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How will COVID-19 affect you? Your postal code matters as much as your genetic code, says Canada’s top doctor

Oct 7, 2021 , , , , by shlf

OTTAWA—When it comes to getting hit by , Canada’s top public health doctor says your postal code matters as much as your genetic code.

“Where you live … or where you don’t have a home” is a critical factor affecting health, said Dr. Theresa Tam, as she released a sobering report that outlined the destructive swath cut by COVID-19 across Canada, with worse outcomes in neighbourhoods of cities like Toronto and Montreal, where lower income and racialized workers often don’t have the luxury of working from home, and face worse outcomes from the disease.

Using data from the start of the pandemic to the end of August, Tam said COVID-19 slammed Canada’s socially and economically disadvantaged groups, with seniors, women, disabled people, and immigrant or racialized workers who deliver essential services in health care and agriculture all bearing the brunt of the pandemic.

The 86-page report bolstered Tam’s call for more public health spending, greater co-operation at all levels of government, and for better national health data collection and pandemic preparedness.

Tam said COVID-19 “didn’t create new inequities, it exposed them.”

Among the report’s grim statistics is a finding that 98 per cent of Canadians who died of COVID-19 in hospital had at least one underlying medical condition.

The echoed conclusions by academics, outside researchers and media outlets like the Star which have reported that 80 per cent of COVID-19 deaths in Canada occurred in long-term-care homes for seniors. It cited several factors, including residents’ advanced age, higher prevalence of chronic underlying medical conditions, a lack of pandemic preparedness plans, shortages of personal protective equipment for health-care workers, overcrowding, old infrastructure with poor ventilation, or chronic understaffing in some facilities.

It said more than 10 per cent of national COVID-19 cases were long-term-care workers.

Tam said she wants to be “optimistic” that some of the lessons of the first wave were learned to prevent a repeat of the overwhelming number of seniors deaths in this second wave. However she worried that current numbers show the high number of infections found in younger adults this fall are beginning to “penetrate into” older populations. Not only are outbreaks occurring again in long-term-care homes, but several facilities have had more than one, she said.

Tam said the pandemic hit hard in racialized neighbourhoods, and pointed to a Statistics Canada Wednesday that found communities with the most visible minorities in the country’s four biggest provinces — Quebec, Ontario, B.C. and Alberta — had the highest infection and mortality rates in the first wave. The report said they experienced higher poverty rates, were more likely to live in overcrowded housing conditions and to work in jobs associated with greater risk of exposure to the virus.

In Toronto, the second wave is starting to look like the first wave in some neighbourhoods.

Mayor John Tory said Wednesday that in the past few weeks the number of positive COVID-19 tests has “drastically” increased in the northwest part of Toronto.

He outlined steps the city is taking to expand space for pop-up testing sites in Rexdale and Black Creek, to boost food banks and to support agencies “serving mainly black Torontonians in northwest Toronto, to provide family support, mental health, social connection and community safety services.”

Medical officer of health Dr. Eileen de Villa said her current data shows 30 per cent of people living in Toronto are classified as living below the low-income threshold, but they accounted for 50 per cent of COVID-19 cases.

“Over the course of the pandemic so far, northwest Toronto stood out for higher rates of COVID-19, lower testing rates and higher positivity rates in comparison to other parts of our city.” But de Villa cautioned that “where a person lives is not a reliable indicator of where they got infected with COVID-19. The people of the northwest of the city are like everyone else, as likely to live in one part of Toronto but travel throughout it.”

Tam said the data show the difference in who gets COVID-19 and how severely they are impacted “is not random.” It depends on factors like income, the type of work people do, how many people they live with, and if they depend on someone else for day-to-day living.

COVID-19 is clearly worse for groups such as seniors, workers provide who provide essential services such as in agriculture and health care, for racialized populations, people living with disabilities, and women, she said.

Tam quoted a University of Calgary sociology professor, Dr. Naomi Lightman, saying “the most vulnerable workers provide the most essential services to the most vulnerable clients under the worst working conditions.”

She said Canada needs to embrace a “health equity agenda” that will require sustained efforts “to improve employment conditions, housing and access to social and health services” to better protect people from “health crises, build resilience and create lasting equitable opportunities.”

Tam said nobody can now ignore the reality. “Before it may have been invisible. Now it’s blatantly obvious. And I trust that everybody wants to reverse those kind of trends.”

Tam flagged another parallel public health crisis unfolding among opioid drug users, as the pandemic has disrupted illicit drug supply chains. Tam said the street drug supply has grown “more unpredictable and toxic” and reversed progress that had been made on fighting the opioid crisis.

Before the pandemic, there had been a 13 per cent decrease in opioid overdose deaths in Canada between 2018 and 2019. The report says now, B.C. Ontario, Saskatchewan, and Alberta are reporting record high deaths, with “the situation most stark in British Columbia.” There were more than 100 “illicit drug toxicity deaths” on average for six consecutive months from March to August in that province.

Preliminary data from Ontario show that the number of confirmed and probable deaths from opioid-related causes increased by almost 50 per cent from January to May.

Tam noted at least one supervised consumption site in Ottawa “dispensed with physical distancing measures after several clients overdosed while waiting in line to get in.”

It was not all bleak.

Tam said she sees the pandemic “as a catalyst for collaboration between health, social and economic sectors” and wants to see the kind of intergovernmental and interdepartmental co-operation in place now continue “beyond the crisis and into recovery.” She added “the economic case” for better preparation is “evident,” a dollar spent on public health can save $14 dollars in health care down the road.

