COVID-19 has taken 'heavy toll' on female immigrants working in health care, report says

A surprisingly high proportion of COVID-19 cases in Ontario have been among women working in health care, according to a new report that experts say intensifies calls for better protection.

The report — co-authored by Dr. Astrid Guttmann, chief science officer at ICES, a not-for-profit research institute — follows a study that linked immigration and provincial health administrative data to look at patterns of COVID-19 testing from mid-January to mid-June among newcomers and their Canadian-born counterparts.

"I was surprised by the high proportion of positive cases, especially amongst women who were health-care workers," Guttmann said in an interview. "It's very clear that the pandemic has taken a very heavy toll on this group of women."

The researchers linked provincial COVID-19 test results from more than 624,000 individuals in Ontario to federal data on 2.6 million immigrants and 549,000 refugees who arrived from 1985 to 2017. Residents of long-term care homes were excluded, as were people who aren't eligible for provincial health coverage, such as asylum seekers awaiting refugee hearings. 

Among all adult females in the study who tested positive for COVID-19, 36 per cent were employed as health-care workers. Of those, a further 45 per cent were immigrants and refugees, with those born in the Philippines, Jamaica and Nigeria accounting for the bulk of cases, the researchers reported on Wednesday.

Many health-care workers who tested positive immigrated as paid caregivers, often coming to Canada as live-in nannies and transitioning to personal support work, Guttmann said.

The findings, she said, should be a "call to action" to address systemic inequities by:

• Allowing people to leave work to be tested.
• Protecting people in their workplaces.
• Providing paid sick leave so people who are precariously employed don't lose income in order to protect themselves and their families while ill.
• Supporting those who can't safely quarantine within their own crowded household.

Guttmann said front-line workers, including those who don't work in the health-care field, often have precarious jobs. "People become sick and in some cases die because they fulfil an economic need within this country, so we need to have policies and practices in place that will protect people."

Joadel Concepcion, 46, is a registered nurse who came to Canada from the the Philippines in 1996 and now works in long-term care in Toronto.

Concepcion said she believes she contracted COVID-19 in late March, when public health officials directed nursing home staff to swab residents who had a fever or respiratory symptoms and lived on multiple floors while personal protective equipment like masks was scarce.

"That time when it was an [emergency], I felt like I was going to die," she said of her time in the hospital.

She returned to work on Aug. 14 and takes heart and diabetes medications that were prescribed after her COVID-19 illness.

Personal support workers need higher pay to counter a chronic shortage of staff, Concepcion said.

"Job security, it's not there at times, too, because the position is not permanent and ... there are no benefits."

Status quo for vulnerable workers 'unacceptable'

"We have a scenario right now where the most vulnerable workers are providing the most essential services in the worst working conditions, and that's completely unacceptable," said Naomi Lightman, an assistant professor of sociology at the University of Calgary who researches inequalities among lower-wage workers in the health, education and domestic service sectors.

She was not involved in the study, which she called damning and powerful in documenting disparities with empirical data.

Lightman said she wants to see political will and money put into improvements such as higher pay to retain personal support workers, sick leave and in some cases safer commuting options for those without private vehicles.

In the longer term, she said, housing insecurity, overcrowding and universal child and elder care should be considered to address growing disparities between the rich and poor in Canadian society.

Steps can be taken, experts say

Dr. Aisha Lofters, a family physician and researcher at Women's College Hospital in Toronto, said she was saddened but not surprised by the results.

Factors such as living in a part of the province with higher rates of COVID-19 and in crowded housing compound the problems people can face, Lofters said.

"Why is it the people who are racialized, people who are immigrants are in this more vulnerable position?" Lofters asked. "I would hope that people would recognize that it's not something biological and genetic, but that it's really about a system that we have created."

Lofters said racism, xenophobia and discrimination are long-standing issues that lead to a power imbalance and are now receiving an unprecedented level of attention in academic institutions, the media and business during the pandemic.

"If you try to tackle one thing at a time, because it's so ingrained into our society and our systems, it really could take forever," Lofters said. "If each [of us] looks at what it is that they can control and work on and approach it in an urgent yet thoughtful manner, I think that's the best way to go about it."

In the health-care sector's shift to virtual care, for example, she suggested looking at which patients aren't accessing care because of a lack of digital technology and providing devices such as smartphones. As well, reminding people about the availability of interpretation services could help prevent them from falling through the cracks, Lofters said.

Guttmann said providing mobile testing units in at-risk communities is one pillar of success in the surveillance and testing strategy.

Toronto-based ICES, formerly known as the Institute for Clinical Evaluative Sciences, studies population-based health data to inform health-care issues.