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 than 10 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 reflects 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 at-risk neighbourhoods in the weeks and months ahead.
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.”
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 self-isolate, 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.
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“You just have to go up to Jane and Finch, and Jane and Sheppard, and see the buildings, see the housing units that make it impossible virtually for people to practise physical distancing,” said Charles-Fridal.
Cramped living has long been endemic in the aging towers in the city’s low-income neighbourhoods, including the northwest corner.
In Toronto, roughly 12 per cent of homes don’t have enough bedrooms to accommodate the size and makeup of the households living there, according to 2016 census data. This metric is dubbed “housing suitability.” It’s a good way to measure crowding — and quantify risk during the pandemic.
In Mount Olive, which has been hardest hit by the virus, 30 per cent of homes are classified as unsuitable. Other neighbourhoods in the northwest corner with a disproportionate COVID-19 burden also fare poorly on this measure, including Black Creek (26 per cent), Glenfield-Jane Heights (23 per cent) and Kingsview Village-The Westway (20 per cent).
While the need to set up COVID recovery centres for individuals experiencing homelessness is “blatantly obvious,” this is also a concern for those who are living in crowded conditions, or in multi-generational households, and can’t self-isolate safely, said Dr. Stephen Hwang, director of the MAP Centre for Urban Health Solutions at St. Michael’s Hospital.
Councillor Cressy said work has been underway for roughly six weeks on a plan to offer free hotel rooms to people without enough space to self-isolate at home — a first in Canada, he said.
“This work is all urgent,” he said. “And being the first country to implement such a program doesn’t mean you get a pat on the back. It means it’s a good thing, now do more,” he said.
Toronto Public Health said it has not declared an outbreak in any apartment building setting. But COVID-19 has heightened the anxiety of some residents, who fear unmet maintenance concerns and cleanliness issues could put them at risk.
Angie Toussaint, 65, who lives on the 23rd floor of a highrise near Jane and Finch, said she is “trying to stay safe.” But her building has not provided hand sanitizer in common areas, she said, despite guidelines issued by the city. Those guidelines also urged landlords to regularly clean common areas and shared surfaces.
Toussaint, who is co-chair of the York West chapter of ACORN Canada, which advocates for low- and moderate-income families, also complained that broken elevators in the building were causing overcrowding — “a pile of people downstairs in the lobby.”
At the urging of ACORN and the Federation of Metro Tenants’ Associations, whose members have reported that more than half of landlords are not following the guidelines, Councillor Josh Matlow will bring forward a motion on June 29 to make these rules mandatory.
“While we’re in the midst of a public health emergency, why on earth, even out of an abundance of caution, would we not tell landlords that we expect some basics?” Matlow said.
Even before the pandemic hit, the corrosive effects of poverty and other systemic ills had already degraded the health of these communities. The maps of many chronic conditions in Toronto — hospitalizations from cardiovascular disease, diabetes rates — look like a doughnut, with a healthy, wealthy core and a ring of sicker communities surrounding it.
“We can’t talk about COVID until we talk about what historically we’ve been seeing in this community with regards to access to health care,” said Michelle Westin, senior analyst for planning, quality and risk at Black Creek Community Health Centre.
Food insecurity, lack of affordable and safe housing, high rates of unemployment — these already had “a huge impact” on the overall health of the community, she said.
And when people in the northwest corner of Toronto do get sick, they are less likely to have a family doctor to turn to. This corner of the city has historically been a “primary care desert,” experts say.
When Ontario researchers examined the geography of primary care gaps in the province, they found that areas of the province with the highest needs were getting the lowest levels of care. In Toronto, those areas clustered in the city’s northwest corner and in south Scarborough.
“You’ve got a lot of poverty of opportunities and of services, and some of (that) is lack of health care,” said Dr. Rick Glazier, a senior scientist at ICES and the lead author of the 2018 report.
Access to a family physician has been vital in the pandemic, Glazier noted — especially in the early months when it was difficult to get tested. Primary care doctors and nurses were crucial in providing advice on how to get tested, how to self-isolate, or when go to the emergency department.
