Leonard Rodriques did not want to go to the hospital. But his breathing was so laboured, his skin so ashy, that his family insisted. His wife, Dorothy Rodriques, drove him to the nearest emergency room and told staff there her husband had COVID-19.
Leonard was ushered inside. Dorothy was turned away: pandemic policy restricts visitors. She worried she had broken her husband’s trust, worried about what care he would receive with no one to advocate for him. The Toronto couple had seen U.S. news reports about Black people dying from the coronavirus at higher rates.
Dorothy drove home and was tidying his room when she heard the front door open. Leonard stumbled into the foyer, half-falling. Instead of being admitted, the 61-year-old was discharged with a prescription for antibiotics.
Two days later, Leonard Rodriques stopped breathing in his bedroom. His children could not resuscitate him.
The pandemic has exposed deep vulnerabilities in this city, province and country, exploiting nearly every system and institution we failed to fortify. Rodriques’s death sits at the intersection of many of these failures.
Some of those failures are becoming painfully clear. Rodriques was a personal support worker, the fifth of seven to die of COVID-19 in Ontario to date. The long-term-care homes and other settings where PSWs work, such as the supportive housing units where Rodriques served, are typically far less resourced than the hospitals the province raced to protect.
Other failures are still hazily understood. While evidence from the U.S. and U.K. has demonstrated that Black and other racialized people are disproportionately affected by COVID-19, Canada has only preliminary, partial evidence this is true.
This absence of evidence is not evidence of absence. Researchers say there is every reason to believe similar patterns hold true here, and that Canada has a longstanding reluctance to confront such problems with data that could make their scope and depth clear. Until that data is collected and analyzed, stories like that of Rodriques can always be dismissed as anecdotes.
Dorothy and Leonard Rodriques chose to begin their life together in Canada. Leonard’s death has made Dorothy doubt that decision.
“When I look at my life and my health and how this has happened to Len, and I’m like, ‘Oh, this is absolutely not what I what I had planned or thought,” she says. “When I look back at what we have given to this country and to the people in this country, all we got was a kick in the teeth.”
Nearly 40 years ago, a friend asked Dorothy: how come you don’t have a boyfriend? She answered by describing the kind of man she was looking for: he has to go to church. He can’t smoke. He can’t drink. To Dorothy’s surprise, the friend said, “I know him. I know a guy who’s just like that.”
The man, Leonard Rodriques, lived in Jamaica, while Dorothy lived in Canada. The two began exchanging letters, until one day Dorothy decided to fly to Jamaica. “I went to his house and knocked on his door. He just flipped right out of his clothes.”
They decided to settle in Canada, believing they would have more opportunities here. They raised two daughters and a son in northwest Toronto. Sometimes Leonard was even more of a good man than Dorothy had bargained for.
Leonard would drop whatever he was doing to repair a neighbour’s washing machine or entertain a gaggle of bored children. Dorothy would look out the window and see a stranger’s car in their driveway, after Leonard offered to fix the brakes.
Leonard Rodriques layered a professional obligation to care for others on top of his natural disposition: he spent 29 years as a personal support worker. He worked for Access Independent Living Services, an agency that provides supports so that people with disabilities and other physical requirements can live independently in the community.
“My dad loved being a PSW,” says Terena Rodriques, his daughter. “He was helping people. That’s what he wanted to do.”
Rodriques would notice when a client’s wheelchair had banged a hole in the wall, and bring a drill and a piece of drywall from home to fix it, his family says. He was a great cook: he would come home bragging that a client called him the “Star of Salad.”
In early April, Rodriques learned that a co-worker had tested positive for COVID-19. To his alarm, the agency did not have enough masks and other personal protective equipment (PPE) for staff, he told his family: his boss was trying to get some, but it “had all gone to the hospitals,” Dorothy remembers him saying.
So Rodriques went out and bought his own masks at the dollar store, his family says.
On April 6, Rodriques was hit with a wave of exhaustion at work. He called his wife to come get him. He would later test positive for the coronavirus. He is one of nine PSWs from Access Independent Living Services who have tested positive, according to Toronto Public Health. Three residents at the York Square building where Rodriques worked, near Eglinton and Keele, have also tested positive.
In written responses to Star’s questions about how these workers were infected, Michael Mathieson, the executive director of Access Independent Living Services, said “Public health guidelines and directives have changed including updated PPE requirements over the course of the pandemic. We are working closely” with public health, and following their directives, he said.
“The York Square location is the only program where Access had an outbreak of COVID-19. We implemented PPE protocols (gloves, gowns, goggles and surgical masks) at that location. We have implemented universal masking, universal eye protection and gloving for all of our programs. These protocols and practices met or exceeded Public Health and Ontario Health guidance and were implemented in advance” of that guidance being issued.
Mathieson also said that “we are heartbroken at Leonard’s passing.”
“I have known Leonard and his wife for almost 30 years,” Mathieson wrote. “He was such a wonderful person, both as someone who cared deeply about the people he provided services to in his role at Access, and as a very proud family man. Leonard often spoke about his family and the pride he had with his children.”
As Leonard Rodriques self-isolated at home, he developed a terrible cough and ragged breathing. His condition began to spiral. But he resisted seeking medical care: his latent distrust of hospitals had been compounded by reports from the U.S. about how COVID-19 was killing African Americans at disproportionately high rates.
