Low income areas in Ontario have borne the brunt of COVID-19 in every single wave of the pandemic, the latest data from the province shows.
In new modelling released on Thursday, the Ontario COVID-19 Science Advisory Table says this finding was evident even in the fifth wave fuelled by the Omicron variant.
Consistent with previous waves, low income neighbourhoods in the fifth wave experienced two to two-and-a-half times the mortality rate experienced in the highest income neighbourhoods.
The data shows that the lowest income neighbourhoods in Ontario recorded the highest COVID-19 death rates in all five pandemic waves.
Given these findings, doctors say they are concerned that COVID-19 could continue to harm people in poor and racialized communities in Ontario disproportionately if all three levels of governments fail to make investments in social safety nets.
Lauren Cipriano, a member of Ontario’s COVID-19 modelling consensus table, said these trends have been apparent since the pandemic first swept Ontario more than two years ago. Cipriano is an associate professor at Western University’s Schulich School of Medicine and Dentistry and Ivey Business School.
“This has been something many people have been talking about since those early days of COVID,” she said.
Cipriano said the findings show that Ontario has not yet learned how to protect marginalized communities from bearing a greater pandemic burden. She said the trends are expected to continue unless actions are taken to address disparities.
Mask mandates in most indoor settings in Ontario are set to lift on Monday. “I certainly am concerned that what we’ve already seen, which is a disproportionate impact, is going to be aggravated,” she said.
Actions needed to reduce COVID-19 impact, prof says
Cipriano said officials can reduce the COVID-19 impact on lower income neighbourhoods by maintaining high workplace safety standards and protections, ensuring there are high ventilation standards in workplaces and schools, and engaging in outreach to marginalized and racialized communities to overcome barriers to vaccination.
According to Cipriano, people in lower income communities have a higher risk of exposure to the virus through their employment in the services sector, are less likely to have received a third dose of a COVID-19 vaccine and are more likely to live in high density multigenerational households.
While higher income people are more likely to be able to work from home, or to work in offices with good spacing and ventilation, lower income individuals are more likely to be front-line workers with large numbers of contacts in their workplaces or to be working in environments with lower-quality ventilation systems, she said.
As well, lower income people are more likely to have more than one job, to use public transit to get to and from work and to be exposed to the virus at work. They are less likely to have paid sick leave, or the flexibility to take a sick day without jeopardizing their jobs.
As for vaccination rates, she said the barriers to access in lower income areas include child care, transportation and time off work for appointments. She said it became evident after the third wave, when vaccines became available, that lower income communities had lower rates.
Cipriano said lower income communities were among the first affected by COVID-19 and the impact of public health measures. People in lower income areas were more likely to lose their jobs or have their work modified without safety nets in place. And they were more likely to pick up riskier forms of ad-hoc employment that increased their exposure to the virus, she said.
The science table recommends wearing good quality masks indoors, staying at home when ill, and getting fully vaccinated.
“Everybody can wear their mask,” Cipriano said. “There’s a lot of COVID still out there in our communities.”
Difference in death rates ‘staggering,’ doctor says
Dr. Andrew Boozary, a primary care physician and executive director of social medicine at the University Health Network, said the disproportionate impact of COVID-19 on low income neighbourhoods has been a “constant theme” throughout the pandemic.
The difference in death rates between low and high income areas is “staggering,” he added.
“One of the really important things to recognize is that this has been consistent throughout the pandemic. This is not about poor individual choices or individual failures. This has really been about the risks that have been imposed on people,” he said.
Low income areas in the GTA include the city of Brampton, parts of the district of Scarborough and Toronto’s northwest. Neighbourhoods in these areas have higher racialized populations, more economic deprivation, more immigrants, refugees and newcomers and higher housing density, Boozary said.
There is talk of learning to live with COVID-19 and Boozary says that means a shift not to strengthen social safety nets but to put the onus on individual choices. People who live in poverty have not had the privilege to stay at home, have been on the front lines of essential work and have been under housed or without housing throughout the pandemic, he said.
People to be left behind if trends continue, doctor says
Given the findings, the idea that society can learn to live with COVID-19 suggests that the status quo is acceptable and it is not, he said. It means COVID-19 and long COVID will be concentrated in low income areas, he added.
“If we do not see real action on the policies that are needed, what we are saying is, we will accept and continue to accept COVID disproportionately impacting neighbourhoods in poverty and racialized communities,” he said.
By real action, Boozary said he means investments in ventilation and air filtration, paid sick leave, access to vaccines and high quality masks, access to primary care and in supportive housing.
“If we don’t address these very serious health disparities, there are many, many people who are going to be left behind and left faced with a far worse health status than when the pandemic began,” he said.
Dr. Danyaal Raza, a family physician at St. Michael’s Hospital in Unity Health Toronto, said providing adequate, accessible paid sick days, creating full-time permanent work instead of offering part-time jobs and granting permanent resident status would all make a difference.
“Nothing about this connection between low income and high rates of COVID-19 or other diseases is inevitable. We have the policy tools, both through social and economic and health policy, to fix this problem,” he said.
Raza said the social, health and economic policies needed to protect vulnerable people against COVID-19 are the same as those needed to protect people from disease and poor health in general.
“We need to continue to focus on implementing these policies,” he said.