The northwest has strong Community Health Centres, which offer a unique model of care and have deep roots in these neighbourhoods. CHCs like Rexdale and Black Creek are mandated to address the health of the community and the social determinants of health, and serve anyone who needs care, even if they are uninsured.
“I can’t say enough wonderful things about them,” said Glazier, a family doctor himself. But he added that they cover a small proportion of the population, and underserviced areas need more.
At the Rexdale Community Health Centre earlier this month, staff noted there were just a few CHCs covering a huge geographic area.
“What are the resources? Look at it — let’s break it down and see where all the resources are,” said Linda Akuamoah-Boateng, a diabetes educator.
“Even north and south Etobicoke — it’s like moving from one world to another.”
In Rexdale, the health centre’s pandemic-related concerns expand far beyond the virus. Their list of food-insecure clients grew from about 50 in late March to over 900 in early June, and was still rising. Mental health impacts have become a grave concern.
But their virus-related issues are also unique compared to wealthier, better-resourced areas. Though this region of the city has high testing rates overall, staff suggested their clients had trouble accessing assessment centres: not everybody drives or owns a car, and travelling by TTC while symptomatic is strongly discouraged.
In Thorncliffe Park, a neighbourhood on the other side of the city with similarly high rates of newcomers, low-income residents, and unsuitable housing, a partnership between health-care providers is breaking down similar barriers to testing.
At Michael Garron Hospital, which operates the closest assessment centre, doctors noticed high test-positivity rates from certain areas in the community. Infectious disease doctor Jeff Powis said the hospital’s close relationship with other, community-driven health partners was key to establishing a response.
“I was able to lean on my colleagues who are already integrated in the community, and already know the subtleties of the connections in the community … luckily, I was able to work with them and hand that piece over.”
Those partners — Health Access Thorncliffe Park and the East Toronto Family Practice Network — worked with the hospital to set up a low-barrier pop-up testing site in a currently vacant community centre, near some of the residential areas with the highest test-positive rates.
Two “community ambassadors” are always present, helping to take information and guide patients. Information handouts are available in multiple languages. Community workers spread the word of the site’s opening through WhatsApp, and when they didn’t see the diversity at the test site they knew to expect, redoubled their efforts. Masks, hand-sewn by volunteers, are piled in boxes and available for giveaway.
In the northwest, no mobile testing that is available to the community has materialized, even though they are the hardest hit by COVID-19.
The Star asked the nearest hospitals operating assessment centres about mobile testing in these communities; they redirected inquiries to public health. City officials suggested that planning for mobile testing, however, was the responsibility of the province’s Local Health Integration Networks, who either didn’t respond or directed the Star back to public health.
De Villa said mobile testing in these neighbourhoods has been “the subject certainly of conversation and soon to be action, I would like to think.” But she reiterated that while Toronto Public Health is a partner in testing efforts, “we are not the testers,” and added that mass testing in harder-hit communities may stigmatize them.
But several community agencies and health centres said they wanted mobile testing in the area.
“We know people face barriers getting to testing sites,” said Cheryl Prescod, executive director of the Black Creek Community Health Centre. “Mobile testing in our community would be incredibly beneficial — going out to community spaces, apartment buildings, places of worship — will help us reach the people we know need testing the most.”
While the various levels of government sort out a response, local organizations continue to work furiously to protect their communities, as they have since the beginning of the pandemic.
“Residents and agencies are really mobilizing,” said Ruth Crammond of United Way Greater Toronto, which has been working with a cluster of community organizations in the northwest corner that have been responding to the pandemic. “It’s not that people are just sitting back and waiting for someone to save them.”
But the northwest neighbourhoods also need what more privileged Toronto communities already have.
“We do need resources to make these changes happen,” said Butterfly Sabrina GoPaul, a community health worker who lives at Jane and Finch. “But the systemic reality is so deep that it’s not going to happen with, you know, pixie dust and curry powder.
“We need to really break down what’s been broken and stop trying to repair and create Band-Aid solutions. Because it’s not working for communities like ours.”
Graphics by Nathan Pilla, Andres Plana and Cameron Tulk