No one is tracking homeless COVID deaths
Officials say just four have died across Canada, but experts are skeptical
OTTAWA— The Public Health Agency of Canada admits it has no clear idea of how many homeless people in Canada have died of COVID-19.
The federal agency responsible for co-ordinating pandemic response and advising the prime minister says as far as it knows, the number is four.
Experts who work in the field of homelessness in several of Canada’s cities say the federal agency’s number is most certainly wrong; that the real number of COVID-19 deaths among homeless people is at least 12 times greater. Possibly more.
Dr. Andrew Bond, medical director of Toronto’s Inner City Health Associates, said in an interview he is “absolutely certain,” based on information exchanged among front-line providers of health care and shelter to the homeless across Canada, that the “most likely” number is between 50 to 100 who have died of COVID-19.
And while that is far fewer than the “thousands” of homeless deaths feared at the outset of the pandemic, it does not count people who died as a result of “co-morbidities” or other long-term or chronic health conditions like heart disease.
That’s also a number difficult to tease out because all efforts to collect meaningful data on the health and well being of homeless people were disrupted by COVID, said Bond.
Nor does the “rough statistic” of 50-100 count the number of homeless persons who succumbed to an opioid overdose, he said.
Dr. Theresa Tam, Canada’s chief public health officer, has reported opioid deaths spiked in the pandemic as people found themselves cut off from their usual mental health or substance use supports, and street drug supplies became more unpredictable and toxic.
Opioid deaths are counted, largely because they are sudden, unexpected, and will often be referred as a coroner’s case. Bond said they “flag systems that then trigger reporting.”
So whereas Bond can point to 132 overdose deaths of homeless persons from January to September in Toronto, deaths as a result of coronavirus infection are harder to get a precise handle on. Bond says it is “four to six” in Toronto.
So this is, in part, an untold success story of aggressive infection controls that worked along with rapid investments by the federal government and cities in isolation housing units to allow for physically distanced accommodation for vulnerable people.
But it is also an alarming failure to capture an accurate picture of what is happening in a kind of “congregate living setting” that isn’t all that different than long-term-care homes.
The Public Health Agency of Canada said it doesn’t collect the data on the homeless population’s experience of COVID-19; it doesn’t compel the provinces or territories to do so.
But when it comes to COVID’s toll on the homeless, the grim reality is nobody really knows for sure.
“It’s shocking that, knowing that homelessness is the single most impactful social determinant of health on people in Canada or North America for that matter, to know that we are not tracking its impact and breadth is really quite astonishing,” says Bond.
In March, those on the front lines feared the worst.
“We’d heard horror stories from our colleagues in New York and the U.K. about how terrible it was going to be,” said Wendy Muckle, head of Ottawa Inner City Health Inc., which provides health care to residents of seven shelters in the national capital and collabo
rates with two facilities dedicated to Indigenous homeless.
“They said, ‘Expect that you will lose about 40 per cent of your staff and at least, in any shelter, 20 per cent of the clients will be infected with COVID.’ ”
Deirdre Freiheit, who heads
the Shepherds of Good Hope shelter blocks from Parliament Hill, said it was a race to find supplies like PPE and hand sanitizer, which “a lot of people donated,” and to lessen crowding in the 268-bed facility.
Muckle said the city’s shelters pooled and shared PPE, set up
“donning and doffing” stations and trained workers in proper PPE use. They put in strict infection control protocols in residences, changed policies to ensure homeless people didn’t move between shelters, and brought in nursing and medical students to help train residents in mask-wearing and handwashing. They erected Plexiglas barriers on tables in the soup kitchens, limited the numbers who enter at any time, and instituted lots of testing.
It all worked to keep the nightmare scenario at bay. Ottawa’s shelters and supportive housing have seen just a dozen COVID-19 cases among an estimated 1,100 homeless “clients”, only five shelter staff tested positive, along with five supportive housing staff. None of the homeless who were infected had to be hospitalized, and there were zero COVID-19 deaths.
“I don’t want to say we were lucky because it didn’t feel lucky, and it was a hellish amount of work, but I do think in the long run it has benefited our community,” said Muckle.
In Toronto, where Bond says about 2,000 to 2,500 people face chronic homelessness, it’s a different picture. Toronto Public Health is attempting to document homeless deaths and identify causes, but it is a work in progress.