Eventually, “I said, ‘listen, I know you don’t want to go, but it’s time,’ says his daughter, Terena. “You have to go.”
His family called 911, who transferred them to Telehealth Ontario, who told them to call 911, who told them to take Rodriques to the nearest emergency department themselves. Dorothy drove him to Humber River Hospital.
The Rodriques family does not know why Leonard was not admitted for further observation or care, despite what they describe as acute, obvious respiratory symptoms. They have no proof that Leonard’s race played a role in his treatment. But it accelerated their fears that Black people are far more likely to be mistreated, under-treated, or simply turned away from the health-care system, a pattern evident in other jurisdictions.
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Asked about the family’s fears and about counteracting potential racial bias in the health-care system, a spokesperson for Humber River Hospital said that “we treat all patients with courtesy and respect, offering fair and equitable treatment, and recognition of individual needs, differences and preferences.” The hospital has “a strategic focus on equity and inclusivity,” said Joe Gorman, which led to the development of an “inclusivity framework.” They also have anti-harassment and anti-discrimination policies.
Gorman said the hospital “does not publicly address individual patient or staff related matters respecting privacy and confidentiality requirements.” (The antibiotic Rodriques was prescribed is used to treat bacterial infections that are the result of viral pneumonia, according to an infectious disease expert.)
In an earlier statement, he said that “we as an organization are deeply saddened to hear of the passing of Mr. Leonard Rodriquez. Standard hospital policy includes clinical assessments for safe discharge, and instructions to return to the Emergency Department for any reason.”
Evidence for racial bias in the American health-care system could fill several editions of this newspaper. Research has shown that African Americans are more likely to be denied access to emergency departments, and once inside hospitals, they are less likely to receive pain medication for broken bones, more likely to have a limb amputated, and more likely to die in childbirth.
The pandemic has exposed similarly brutal disparities. The U.S. Centers for Disease Control has noted that Black people are signficantly overrepresented among hospitalized COVID-19 patients. New York City has reported death rates from COVID-19 that are twice as high among Black people than white people.
While Black people are also more likely to have underlying health conditions that can make COVID-19 more severe, research has also shown that the higher burden of these conditions is linked to unequal access to health care and other forms of discrimination.
Canada has very little data to support the existence of these trends. Researchers say that is not because the same problems don’t exist, but because Canadian jurisdictions do not routinely collected race-based statistics. When they do, the data is incredibly difficult to access.
“This is a huge problem,” says Arjumand Siddiqi, Canada Research Chair in population health equity at the University of Toronto’s Dalla Lana School of Public Health.
“Given the fact that racism is so deeply embedded in society, it would be really surprising if it doesn’t show up in the health-care system. But how systematic it is, at what points it happens, in what way it happens — in Canada, I don’t know at all.”
Ontario’s chief medical officer of health initially dismissed the need for race-based statistics on COVID-19, but the province reversed course, and now says it will collect this information. Researchers have been left to comb through geographically based trends — analyses that use census data and patient postal codes — a cruder measure than individual-level data, but still suggestive.
What they have seen so far is troubling. Sixty-eight per cent of COVID-19 deaths in Ontario have occurred in residents of the top 40 per cent most “ethnically concentrated” areas of the province, compared to 15 per cent in neighbourhoods in the bottom 40 per cent of ethnic concentration, according to analyses led by Dalla Lana’s Emmalin Buajitti and Laura Rosella.
Their work suggests that the burden of infection is increasingly shifting into less socio-economically advantaged, more ethnically concentrated areas as the pandemic goes on.
“There’s something about society that fundamentally structures risk so that we offload it onto the people who are the most disadvantaged,” says Siddiqi.
Two days after being sent home from the hospital, Dorothy knocked on Leonard’s door with soup. He didn’t answer. She opened the door and saw him keeled over.
His daughter Terena did chest compressions; 911 instructed his son, Temall, on giving him mouth-to-mouth resuscitation. Paramedics finally arrived and took over, but could not revive him.
The indignities did not end. The family was told that the coroner would come to collect the body, but hours later were informed that wasn’t the case: they would have to arrange for a funeral home to take him. They called one, which simply never showed up. They called another, which came quickly.
By that point Rodriques had been lying on the floor for five hours. His son sat staring in shock at his father’s body the entire time.
Dorothy and her children learned at the last minute that because of their exposure, they wouldn’t be able to attend his funeral, so it was cancelled. Leonard Rodriques was cremated with no one who loved him in attendance.
As the family processed their grief, they sought to be tested themselves. Their family doctor phoned ahead to Mount Sinai Hospital and arranged for them to be swabbed, but when they arrived downtown, they say they had to argue to get inside. Days later, they say they were told the samples had been lost and they had to come back.
Temall tested positive, news his mother Dorothy related through tears.
Leonard Rodriques didn’t trust the health-care system, but his doubts and fears had been fuelled primarily by American media reports. Struggling to comprehend what she just lived through, Dorothy sometimes seems surprised, and sometimes not.
“I never in my wildest dreams would think this would happen in Canada,” says Dorothy Rodriques.
“I feel like I’m a stranger in this land. I feel like I’m a stranger here.”
Kate Allen is a Toronto-based reporter covering science and technology for the Star. Follow her on Twitter: @katecallen