Governments across the country are locking things down again. The Ford government in Ontario has pretty much replicated the Spring lockdown (with some exceptions such as schools) for the City of Toronto and neighbouring Peel Region while other suburban Toronto regions are severely restricted.
The lockdown concept has an obvious allure: accept more pain now in return for a COVID-free world some months down the road – after this second lockdown. And what delivers this Covid free world after the tight restrictions imposed in the last month are loosened? A “world class” test-trace-isolate system.
But wait, weren’t we supposed to get that “world class” test-trace-isolate system months ago – after the spring lockdown? Didn’t the politicians and public health experts spend the summer telling us that the key to keeping the virus under control was putting in place a comprehensive system of testing and tracing so that outbreaks could be quickly identified, isolated and extinguished?
And didn’t the federal government, as part of its $19-billion “Safe Restart Program” in August, earmark $4.28 billion for the provinces to build such systems? Didn’t Ontario itself get $1.16 billion of that? And didn’t Premier Doug Ford, for one, promise over and over that he was on the testing/tracing issue like “a dog with a bone”?
Yes, yes, yes, yes and yes. And yet, when school returned in September and Ontarians quite predictably went looking for those tests, the lines were so long that many people just gave up, and the government effectively restricted them by requiring that appointments for tests be made online. And Toronto Public Health gave up for a time on contact tracing for most people. Toronto Health wasn’t up to the challenge so they basically stopped tracing as cases climbed.
And suburban Peel – by far the hardest hit region in Ontario – is dramatically cutting back on its contact tracing efforts as well. “Given the surge of cases, we introduced a change to contact tracing and we’ll only trace our highest risk exposures and contacts,” says Dr. Lawrence Loh, Peel’s Medical Officer of Health.
“We’ll ask residents to contact their own high-risk contacts.”
The failure of the province’s test, isolate and contact tracing system is the key to understanding Ontario’s inability to control the Covid virus. After so many months, with more than a billion federal dollars pledged for the effort, surely the time for excuses and promises in this area is past. The way to get mandatory testing for those most vulnerable to infection, is for the government to mandate it at high risk workplaces, not to keep on issuing increasingly hollow-sounding statements of intent. For heaven’s sake, just do it – and start in the hardest-hit neighbourhoods such as the City of Brampton, the northwest section of the City of Toronto and southern Vaughn in York Region. And while you’re at it, implement the same mandatory testing regime in hard-hit parts of Scarborough, southeastern York Region and high-rate neighbourhoods in Pickering and Ajax in Durham Region.
Ford himself acknowledges that public health authorities need the public’s buy-in for a second big set of restrictions. But the promise of governments, not just in Ontario, to deliver on the basic bargain of last spring (lock down now and we’ll build a test and isolate system to protect you down the road) has not been met.
That’s one reason why public buy-in for another long, strict lockdown is unlikely to be there. Measures targeted at areas that are especially hard-hit, such as the specific neighbourhoods cited above in Toronto, Peel, York and Durham Regions – all with above average per capita case counts – are what are required to contain the spread of the virus and to regain the public’s trust in government.
The problem is that governments and public health authorities are choosing the wrong public health measures. They are opting for broad-based social interaction restrictions across entire public health authorities (e.g. the strict lockdowns on all of Peel Region and the entire City of Toronto, covering 4.5 million people) instead of focusing their new measures on protecting residents of the hardest-hit neighbourhoods by determining exactly where those testing positive work and how they live.
The reason that applying broad-based social lockdowns to entire public health authorities is a mistake is that it doesn’t acknowledge that even within Peel Region and the City of Toronto, there are many neighbourhoods where Covid case rates are well above the provincial average and many that are well below the provincial average. And those that are well below the provincial average are going to stay well below the provincial average no matter what the government keeps open and what it closes. These neighbourhoods do not have a Covid crisis and they are not going to have one.
And the reason they don’t have a Covid crisis is that their residents don’t have jobs that force them into workplace settings over which they have no control and where safe social distancing can’t be practiced. In fact, most residents of these neighbourhoods have the luxury of being able to choose to work from home – which is what they are doing. And in the unlikely event that they contract the virus, residents of these comfortably-off neighbourhoods generally have plenty of room at home to isolate in a manner that protects their families.
The hard truth is that when it comes to Covid-19, we are not “all in this together”. The neighbourhoods where people live in overcrowded housing and work in manufacturing, warehousing, food processing and retail are getting slammed with Covid rates as much as 15 times higher than more affluent neighbourhoods a 20-minute drive away.
And the gap between neighbourhoods that are being crushed by the virus and those where Coved barely exists, is getting wider by the day.
