Community spread of COVID-19 has stopped among much of privileged Toronto, analysis shows

David Hains and Jessica Smith Cross

As Ontario's largest city awaits its economic reopening, analysis shows the community spread of COVID-19 is concentrated among residents of a handful of neighbourhoods, while large swaths of the city's most privileged areas have seen no new cases.

The analysis by QP Briefing finds that the recent "sporadic" cases of COVID-19 in Toronto are people who live predominantly in just a few neighbourhoods. "Sporadic" is how the city refers to cases that didn't originate from an outbreak in a congregate setting such as a long-term care home or homeless shelter. The analysis doesn't indicate where the infection occurred, but where the infected person lives.

The neighbourhoods with continued sporadic spread are predominantly low-income, racialized and feature higher levels of communal living, with health officials warning that Ontario will have to address how under-housed people with COVID-19 are able to self-isolate to control the spread of the disease.

In Toronto, half of the 598 sporadic cases reported over the ten days from June 7 to June 16 are among people who live in just 13 of the city's 140 neighbourhoods. Northwest Toronto, which Premier Doug Ford represents in the legislature, was especially hard hit, as were some other neighbourhoods like Thorncliffe Park. The Mount Olive-Silverstone-Jamestown neighbourhood, which includes Rexdale, was by far and away the leader, with 64 new cases.

These neighbourhoods are correlated with lower incomes, higher immigrant populations and an increased reliance on intergenerational families living in apartments, according to city data.

About one-third of Toronto's 140 neighbourhoods had no new cases in that time, and half had one case or fewer.

This disparity, health experts say, exposes a host of risk factors that makes some residents especially vulnerable to the novel coronavirus.

"We've known for some time that COVID is not an equal opportunity virus," University of Toronto epidemiologist Colin Furness told QP Briefing.

The findings follow a Public Health Ontario analysis released earlier this month finding the rate of transmission was three times higher in the most ethnically diverse Ontario communities, compared to the most uniformly white communities, and in the most impoverished communities, compared to the wealthiest.

This context comes as Toronto is one of the only regions in the province not to reach stage two of lifting public health restrictions, as its case count has not sufficiently progressed.

While the likelihood of transmission would be equal between two people in the same environment and who have the same means, Furness explained that the social determinants of health play a very important role in who gets infected, and the means they have to mitigate the spread of the virus.

The virus "really favours people who are lower on the socio-economic ladder," he said. This is because they tend to cohabitate in larger settings and work low-safety jobs for low pay, among other reasons. These residents may pick up the virus at work and then take it home with them, where they are less able to self-isolate compared to people who may live in detached homes.

Furness said that a warning sign should have been the health outcomes in Italy, which was particularly hard hit early on by the coronavirus, in part because of intergenerational living. That this would predominantly affect racialized residents should not come as a surprise, he said, and it should be understood as part of the conversation about racial justice too. "This is not unrelated to systemic racism," he observed, pointing out that the map of tuberculosis infections looks similar.

Furness said that public health units must do intensive ongoing outreach to these communities. That could involve allocating more resources toward these neighbourhoods, reaching out by going door-to-door, building trust and hiring from within the community to do this work.

Furness also urged the government to do more to ensure paid sick days are provided to incentivize better health outcomes for everyone.

Toronto Board of Health Chair Joe Cressy echoed Furness's sentiments. "I'm deeply concerned that this is a story that will continue to unfold until there is a vaccine," the second-term councillor told QP Briefing.

Cressy said that gathering and analyzing this data is important to address the problem, and added that Toronto Public Health will release additional information as soon as next week that will allow more detailed analysis, including tying rates of coronavirus tests to race and housing status, rather than just correlating it to neighbourhood-level stats.

Cressy also added the city is exploring how to solve some of the issues the numbers have shown, including early discussions on how people who are under-housed and cannot properly isolate at home can get accommodations.

Provincial disparity

Across the province, COVID-19 has been spreading unevenly. The Ford government has delayed the second stage of economic reopening in Toronto, Peel and Windsor-Essex, while allowing it to proceed elsewhere.

Toronto and Peel have had the most new sporadic cases in the past 10 days, with 607 and 317 respectively, but Windsor-Essex's 222 cases mean it has had the highest rate per 100,000 people, considering its lower population.

The Windsor-Essex region has two current challenges: the spread of COVID-19 among migrant farm workers and cases among cross-border workers, said Health Minister Christine Elliott when asked about the region on Wednesday.

"The issue of the migrant workers is the biggest issue that relates to Windsor-Essex, that's preventing them from moving into stage two, but there are also quite a number of workers, particularly in the health-care sector, that also live in Windsor and work in the United States and go back and forth," she said. Elliott also noted that the cross-border cases pose a problem for Windsor-Essex that other rural areas haven't had to deal with while having agricultural worker outbreaks — which is why those other areas have been greenlit for reopening. 

Windsor-Essex has more than 300 cases among farm workers, most of them migrant workers who've tested positive recently, according to the local health unit. Those are classified as sporadic, rather than outbreak-related, in the province's integrated data system.

Both Ford and Elliott committed to working with the local public health unit and agricultural community to increase testing among migrant workers and to re-evaluate when the area can move to stage two as time goes on.