Why COVID clusters on the edge of town
Some 16 neighbourhoods with Toronto’s highest infection rates are located in the northwest corner of the city. Community advocates say the pandemic has only magnified existing problems like crowded housing, vulnerable workers and harder-to-access to health care
When Toronto Public Health released its map of neighbourhoods hardest hit by COVID-19, for people in the city’s northwest it felt like déjà vu.
It looked strikingly similar to the map showing where chronic diseases like diabetes are highest. It mirrored a 2014 report highlighting Toronto neighbourhoods facing the biggest social and economic disadvantages. It might as well have been any number of maps showing some of the city’s highest concentrations of poverty in highrises or lowest post-secondary education.
Every time, the same northwest neighbourhoods pop out — a cluster of communities spanning a large swath of Toronto, wedged between Dufferin St. and Highway 427 to the west, running south from Steeles Ave. to Eglinton Ave.
So when the COVID-19 neighbourhood map came out, “I was definitely not surprised,” said Tesfai Mengesha, head of Success Beyond Limits, a community group in the Jane-Finch area. “Yet again, our system has failed people from our community.”
“COVID-19 is just another thing, another issue, that highlights the challenge that our communities face,” said Floydeen Charles-Fridal, executive director of Caribbean African Canadian Social Services, a not-for-profit in the neighbourhood.
“It’s just a really heartbreaking truth,” said Leticia Deawuo, the executive director of Black Creek Community Farm.
The COVID-19 rates are more than10 times higher in some of these neighbourhoods than in the least-affected areas, which are wealthier and more central.
The neighbourhood with the most cases, Mount Olive- Silverstone
Jamestown, has nearly 400 cases, while the Beaches has just 11. (The Star’s analysis looked at sporadic cases, which do not include institutional outbreaks and better reflect patterns within the community at large.)
Researchers and public health officials are still collecting and analyzing data to better understand who is being most affected by the pandemic and why — and why the northwest corner is so vastly overburdened by COVID, even compared to other areas of the city with similar socioeconomic profiles.
Testing rates may be playing a role. The northwest corner has had some of the highest testing per capita in the city, though much of that volume could be tied to two massive outbreaks at long-term-care facilities where the military was called in.
Parts of Scarborough with similar demographic profiles have some of the lowest testing rates in Toronto, and could prove to be hot spots as access to testing improves.
“The fascinating thing about COVID-19 is that it has actually really laid bare where the health inequities are in the city, in a way that frankly all the reports that we have done over the years just haven’t done as effectively,” said Toronto’s medical officer of health, Dr. Eileen de Villa, in an interview.
On Wednesday, Toronto Public Health announced a proposal to provide alternative accommodations for residents struggling to self-isolate in cramped, unsuitable housing, which de Villa and Councillor Joe Cressy said would help gird vulnerable communities against the pandemic.
Community advocates say officials should have acted faster on the mountain of evidence already available that suggested neighbourhoods like these would be the most vulnerable to COVID, as they had been to many other health risks. They fear the pandemic is having a disproportionate impact on the Black community and is yet another spotlight on the pernicious effects of systemic racism: the city’s northwest neighbourhoods also have the city’s largest proportion of Black residents.
De Villa suggested that many of the approaches to address the deep roots of these systemic inequities were beyond the control of her department. Cressy, who is chair of the Toronto board of health, acknowledged that the city, the province and Ottawa all bear some blame.
“All levels of government have a responsibility for the continued health inequities that have long plagued certain neighbourhoods,” he said, “and all levels of government have failed to do enough. And COVID has made that painfully visible for everyone to see.”
Toronto Public Health says it is investigating why neighbourhoods in the northwest have been disproportionately burdened by COVID.
The Star examined datasets and research and interviewed more than 40 residents, advocates, health workers, experts and officials to try to understand more. As some warn of a second wave, our findings offer clues about how the virus infiltrated the city’s hardest-hit corner, and how to protect atrisk neighbourhoods in the weeks and months ahead.
THE WORKPLACE For months, the mantra from public health authorities has been: “stay home.” But which communities have had the luxury of heeding this advice, wonders Deawuo from Black Creek Community Farm — and which ones haven’t?
“Working from home is for who?” she asks. “Who gets the opportunity to do that work from home, or even who has the capacity?”
In the city’s northwest, the answer has been “not many,” according to census data and community advocates. At Delta Family Resource Centre, which has three locations in northwest neighbourhoods, many clients are new immigrants, refugees or those without legal status — people who might “live on the edge at the best of times,” said executive director Kemi Jacobs.