The source of the problem: The combination of unsafe workplaces and overcrowded housing
The point can’t be made strongly enough – outside of its long-term care residences, Ontario’s Covid problem are neighbourhoods where residents work in unsafe workplaces and go home to overcrowded housing.
Peel Region, in particular, lends itself to closer examination as this dynamic is most evident there. For over a month, Peel has been recording twice the per capita rate of new infections than the City of Toronto – which has the second highest case count per capita in Ontario.
And at the heart of the Peel Region explosion in Covid cases is the City of Brampton, with infection rates well above even the Region’s very high average.
Tellingly, the City of Brampton is doing everything it can to keep the focus on its workplaces, which are clearly the largest source of surging infection rates in the city.
Brampton contains one of the country’s largest warehouse and distribution hubs, and businesses in the region employ many immigrants and members of multigenerational households. Widespread outbreaks in manufacturing and food processing have led to rapid household and community spread as public officials grapple with how to protect workers.
Peel (and in particular Brampton) is seeing transmission in industrial settings as well as outbreaks in food processing and transportation and logistics. While many people are sitting in the comfort of their homes and going to grocery stores, it’s a Brampton distribution centre worker, a Brampton trucker, or a Brampton food processing plant worker, that made sure there was food in the store.
The Peel Region has the highest cumulative rate of COVID-19 cases in Ontario, at 1,200 cases per 100,000 people. The area has seen 116 total workplace outbreaks, more than the number that have occurred in long-term care home and school outbreaks combined. Manufacturing and industrial facilities account for 34 per cent of the workplace outbreaks, while retail and food processing make up 14 per cent and 10 per cent respectively, according to data from Peel Region.
Food processing plants have been at the heart of massive outbreaks elsewhere. In Alberta, more than 1,500 workers were infected at a meat-processing plant, making it the site of the largest single-facility outbreak in Canada. Three deaths were linked to that occurrence.
Across the province, the Ministry of Labour has issued 37 COVID-related stop work orders, which are used when there is an immediate risk of worker injury. The orders require the business to halt operations until the issue is addressed. Seven of those orders were issued to businesses in Peel.
A lack of physical distancing in lunch rooms and other common areas, improper mask use, carpooling with other employees and failure to conduct the legally required workplace screening process to prevent symptomatic workers from entering a facility, are the leading causes of infection in workplaces, according to Peel Public Health.
But as COVID-19 infections rapidly climb, contact tracing is becoming more difficult. Public-health unit resources have been diverted to address only the most severe cases, according to Peel Region’s Medical Officer of Health, Lawrence Loh. And workplaces are slipping through the cracks.
“The vast majority of our workplaces have been taking precautions and are working with Peel public health, but I must be clear, increasingly we are seeing less compliance.” Dr. Loh said at a recent news conference. “In protecting workers, we know that the absence of worker protections and paid sick leave does result in outbreaks because, people will show up because they’re choosing between their livelihood and their lives.”
To be fair, the province is sending Peel region up to 70 additional case and contact management workers to assist with tracing to understand where people are becoming infected. But this isn’t nearly enough.
Peel’s local health unit is also prohibiting all non-essential visitors to workplaces. The region recently introduced fines of $5,000 a day for business owners and operators that fail to implement measures to prevent the spread of the virus.
But industrial workers don’t have the option to work from home and more measures are needed to ensure their safety, according to the Warehouse Workers Centre (WWC), a Brampton-based group that educates workers in the sector on their rights. Spokesperson Gagandeep Kaur said that stricter regulations and increased inspections are necessary to ensure that industrial businesses are investing in preventative measures, such as protective equipment and physical distancing.
The WWC launched about a month before the virus spread across Canada to advocate for better working conditions for labourers, provide support with workers’ compensation claims and offer legal assistance on employer disputes. Since COVID-19 flared in March, the majority of calls that the group receives are from workers who have lost their jobs owing to the pandemic as well as individuals with concerns about employers failing to implement safety measures.
“They are going to work and they are unsure of whether they will be safe in the coming days, or whether they will get sick, and they will make others sick in their houses or their families,” Ms. Kaur said. “Still, they really have no choice because you cannot just stay home without getting paid for long.”
Crowded housing a key contributor to the spread of Covid
The Brampton neighbourhoods with the highest per cent positivity rate include a dozen census tracts, or small geographic areas defined by Statistics Canada. Of these, nine had infection rates of more than 200 per 100,000 people during the first week of November, according to data from Peel Public Health. This is five times the infection rate required to move into the province’s red or “control” zone.
