Advocates brace for 'poorer health outcomes' in areas hard-hit by COVID-19

Ten months after Toronto reported its first case of COVID-19, close to 40,000 people across the city have had confirmed novel coronavirus infections.

What's less clear is how many of the survivors will have long-term impacts from their illness — for months, or even years, down the line.

"We're hearing increasingly of those who are suffering from longer-term consequences," said Toronto's Medical Officer of Health Dr. Eileen de Villa in November.

Be it lengthy recoveries after time spent in an intensive care unit or lingering symptoms after a milder infection, local health-care providers are seeing a range of issues.

And in some of Toronto's hardest-hit communities, concerns are already growing about the long-term supports potentially needed for some residents given the high rate of infections.

"They're going to have poorer health outcomes because of this," said Michelle Westin, a senior analyst with Black Creek Community Health Centre.

Years of 'systemic barriers'

A Toronto Public Health analysis showed multiple lower-income neighbourhoods are among the highest for the number of tests coming back positive — with Mount Olive-Silverstone-Jamestown veering close to one-in-five tests picking up the virus.

Other areas in the northwest corner, including Black Creek — which has a test positivity rate of around 14 per cent, recent data shows — are also being hit hard.

Neighbourhoods in the northwest end typically lack strong community and health-care supports and feature a population often living in crowded apartment buildings or multigenerational homes, Westin noted.

"We know this community has been suffering systemic barriers for years," she added, citing common pre-existing health conditions like diabetes, chronic obstructive pulmonary disease, heart disease, and "disproportionately high rates of poverty."

Any long-term health impacts from COVID-19, according to Westin, would be layered on top of all those other challenges.

On one hand, that can mean the months of rehabilitation required after being intubated in an intensive care unit — a well-known issue for a variety of ailments beyond COVID-19.

Westin noted a long recovery from a serious illness can prevent someone from returning to work, further exacerbating financial strain on top of someone's health issues.

A growing online community of "long-haulers" is also documenting lingering symptoms after an initial infection, from fatigue to respiratory issues to headaches, and calling for more research into the lasting effects of COVID-19.

According to de Villa, it will take time to understand the full spectrum of symptoms to determine what kinds of supports are needed to bring people to "optimal health."

"That's one of the issues that we're going to be following on a longer-term basis," she said, "and one that I know will require the partnership with our health-care sector and many, many others to address it properly."

Supports to ensure 'optimal health'

When it comes to who could be hardest hit by poorer health outcomes, Toronto Public Health figures show that, as it stands, the virus affects lower-income residents and minorities the most city-wide.

"The most significant indicator of your health status is not your genetic code, it's your postal code," said Coun. Joe Cressy, chair of the city's board of health.

"Where you live, the job you have, the type of housing you sleep in."

Cressy said collecting ongoing data on the demographics of those hardest hit by COVID-19 will be crucial to inform public health responses during the pandemic, and long after.

"If governments don't collect the data," he added, "there's no pressure on them to fix it."

But understanding which communities could face the poorest health outcomes from the pandemic is only one step, noted advocate and University of Toronto medical student Semir Bulle.

While growing up in Rexdale, Bulle said he saw first-hand the lack of community centres and resources — and a clear distrust in the health-care system among residents.

More community supports are crucial, he said, to address those ongoing issues and support the growing number of COVID-19 survivors and their families.

"If you don't look at these issues from the ground up," he questioned, "how are you going to solve them?"

This ongoing series is exploring how the COVID-19 pandemic could reshape Toronto in the years ahead. Get in touch with your suggestions for issues or neighbourhoods to cover.