."
She isn't sure how Innocent might have caught the virus. He worked at a plastics factory and had been deemed an essential worker, heading out every day while others stayed home.
Montréal-Nord, the borough where they'd settled, now has the highest number of confirmed COVID-19 cases in Montreal, the epicentre of the pandemic in Canada.
It is also one of the poorest districts in Canada. The median income is $23,412, and the unemployment rate in the borough is typically between three and five points higher than the rest of the island.
Half the population is from a visible minority, and more than 40 per cent are immigrants.
'Completely predictable'
Montreal has now recorded more than 20,000 cases and more than 2,100 deaths — and with no immediate downturn in sight, the situation remains so grim that Premier François Legault has halted plans to reopen schools in the metropolitan region before the fall.
The first COVID-19 cases were transmitted by travellers returning from the province's early March break, cellphone data has shown.
But two months later, the virus has spread quickly through poorer boroughs, including Montréal-Nord, Mercier–Hochelaga-Maisonneuve and Ahuntsic-Cartierville, while early outbreaks in more affluent areas have been better contained.
For public health experts, the pattern was "completely predictable."
"Anyone who sees these health inequalities emerge is completely unsurprised," said Nicholas King, a professor at McGill University in Montreal who conducts research in public health ethics and policy.
Studies bear this out, he said: People living in low-income neighbourhoods are more susceptible to illness, for a number of reasons.
The neighbourhoods are densely populated, with more multigenerational families.
More residents work in jobs where they are likely to be exposed to illness — stocking shelves or working the cash register in grocery stores, or at the bottom rung of the health-care sector, as orderlies and cleaners.
Public health data suggests that's the scenario in Montreal, where 19 per cent of confirmed cases have been among health care workers, many of them in the hardest-hit boroughs. Twenty-four per cent of the more than 1,800 COVID-19 cases in Montréal-Nord have been health care workers, according to data compiled by the city's health department.
Dr. Nima Machouf, an epidemiologist and instructor in the school of public health at Université de Montréal, said the pattern is clear: The contagion of Montreal's long-term care institutions, known as CHSLDs, has spread to the neighbourhoods where workers in those facilities live.
"The community transmission in low-income communities is a consequence of the spread in CHSLDs," she said.
At the plastics factory where Innocent worked the night shift, employees wore masks and were tested regularly. He seems to have caught it anyway, though how or where is not clear.
Michaud said she wanted to share her family's story because so many others in her neighbourhood are experiencing similar loss.
Her cousin — a patient attendant working through a placement agency — tested positive for COVID-19 last month. Her cousin infected her father-in-law, who lived with her, and he died in early May.
'Working-class folks are the essential workers'
Tiffany Callender, executive director of the Côte-des-Neiges Black Community Association, said the municipal and provincial governments should have anticipated the problem sooner.
Like Montréal-Nord, Côte-des-Neiges has a diverse population, with many residents working in low-paying essential service jobs. There, too, the number of cases of COVID-19 is on the rise.
"We have to consider how socioeconomics and employment and poverty play into COVID," said Callender. "Working-class folks are the essential workers."
A city bus that's been turned into a mobile coronavirus testing unit showed up in Côte-des-Neiges earlier this week, and two mobile testing sites were parked in Montréal-Nord on Thursday.
Callender welcomed the city's commitment to increased testing, but she said it should be handing out masks and taking other measures to ensure people are able to practise physical distancing.
Like other civil rights advocates, she said Montreal needs to keep race-based and socioeconomic data, to better understand how the virus is spreading, as Toronto is doing.
Montreal Mayor Valérie Plante said Thursday the "issue of inequality" has been a focus of discussions with the premier.
"Thank you for your openness to put targeted measures for the most vulnerable neighbourhoods and populations," she said at a Montreal news briefing where they were both present Thursday.
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Dancing and singing on Sundays
Michaud and Innocent worked opposite shifts — she in the morning, he at night — but on Sundays they were home together. She would dance as he sang along to Haitian evangelical music.
The pair met and fell in love in the United States. Michaud was pregnant when they crossed the border into Canada in 2017 at Roxham Road, a well-trodden entry point for asylum-seekers coming from the U.S.
Michaud gave birth about five months later. She obtained refugee status, and the couple had been in the process of seeking permanent residency for Innocent.
Now she's making funeral arrangements, with help from the company Innocent worked for.
Michaud says she's finding reasons to keep her faith.
When she got the news that she and her toddler had tested negative for the coronavirus, "I thanked God," she said.
She's thankful, too, for the help she's getting with groceries and supplies from members of the community who are taking time to help grieving people like her.
"I'm in pain like everyone else," she says. "It's not just me."
With files from CBC's Alison Northcott