One census tract — just southeast of the Countryside Drive and Airport Road intersection — has Peel’s highest proportion of large households, with 49 per cent of homes occupied by five or more people. Peel has more occupants per household than cities like Toronto and Ottawa, according to Medical Officer of Health Dr. Lawrence Loh, and household contacts have accounted for 40 per cent of its COVID-19 cases over the past two weeks. Last week, the federal government announced it would fund a $6.5-million facility in Peel Region for people who can’t adequately self-isolate in their own homes.
This part of Brampton is also densely populated with essential workers, census data shows. One community of about 2,360 residents — an immigrant-heavy area near Queen Street East and Highway 50 — has Peel’s highest proportion of people who work in manufacturing, with 22 per cent of residents working in this industry.
What needs to be done
When Toronto Mayor John Tory asked the province to increase restrictions in Canada’s largest city to help curb the spread of COVID-19, among the recommendations was support for workers, so they can take time off to isolate and get tested for COVID-19 without fear of losing their incomes or jobs.
Deena Ladd, executive director of the Workers’ Action Centre, has been calling for the province to implement job-protected paid sick days for months. The people who don’t have paid sick days are often the most vulnerable — meaning they may choose work over health and safety because they can’t afford otherwise, she said.
“The provincial government has absolutely ignored this issue,” Ladd said.
Kate Hayman, an emergency physician, assistant professor at the University of Toronto and member of the steering committee for the Decent Work and Health Network, has also been calling for universal paid sick leave.
It’s our most precarious workers who are most likely to not have paid sick days — low-income workers, essential workers, people who can’t work from home, marginalized workers and many health-care workers, she said.
During the pandemic, the province is guaranteeing unlimited unpaid, job-protected sick days related to COVID-19. In 2018, Premier Doug Ford cut the two paid sick days the province once offered. Ontario was one of just three provinces that guaranteed a small number of paid sick days. Now only Quebec and Prince Edward Island require employers to provide paid sick leave, two days and one day respectively. (Federally regulated employees are entitled to three days paid sick leave.)
Patty Coates, president of the Ontario Federation of Labour, said though Doug Ford was praised earlier on in the pandemic, his popularity is now waning among labour advocates, who have been asking for paid sick days since the beginning of the pandemic.
“This government has done the bare minimum,” Coates said.
The organizations Ladd, Coates and Hayman represent all want the same thing: for the province to mandate seven permanent days of sick leave for all workers, plus 14 extra days during the pandemic.
The seven days should be provided by the employer, Ladd said, adding that the province should look at subsidizing the other 14 for those businesses struggling to get by right now.
Though the federal government is offering a yearlong emergency benefit for people isolating due to COVID-19, Ladd said the time it takes to access the benefit is prohibitive to many low-income workers.
Coates added that the federal benefit offers no job protection, meaning employees may feel intimidated or risk losing their jobs if they take it.
Jim Stanford, director of the Centre for Future Work, thinks offering provincially mandated paid sick leave is a “no-brainer,” especially during the pandemic, and says the government should carry at least some of the cost.
Less than half of Canadian workers have access to paid sick leave through their employer, he said, and among low-wage workers it’s closer to 11 per cent.
“The overlap between COVID-19 and precarious work is frightening,” Stanford said. It’s “undermining the public health battle” as low-income workers are more likely to get COVID-19.
Ladd said the workers most likely to not have paid sick leave, and therefore to go to work sick, are those in the hardest-hit zones, such as Peel, “an area where temp agency work is rampant.”
Another sector where precarious low-paid work is common — again, without paid sick days for staff — is long-term care, where Canada has seen a number of deadly outbreaks, she added.
As provinces implement various forms of restrictions, the important thing is not to squander the next three or four weeks and to put in place a set of policies that will allow broad-based restrictions to begin to be loosened before Christmas.
What are these policies? First, make regular testing mandatory in high risk workplaces such as manufacturing, distribution centres, food processing plants and retail establishments. This new testing regime should be rolled out first in high case count areas such as the ones cited above. Moreover, the less expensive but faster antigen tests should be used as much as possible. Second, the Province must institute paid sick leave – at least 7 days of which would be paid by employers. Third, governments must work together to establish isolation centres and rent hotel rooms for people who test positive and need to isolate and can’t because of over-crowded living conditions.
Finally, our governments must ask the really tough questions. Do we have appropriate community engagement? Or appropriate communication strategies in an age-, cultural- and language-appropriate manner? Do we have appropriate diagnostic testing capacity? Do we have a surveillance system for early detection in communities? Do we have logistics to facilitate our plan?
Why do we need to get all these things right? Because if we don’t, implementation of the vaccine will be as big a disaster as implementation of the failed test-trace-isolate system.