Result times for tests have become so long that Toronto Public Health stopped contact tracing, as by the time the positive result was back, it was too late to act, they write.
Second wave for some, tsunami for others. Medical experts on why the Ontario government’s one-size-fits-all approach doesn’t work
COVID-19 doesn’t impact everyone equally. It is not a great equalizer but a great magnifier of the racial inequality that plagues our city, with BIPOC making up 83 per cent of first wave cases, they write.
Result times for tests have become so long that Toronto Public Health stopped contact tracing, as by the time the positive result was back, it was too late to act, they write.
By Dr. Suzanne Shoush , Semir Bulle , Dr. Naheed Dosani Contributors
If three per cent is the ‘critical’ threshold for COVID-19 test positivity rates, communities of colour are facing a tsunami.
According to experts, three per cent is the maximum acceptable test positivity rate at which we can keep schools and the economy open safely. Last week, the Toronto Star broke the news: racialized communities in Toronto are experiencing more than two to three times this ‘critical threshold,’ with eleven majority Black and Brown neighbourhoods having COVID-19 positivity rates of seven to ten per cent.
While shocking, this data confirmed what we had already learned from the first wave. This pandemic doesn’t impact everyone equally. It is not a great equalizer but a great magnifier of the racial inequality that plagues our city, with BIPOC (Black, Indigenous, People of Colour) making up 83 per cent of first wave cases.
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A one size fits all approach just won’t work.
Premier Doug Ford has stated he will dedicate millions of dollars towards educational campaigns targeting communities of colour in “both mainstream and ethnic media.” This statement omits the critical reality that it is not a lack of ‘awareness’ or ‘education’ around COVID-19 that has resulted in this tsunami, but fundamental structures of race-based inequity.
Spending millions of dollars on educational campaigns will not address workplace discrimination, a lack of affordable housing, jobs that pay a living wage, the need for paid sick leave or affordable child care. In fact, many of those impacted in low-income, racialized neighbourhoods are all too aware of the risks they face in this pandemic as they are the front line workers who have served our community’s gas stations, factories, grocery stores, schools, and health care systems.
We have seen weeks of long lineups at assessment centres in Toronto. We have seen parents sleeping outside hospital doors to ensure their children can have a COVID-19 test. In addition, confusion and anxiety wrought havoc on families trying to navigate school safety and learning. Result times for tests have become so long that Toronto Public Health stopped contact tracing, as by the time the positive result was back, it was too late to act. The province has now moved to phone and web appointments at the assessment centres, which will likely cause further challenges for people experiencing homelessness or those who lack access to the internet and mobile phones.
In these circumstances, those who suffer most are people with precarious employment who are forced to take time off work, often without sick leave, just to access the care they need. Families are deeply disadvantaged, as parents have to juggle testing access and health care with child care and employment. Accessing material needs such as groceries and medicine is nearly impossible to balance with the realities of isolation and quarantine. Women carry a significant burden in this sense, as they are forced to choose between caregiving with breadwinning.
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The only way to get COVID-19 under control and avoid significant morbidity and mortality is for the province to take an equity approach to pandemic planning, adopting a population-based approach that addresses Anti-Black and Anti-Indigenous racism, and target our interventions to those who will likely need it the most.
A health-equity approach means appropriately resourcing communities to meet their unique needs rather than resourcing all communities equally. A statement made this past week by The Alliance for Healthier Communities provides a way that could greatly benefit those experiencing structural vulnerabilities.
A nuanced approach to public health messaging that includes social media platforms like TikTok and Instagram is essential to reach people from various demographics. However, to see behavioural changes, we must also ensure families, households and individuals are empowered to balance public health with basic needs.
To create an equity approach to public health interventions, we must know where and how to act urgently. We must listen to and fund community health organizations that have long-standing relationships with the people living in hardest-hit communities. From mobile testing to surveillance, a locally-driven co-ordinated response will allow us to target impacted areas through trustful connections between people that have been built over the years.
Finally, the province must include BIPOC voices of patients and experienced health workers and leaders in second wave planning. Only by including and empowering the voices of those hardest hit will we mitigate pandemic health inequities.
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With the second wave upon us, we can no longer pretend that this virus impacts us equally or that we were all in the same boat before COVID-19 struck. We were not. Only a health equity approach can lead to a healthy post-pandemic city.
Dr. Suzanne Shoush is a Black and Indigenous mother and physician, and the Indigneous Health Faculty Lead for the Department of Family and Community Medicine at the University of Toronto.
Semir Bulle is the outgoing co-president of the Black Medical Students Association at the University of Toronto and co-founder of Doctors for Defunding Police. Follow him at @SemirBulle.
Dr. Naheed Dosani is a Palliative Care Physician and Health Justice Activist who serves as Lecturer for the Department of Family and Community Medicine at the University of Toronto and Assistant Clinical Professor for the Department of Family Medicine at McMaster University. Follow him at @NaheedD.