“The people we serve; if they have a job, they don’t have the luxury of not going out. They’re the personal support workers, they’re the people working in grocery stores as cashiers,” she said. “They’re the most poorly fed and the most vulnerable.”
To better understand employment risk in these communities, the Star analyzed custom workplace data provided by Statistics Canada for the 16 neighbourhoods with the highest COVID rates in Toronto — all of which are clustered in the city’s northwest corner.
In each of these 16 neighbourhoods, 26 to 32 per cent of residents work in “sales and services,” especially in a subcategory that includes cashiers and shelf stockers.
Out of the city’s 140 neighbourhoods, the five with the largest proportion of cashiers are all in the northwest corner — and all are in the top 10 neighbourhoods with the highest rates of COVID.
When looking at industry data, the manufacturing sector is also a standout; many of the neighbourhoods with the highest COVID rates also have the biggest proportions of residents working in this sector.
In the 16 neighbourhoods hardest hit by COVID, between 11 and 25 per cent of residents work in manufacturing; by comparison, the city average is 8 per cent.
The manufacturing sector is heavily reliant on lower-income workers and temp agency workers, many of whom live in the city’s northwest. And during the pandemic, while the rest of the city has locked down, factories, like food processing plants, have revved up.
At one north Etobicoke plant in the food services industry, there have been at least a dozen workers infected by COVID, according to documents obtained by the Star and a production line worker, who asked not to be named because of concerns over his job.
According to the worker, the plant has been operating at a frenetic pace since the pandemic began; half of the workers on his shifts are new faces that have been recently brought in. But despite the growing number of worker infections, he said his plant has yet to cancel any shifts, shutting down only a couple of times for two or three hours so the premises could be cleaned.
“People were crying in the break room,” the worker said. The virus “went pretty quick through the plant.” At Rexdale Community Health Centre, nurse practitioner Almut Brenne-Davies has also heard alarming stories. She recalled one woman she saw who worked in a factory and was unexpectedly told by her bosses to go on break along with half of her co-workers, because inspectors were about to come in.
This was “so that they got the impression they were social distancing,” Brenne-Davies said. “And then they had an outbreak.”
While they are not captured in Statistics Canada data, vulnerable temp agency workers are common in the city’s northwest, according to to Farid Partovi, a community development worker with the Jane/ Finch Community and Family Centre. A report released last year by Jane Finch Action Against Poverty noted there are as many as 100 temp agencies in the area. While TTC ridership has plummeted during the pandemic, some of the city’s most crowded bus lines have been in the city’s northwest. Many workers commute to industrial jobs in the 905 region, Partovi said. According to Statistics Canada data, the neighbourhoods with the city’s highest COVID rates all have either Vaughan or Mississauga as one of their top three work locations.
The public health units in York and Peel both started identifying a rise in workplace outbreaks in their regions early on. York has reported 475 workplace clusters, Peel has investigated 17. In both health regions, a significant proportion of those outbreaks have occurred in manufacturing and food processing plants.
Toronto Public Health did not release numbers on workplace outbreaks, stating it is still “developing a process for posting COVID-19 workplace clusters on our website.”
HOUSING When Deawuo, who lives at Jane and Sheppard, discovered that her neighbourhood is among those hardest hit by COVID-19, she thought about a distressing chain of events that she imagined playing out all around her — front-line workers becoming infected and “going back home into their communities, and taking the virus with them.”
“It’s a bit scary to think about, and trying to just figure out how we can keep each other safe and make it through this pandemic,” said Deawuo, a single mom to two children, 17 and 8.
Residents, community advocates and experts say that the overcrowding and poor housing conditions that have long plagued these neighbourhoods could be playing a role in virus transmission.
De Villa told the Star that “close contact within the household is a major risk factor,” and that public health officials are investigating cases to find out more about how this is playing into transmission in parts of the city hard-hit by COVID-19. Toronto Public Health has also started collecting individual-level data on household size to better understand this phenomenon.
Space is key to stopping the spread of COVID-19. Public health officials urge people on the street and in the grocery store to stay at least two metres apart. At home, those infected with COVID-19 are told to selfisolate, away from family, in a separate room, and to use a separate bathroom.
Quarantine is a “luxury good,” say experts like Jim Dunn, chair of the department of health, aging and society at McMaster University.