Toronto researchers to study COVID-19 among people experiencing homelessness

Researchers are hoping to recruit participants starting next week for a study that will look at how big a problem COVID-19 is among people experiencing homelessness in Toronto.

Dr. Stephen Hwang, director of the MAP centre for urban health solutions at St. Michael's Hospital, will lead a research team on what is being called the Covenant Study.

The year-long project has received $1.9 million in federal funding through the COVID-19 Immunity Task Force, a organization formed by the federal government in late April to track virus spread in Canada.

"People experiencing homelessness are at greatly increased risk of getting COVID-19. However, we don't know what proportion of the homeless population has been exposed to COVID over the last year," Hwang said on Wednesday.

The specialist in general internal medicine said the study aims to gather evidence that will guide public health measures across the country to curb spread of COVID-19 among unhoused people. The research team will include university and hospital experts in epidemiology and lab testing.

"It's really important that we obtain this information so that we can intervene to control the infection and also understand the importance of potentially prioritizing this population for the vaccine when it's available," Hwang said.

Toronto has the largest unhoused population in the country.

According to the city's data on daily shelter occupancy, the number of people who used its shelter services on Tuesday was more than 6,000. As of Tuesday at 2 p.m., there have been a total of 663 COVID-19 cases linked to outbreaks in shelters since the pandemic began.

There have been five COVID-19-related deaths among people who have used Toronto's shelter system. Four of the deaths were linked to shelter outbreaks. The last reported COVID-19-related death in a person who used the shelter system happened on May 28.

With the help of the city and community organizations, researchers hope to recruit 700 people from shelters, 24-hour respite centres, shelter hotels and homeless encampments.

Hwang said recruitment will likely take a few months, and when finished, the research team will produce an initial report, likely in March. The project is expected to wrap up with a final report in 2022.

He said researchers want to recruit a random sample of people experiencing homelessness and would like the sample to be representative.

"We need to capture a broad cross-section of people, which includes youth, families, single adults, men and women as well as people in encampments who are homeless," he said.

Researchers to check in with participants every 3 months

Researchers hope to recruit people from the five largest encampments, including Moss Park, Alexandra Park and Trinity Bellwoods Park. Advocates estimate that about 1,000 people live in tents in encampments in Toronto, although the city estimates the number to be closer to 400.

Hwang said the researchers plan to check in on participants every three months for a year to track the number of new infections and the rate at which unhoused people are developing COVID-19 symptoms, to assess to what degree they are able to access the vaccine and to identify groups within the unhoused population who might have less access to the vaccine.

"Certainly, the goal should be to vaccinate this group. The question would be to what degree people who are homeless are willing to get vaccinated and are able to access the vaccine. That's something we will also be looking at," he said.

At each check-in or interview, researchers will test participants for current and past infections of COVID-19. Researchers will ask about any COVID-19 symptoms and any interactions with the health-care and shelter systems.

The researchers will use the data to build a computer simulation model that will make projections of COVID-19 transmission in the city's homeless population and evaluate the potential impact of public health measures to curb the spread.

According to the task force, participants will receive an honorarium of $40 at each interview. For follow-up interviews, participants will receive an additional honorarium of $10 if they call the research team to check in before the interview.

The research team will include 15 scientists from such institutions as the University of Toronto, St. Michael's Hospital and Mount Sinai Hospital.

In a news release on Wednesday, the task force said: "COVID-19 poses a serious health threat to people experiencing homelessness. Homelessness puts people at high risk during the COVID-19 pandemic, as shelters are an ideal environment for the transmission of SARS-CoV-2, the virus that causes COVID-19."

It said the study aims to inform better public health measures, which could include repeated screening of the homeless population as opposed to one-time screening, creation of smaller shelter facilities, and housing high-risk individuals in hotels.

The task force said the study's overall goal is to lower adverse health outcomes among unhoused people and ease the resulting impact on the health-care system. It said study results will be used to aid health policy and research in cities across Canada.

City says it supports research project

Mary-Anne Bedard, general manager of the city's shelter support and housing administration division, said the city is supporting the project because the results will enable the city to adapt its pandemic response.

She noted that the city screens all people staying in shelters daily. When anyone has symptoms, they can be tested at a provincial assessment centre, and the person can stay in a recovery program if awaiting test results or if the result is positive for COVID-19.

"The random testing as part of this study provides an additional measure to identify the potential risk of asymptomatic transmission in this population. Again, anyone who is identified as testing positive through the study will be immediately referred to the recovery program for isolation and health supports," Bedard said.