Tam took a not-so-veiled shot at decisions made to allow her agency’s own capacity to dwindle, saying the national emergency stockpile and the Global Public Health Information Network — the virus early-warning system that was silenced, had to be strengthened. She said at the Public Health Agency of Canada, “we need to continue to remember this moment in history and why we need those capacities.”

Tonda MacCharles is an Ottawa-based reporter covering federal politics for the Star. Follow her on Twitter:

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‘I didn’t feel right’: This 80-year-old Toronto shelter resident thought she was losing her mind. Turns out, she had COVID-19 — with none of the typical symptoms

Aug 12, 2021 , , , , by shlf

Mary Moore never felt the typical symptoms of COVID-19.

The 80-year-old resident of Toronto’s shelter system never came down with a fever, never felt her chest tighten or a cough tickle her throat. Despite sharing a room at an Etobicoke women’s shelter with three others, and despite the risk of her age, she hadn’t been scared of contracting the virus — reasoning that her only real exposure to the outside world was walking regularly, about a mile away then back.

But then, last month, she got sick — and fast. At first, it was hard to pinpoint precisely what was wrong.

“You know when you feel there’s something just not right?” Moore said. She asked staff to help her get to a nearby hospital. Then things started to deteriorate.

“I can remember being in the ambulance outside, and vaguely remember being in the emergency room,” Moore recalled.

A test confirmed that she’d contracted COVID-19. But for the next few weeks, as she battled the virus in hospital, her primary symptom still wasn’t one that she recognized from warnings. She was hallucinating — imagining small animals in her hospital room, or that she’d been discharged, and was sitting down to a meal in Toronto’s Chinatown neighbourhood.

That kind of delirium is one of the atypical ways that COVID-19 can show up, particularly in older adults, said Toronto geriatrician Dr. Nathan Stall. But because it doesn’t look like a typical case, it’s also the kind of situation where the virus can go undetected.

In Stall’s view, Moore’s case is evidence that the bar for older adults to get tested for COVID-19 should be “extremely low” as cases have risen this fall.

The risks are particularly high in the shelter system as a congregate environment that caters to vulnerable populations, he said. Symptoms like Moore’s may end up incorrectly attributed to other causes that show up more regularly among shelter users — addictions, mental illness or even dementia, he added.

That Moore’s case could have slipped through the cracks isn’t lost on her. “If I hadn’t gone to the hospital that day, God knows how long I would have been walking around with it,” she said.

Unknown to her, one of her roommates would later test positive for the virus as well, without showing any symptoms — prompting a Toronto shelter worker to call for broader-scale testing.

The most recent screening tool from Toronto’s Shelter, Support and Housing Administration asks staff to check if their adult clients have a fever; any new or worsening symptoms including a cough, difficulty breathing, sore throat, difficulty swallowing, runny nose, lost sense of taste or smell, nausea, vomiting or diarrhea; or fatigue, increased falls, chills or headaches.

The document includes a link to a longer , which includes delirium unrelated to “known causes or conditions” including alcohol withdrawal or other substance uses. But Dr. Stefan Baral, a physician with Toronto’s Inner City Health Associates, said they’ve been trying to stress that any unexplained change in a person is worth flagging.

That’s where shelter workers’ familiarity with their clients can play a major role, Baral said — and where assessing unfamiliar clients can present a challenge.

Anyone with atypical symptoms would be connected to “clinical partners,” said shelter system director Gord Tanner.

But street nurse Cathy Crowe worries about the task being assigned to shelter staff: “We know that shelter workers are swamped, so how much attention can really be paid properly to screening?”

Back in the hospital, Moore struggled to come to terms with her diagnosis. It didn’t seem to sink in, because she didn’t feel physically ill.

“I kept saying ‘No, there’s nothing wrong, there’s nothing wrong,’” she said.

The worst part of the experience was feeling like she was losing her mind. She was scared, but said the hospital nurses were attentive, and gently pointed out when she veered into hallucinations.

“’Honey, there’s nobody there. You’re talking and getting your own answers,’” she recalls one saying.

She tried not to panic or consider the grimmest outcomes, fearing it would make things worse.

Stall, who didn’t treat Moore, said auditory or visual hallucinations are consistent with delirium. Earlier in the pandemic, he and his colleagues at Mount Sinai hospital wrote a case report about an 83-year-old, who arrived in the emergency department after a fall at home.

The woman’s only complaint was a vague sense of dizziness. She was deemed a low risk for COVID-19 at triage, but diagnostic tests later revealed she was infected.

Atypical presentation of illness is actually common in older adults, the doctors wrote — with symptoms like falls, functional decline or delirium. For that reason, like Baral, Stall stressed that any change from a person’s baseline health should be cause for alarm, especially with seniors.

After being discharged from hospital, Moore spent several days at an isolation site for people with no fixed address. While she was lonely — “you have nobody to talk to, maybe your own walker or your walls,” she said — she had a comfortable bed, a TV and her own washroom.

Now back at the shelter, she’s urging more understanding about the different ways a COVID-19 infection can show up.

“Don’t take something for granted. If you think you have a sick stomach, or something like that, get it looked after right away, because there are different ways of feeling it,” she said.

“To me, I didn’t feel right. And after that, everything is a blur.”

Victoria Gibson is a Toronto-based reporter for the Star covering affordable housing. Her reporting is funded by the Canadian government through its Local Journalism Initiative. Reach her via email: