COVID’s Omicron waves saw lower-income Ontarians die at higher rates, analysis shows

Low-income Ontarians continue to die from COVID-19 at much higher rates than higher-income ones – a disturbing pattern repeated in each of the province’s six pandemic waves, new data shows.

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In yet another sign that COVID is not an equal-opportunity disease, University of Toronto researchers have found that the death rate from the virus in Ontario’s lowest-income neighborhood nearly doubled in the province’s richest areas during the entire pandemic. Is.

COVID deaths remain concentrated in low-income neighborhoods even after the rollout of vaccines, antiviral drugs and COVID treatments – in addition to endless calls for equitable access to public health resources – shows that the pandemic is not over for many.

“This begs the question: between whom are we flattening the curve?” said Dr. Sharmistha Mishra, an infectious disease physician and mathematical modeler at St. Michael’s Hospital in Toronto. Mishra heads a research team that analyzes COVID mortality data. He shared the sixth wave analysis with STAR; The team’s analysis of the other five waves is presented earlier by the Ontario COVID-19 Science Advisory Table.

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With another wave of the virus expected this fall, Mishra and other experts are calling on the province to pursue continued prevention and treatment strategies for the most vulnerable, including older Ontarians and the lowest-income communities. Huh.

Mishra, whose Unity Health Toronto team analyzed data on COVID deaths and illness during the pandemic, said the same pattern of disparity persists in hospitalizations and ICU stays, even when underlying health conditions are accounted for. Is. Misra said the team used COVID data from Ontario’s Case and Contact Management System with income-level data from Statistics Canada, which accounts for the cost of living within areas.

The analysis found that the pattern of inequality held true across the province, Mishra said, with low-income areas – many with high numbers of essential workers – including areas of Peel, the northwest corner of Toronto, disproportionately high in COVID deaths. Looking at the numbers, parts of Ottawa and northern Ontario, including Thunder Bay. He said that people who are underhouse or who are experiencing homelessness are also being continuously affected by COVID.

Research over the past two years has shown that in every wave of the pandemic, Ontario’s working poor, racial and immigrant populations have suffered not only disproportionate rates of infection, but their unequal access to testing, treatment and vaccines. is also.

In April 2021, after the first dose of the COVID vaccine was introduced, postal code data showed that many areas most vulnerable to the virus simply weren’t getting the shot. Toronto’s Jane and Finch neighborhood, for example, home to many multi-generational homes and essential workers, had some of the lowest vaccination rates at the time. In contrast, the wealthy Moore Park neighborhood had the highest vaccination rates.

Last spring, research by the Gattuso Center for Social Medicine and the University Health Network found that people who lived in Toronto and Peel COVID hot spots were almost twice as likely to be racist and nearly four times as likely to be employed. was more. manufacturing and utilities compared to residents of other neighborhoods in the areas.

When it comes to booster shots, as recently as last January, data showed that less than 20 percent of residents in the North Peel area and hard-hit Northwest Corner of Toronto had received a third dose.

Dr. Fahad Razak, Scientific Director of the Ontario COVID-19 Science Advisory Table, said, “The pandemic has sadly reinforced what we have seen for many other diseases in human history: that they are concentrated among the poorest and most vulnerable. Huh.”

“The burden of COVID-19 in low-income neighborhoods and among racial groups highlights the need to focus our protective strategies with the widest possible lens: considering workplace risks, poor housing and schools, for example. “

Health ministry spokesman WD Lighthall said the province was adopting a variety of strategies to connect with communities with low vaccination rates, including offering more diverse clinic locations, focused communication on traditional and social media channels about their roasted patients. Includes providing data for primary care. and providing information in more than 300 languages ​​through the Provincial Vaccine Contact Center.

Whitehall said the province’s GO-VAXX fleet is still active and prioritizes vulnerable communities with fewer vaccinations, including a host of clinics at senior and community centers, schools, shelters and places of worship.

“The Government of Ontario will continue to provide COVID-19 vaccines to all eligible individuals who wish to receive their first, second or booster doses, and will continue to focus outreach and engagement efforts on vulnerable and elderly populations who may not be up to date on vaccines. Huh. Whitehall said in an email.

While the province tailor-made a first- and second-dose vaccine rollout for communities with high infection rates last summer, Mishra said ongoing research by his team is trying to understand why the disparity in deaths and hospitalizations Remained.

“Could it be that the third-dose approach was not consistent? Is it that we were not fully addressing exposure risks based on structural elements, including paid sick leave and housing support – and is it some This was something that could not be overcome with vaccination alone? Is there a need for more tailored delivery and access to therapeutics that reduce the severity of COVID?

Sofia Ikura, executive director of the Health Commons Solutions Lab, a publicly funded, non-profit organization at Sinai Health in Toronto, said the province’s efforts to work with communities helped close the gap on COVID inequalities. is done, although more needs to be done.

“We have seen tremendous loss of life in these communities,” Ikura said, calling the disparity in COVID mortality rates “a tragedy” in the neighborhood.

The Health Commons Solutions Lab works with a team of approximately 200 community outreach ambassadors who work in primary neighborhoods, providing information and assistance with the delivery of COVID vaccines and treatments, including the antiviral Paxlovid.

Ikura said ambassadors are reporting growing hesitation among residents about receiving the booster, though he hopes ongoing education and distribution efforts will help residents feel safer taking the antiviral.

“These communities have always gotten the short end of the stick … and that continues to contribute to the lack of trust,” she said. “It’s become a very difficult cycle.”

Ikura said the “structural realities” facing residents of low-income neighborhoods, such as housing that doesn’t allow physical distancing and the need for public transportation to work, have contributed to the spread of COVID infection throughout the pandemic. has contributed to the high rate of .

These same structural inequalities, including a lack of safe, stable housing, food insecurity and low employment avenues, also increase the risk of chronic disease such as diabetes and heart failure. This in turn raises the risk for COVID illness and death, she said.

Dr. Mustafa Hirji, Acting Medical Officer for Health for the Niagara Region, noted that one reason people with low incomes tend to have worse outcomes from COVID is that they cannot get away from work when they are sick.

“Otherwise they won’t be able to pay their bills or keep food on the table. So they go to work and they spread that infection around to everyone,” said Hirji, who is on three subsidized temporary paid sick days. The U.S. is seeking an extension for at least one more year, known as the Worker Income Protection Benefit, that the province introduced in April 2021.

He is also calling for a study on how to make these sick days permanent and increase the total sick days to 10 that workers would be entitled to in a way that does not harm the economy.

Just last week, a group of more than 160 physicians, nurses and health care workers organized a Open Letter to Premier Doug Ford Called for legislation to provide for 10 permanent sick days for all workers, but especially those who are racist in low pay and precarious jobs.

“Paid sick days are partly about helping to create a culture where we stay home when we are sick and control infectious diseases for longer periods of time,” Hirji said. “But it’s also specifically about equalizing people’s ability to stay home so that people with low incomes don’t have that option.”

Ikura acknowledged that many people are tired of COVID, which includes wearing masks and following public health recommendations. But she expects people not to be shocked by the fact that people are still dying from the virus – and that those deaths are disproportionately high in vulnerable communities.

“We must never tire of hearing about the loss of life – and the lack of justice surrounding it. We must not allow ourselves to be harsh about the number of people killed in these communities and how unjust this is.

Megan Ogilvy is a Toronto-based health reporter for Star. Follow him on Twitter: @megan_ogilvie
Kenyon Wallace is a Toronto-based investigative reporter for Star. Follow him on Twitter: @KenyonWallace or reach him via email: [email protected]

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