Why doctors say it's crucial to focus on COVID-19 spread in working-class neighbourhoods

Toronto doctors say they're optimistic politicians are beginning to turn their attention to the spread of COVID-19 in working-class neighbourhoods full of essential workers, and that Ontario's new testing strategy could help tackle one of the virus' last bastions in Canada.

Naheed Dosani, a Toronto physician who works with vulnerable communities, says he was elated when the city finally released COVID-19 postal code data this week, which showed that residents in lower income neighbourhoods appear to be disproportionately affected by the virus in Toronto.

A day after that data was released, Ontario announced it would shift its testing strategy to focus on vulnerable communities and essential workers — which includes the addition of pop-up assessment centres in some of the province's hardest-hit areas.

Dosani says both of these things signal a big step in the right direction, and a lack of focus on these populations until now could be one of the reasons Ontario has struggled to get its outbreak under control.

"We now have another iteration of data showing that COVID-19 is not impacting our communities equally," he said in an interview with CBC's The Weekly. "And if our [vulnerable populations] are more likely to get COVID-19, then so are all of us." 

'These are folks who actually have to show up to work'

Epidemiologist David Fisman says it has become clear in recent weeks that the virus has largely moved from institutional outbreaks in Ontario, like in hospitals and long-term care homes, to workplaces and working-class neighbourhoods in places like Toronto, Peel Region, and Windsor.

A similar story is playing out in Quebec, where low-income neighbourhoods, home to a large percentage of essential workers, have also become COVID-19 hotspots. 

"These are folks who actually have to show up to work. They have to show up to long-term care facilities, they have to show up to factories," said Fisman, who is also a physician and professor at the University of Toronto's Dalla Lana School of Public Health.

He says many of these essential workers are required to gather in confined spaces as part of their job, and working-class neighbourhoods tend to have a larger percentage of multi-generational households.

"If you have multigenerational households, where the younger people are doing essential work, and then bringing the disease home to their mom or their dad, or their grandma and grandpa — those folks can get very sick, and they can die," he said.

Some infectious disease experts, Fisman included, have thus far been critical of Ontario's messaging on testing.

But Fisman calls Ontario's new plan — which will include targeted campaigns to test asymptomatic essential workers, like taxi drivers, factory workers, and retail employees — "amazing news."

"If it's implemented as it was written, then I think we're going to turn the corner." 

On Friday, Ontario completed over 20,000 COVID-19 tests, the most it has ever completed in one day — and well above its target total of 16,000 daily.

Targeted messaging

While Dosani welcomes wide-spread testing with enthusiasm, he says it's only part of the equation. He hopes that politicians and public health officials are also thinking more about how to better support vulnerable communities, through things like access to sick leave, safe housing, places to self-isolate, proper protections at work, and a focus on the use of shared spaces like transit and parks.

He says communication is also important. 

"I think that sometimes the [public health] messaging focuses on a very particular population. We need to think about language, we need to think about culture… we need to find creative ways to communicate these messages so that every Canadian understands their role," he said.

Fisman wonders if officials in Quebec and Ontario could also start sharing their experiences as they begin to prepare for a potential second wave. "It really does seem like the end game is very similar in Montreal and in Toronto, and perhaps we can learn and support each other."

Both agree that knowing who is most vulnerable to the virus, and focusing public health support on them, is an important piece of the puzzle.

"There is no doubt that income, housing status, workplaces, and racial backgrounds have a huge impact on who's getting COVID-19," said Dosani. "There are multiple risks at play… you just have to dig a little deeper to see them."