Omicron waves of COVID saw low-income Ontarians die at higher rates, analysis shows

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

In yet another indication that COVID is not an equal opportunity disease, researchers at the University of Toronto found that death rates from the virus in Ontario’s lowest-income neighborhoods have been about twice as high as in the wealthier areas of the province during the pandemic.

The fact that COVID deaths continue to be disproportionately concentrated in low-income neighborhoods, even after the rollout of COVID vaccines, antiviral drugs, and treatments—in addition to seemingly endless calls for equitable access to health resources public—illustrates that, for many, the pandemic is far from over.

“The question arises: 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 is leading a research team analyzing COVID mortality data. She shared the sixth wave analysis with the Star; The team’s analysis of the other five waves has been previously presented by the Ontario COVID-19 Scientific Advisory Board.

With another wave of the virus expected this fall, Mishra and other experts are calling on the province to fund more personalized prevention and treatment strategies for the most vulnerable, including older Ontarians and communities with the lowest income levels.

Mishra, whose team at Unity Health Toronto analyzed data on COVID deaths and illnesses during the pandemic, said the same pattern of inequity holds for hospitalizations and ICU stays, even when health conditions are taken into account. underlying. The team used COVID data from the Ontario Case and Contact Management System overlaid with income level data from Statistics Canada representing cost of living within regions, Mishra said.

The analysis found the pattern of inequity to be true across the province, Mishra said, with low-income areas, many with large numbers of essential workers, seeing a disproportionate number of COVID deaths, including in regions of Peel, the northwest corner of Toronto, parts of Ottawa, and northern Ontario, including Thunder Bay. People who are homeless or experiencing homelessness also continue to be disproportionately affected by COVID, she said.

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

In April 2021, after the first doses of the COVID vaccine were released, zip code data showed that many areas hard hit by the virus were simply not getting the vaccine. Toronto’s Jane and Finch neighborhood, for example, home to many multigenerational households and essential workers, had the lowest vaccination rates at the time. By contrast, the wealthy neighborhood of Moore Park had the highest vaccination rates.

Last spring, research by the Gattuso Center for Social Medicine and the University Health Network found that people living in the Toronto and Peel COVID hotspots were, on average, about twice as likely to be of color and about four times more likely to be employed in manufacturing and public services compared to residents of other neighborhoods in the regions.

When it comes to booster shots, as of last January, data showed that fewer than 20 percent of residents in the northern Peel region and the hardest-hit northwest corner of Toronto had received the third dose.

“The pandemic has unfortunately reinforced what we have seen in so many other diseases in human history: that they are concentrated among the poorest and most vulnerable,” said Dr. Fahad Razak, scientific director of the COVID-19 Scientific Advisory Board of Ontario.

“The burden of COVID-19 in low-income neighborhoods and among racialized groups highlights the need to approach our protection strategies with the broadest lens possible: considering, for example, workplace exposures, substandard housing, and schools.”

Ministry of Health spokesman WD Lighthall said the province continues to employ a variety of strategies to connect with communities with lower vaccination rates, including offering more diverse clinical locations, focused communication through social media channels and traditional, providing data to primary care on their registered patients. and providing information in more than 300 languages ​​through the Provincial Vaccine Contact Center.

Whitehall added that the province’s GO-VAXX fleet is still active and prioritizing vulnerable communities with low vaccine uptake, including hosting clinics at community and senior centers, schools, shelters and places of worship.

“The Government of Ontario will continue to offer COVID-19 vaccines to all eligible individuals who wish to receive their first, second or booster doses, and continues to focus outreach and engagement efforts on older and vulnerable populations who are not up to date on vaccinations. ,” Whitehall said in an email.

While the province last summer tailored the rollout of the first- and second-dose vaccine to communities with high infection rates, Mishra said his team’s ongoing research is trying to understand why disparities in deaths persist. and hospitalizations.

“Could it be that the third dose approach was not so personalized? Were we not fully addressing exposure risks based on structural elements, including paid sick leave and housing supports, and was this something that vaccination alone could not overcome? Is there a need for more personalized distribution and access to therapies that lessen the severity of COVID?”

Sophia Ikura, executive director of the Health Commons Solutions Lab, a publicly funded nonprofit at Sinai Health in Toronto, said the province’s efforts to work with communities have helped close the gap on COVID inequalities. although more is needed. done.

“We’ve seen a tremendous loss of life in these communities,” Ikura said, calling the disparity in neighborhood death rates from COVID “a tragedy.”

Health Commons Solutions Lab works with a team of nearly 200 outreach ambassadors working in priority neighborhoods, providing information and helping support the distribution of COVID vaccines and treatments, including the antiviral Paxlovid.

Ikura said ambassadors are reporting that residents are increasingly hesitant to get boosters, though he hopes continued education and distribution efforts will help encourage residents to feel safe taking antivirals.

“These communities have always gotten the worst of it … and it continues to contribute to this lack of trust,” he said. “It has become a very difficult cycle.”

“Structural realities” faced by residents of low-income neighborhoods, such as housing that does not allow for physical distancing and the need to use public transportation to get to work, have contributed to higher rates of COVID infection during the pandemic Ikura said.

These same structural inequalities, including a lack of safe and stable housing, food insecurity, and limited job options, also lead to increased risk of chronic diseases, such as diabetes and heart failure. This in turn increases the risk of illness and death from COVID, he said.

Dr. Mustafa Hirji, Niagara Region Acting Medical Officer of Health, notes that one reason people with lower incomes tend to have worse COVID outcomes is that they can’t afford to take time off work. when they are sick.

“Otherwise they won’t be able to pay their bills or put food on the table. So they go to work and spread that infection to everyone else,” said Hirji, who is calling for an extension for at least another year of the three subsidized temporary paid sick days, known as the Worker Income Protection Benefit, which the province presented in April 2021.

He is also calling for a study looking at how to make these sick days permanent and also increase the total number of sick days workers would be entitled to to 10 in a way that doesn’t hurt the economy.

Last week, a group of more than 160 doctors, nurses and health workers sent a open letter to Prime Minister Doug Ford calling for 10 permanent sick days to be legislated for all workers, but particularly for those who are of color in low-paying, precarious jobs.

“Paid sick days are in part about helping to build that culture where we stay home when we’re sick and manage long-term infectious diseases,” Hirji said. “But it’s also particularly about equalizing people’s ability to stay home so that those on low incomes who don’t have that option start to have that option.”

Ikura acknowledges that many people are tired of COVID, including wearing masks and keeping up with public health recommendations. But she hopes people don’t become insensitive to the fact that people are still dying from the virus, and that those deaths are disproportionately higher in vulnerable communities.

“We should never tire of hearing about the loss of life and the lack of justice surrounding it. We must not allow ourselves to become insensitive to the number of people who have died in these communities and how totally unfair this is.”

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