Advocates urging governments to provide more shelters, amenities for homeless.
In an unprecedented move, Doctors Without Borders, which usually operates in developing countries, is building a 400-bed facility for the homeless who test positive for COVID-19. It will be run by local health-care workers in Toronto.
“It’s an important effort and one that is really vital, but is also, I think, a sobering reminder of the potential magnitude of the problem that we would be facing if there’s extensive spread of COVID-19,” said Stephen Hwang, a staff physician at St. Michael’s Hospital in Toronto, and director of MAP Centre for Urban Health Solutions.
Hwang understands first-hand the vulnerability the homeless population faces. On top of his two roles, he runs a clinic at Seaton House, a Toronto men’s shelter. But because he works in the hospital and wants to mitigate the risk to those using Seaton House, he’s not going to the shelter.
He’s not just concerned about the homeless. He also worries about the safety of staff working in shelters.
“They are very concerned about the potential for an outbreak in their shelter and getting it themselves,” Hwang said.
By Andrew Pinto (contributors: Pinky Hapsari and Debra Slater)
You’ve likely noticed many grocery workers now wear personal protective equipment (PPE), including gloves and face masks, and have hand sanitizer within reach. It’s comforting to know stores have taken precautions for everyone’s safety.
Now imagine you are in a long-term care facility or require home care, and the workers do not have access to adequate PPE. This is the reality for many of the estimated 100,000 personal support workers (PSWs) in Ontario.
PSWs are a critical part of the health system. They often criss-cross a region to care for the ill and elderly, assisting with key activities important for our health: washing, dressing, eating, and taking medication. They also work extensively in long-term care and other health facilities, in close contact with people at high risk from COVID-19. Because of their efforts, hospitals are able to discharge patients to the community, freeing up acute care beds for others.
However, PSWs are chronically undervalued as front-line health workers. They often cope with precarious and dangerous work conditions. Many PSWs receive schedules with little notice, receive inadequate hours, and struggle to make ends meet given their low pay. We have been engaged in a community-based participatory research project to examine the working conditions of PSWs and the impact on their health. Last week, when we met (virtually), a dozen PSWs shared their mounting frustration and fear around their inadequate protection against COVID-19.
As the COVID-19 pandemic uproots the lives of people everywhere, the global research community is ramping up efforts to find ways to tackle the virus. Scientists at St. Michael’s Hospital were given a boost in the form of funding from St. Michael’s Hospital Foundation’s Research Innovation Council (RIC).
Members of the Council — a group of St. Michael’s Foundation donors who pool their donations and select high-potential research projects to support — usually meet each June to vote on the projects they will fund. But this year their investment meeting was moved up to support science that take on COVID-19 — in the Foundation’s first-ever online event.
The 25 RIC members were given the choice of three game-changing projects. Dr. Sharmistha Mishra and her team are creating a mathematical model to deploy population-specific interventions based on geography and demographics. Dr. Paul Dorian and his team aim to build a simple defibrillator to help COVID-19 patients get more oxygen into their lungs. And Drs. Fahad Razak and Amol Verma plan to use artificial intelligence to reduce the rate of COVID-19 transfer from long-term care to acute care.
After two rounds of intense deliberation, the need for more crucial data won out. Dr. Mishra was awarded $190,000 in funding.
Dr. Mishra is an infectious disease physician whose research focuses on the mathematical modeling of virus transmissions. She and the Research Group in Mathematical Modeling and Program Science will work with colleagues across a number of institutions (including Drs. Stefan Baral, Matthew Muller, Stephen Hwang, Rafal Kustra, Jeff Kwong, Adrienne Chan, and others) to carry out the research.
“We are so grateful to the Foundation for the privilege of supporting the local response in the GTA,” Dr. Mishra says. “The funding will help us produce data-driven, population-specific strategies to flatten the curve in our local communities.”
The closure of the community centres and meal programs and the restrictions around maintaining physical distance are compounding the stresses on people who are homeless. The cost of doing nothing about homelessness and accepting the status quo has never been more starkly apparent. Will COVID-19 force us to change how we deal with this pressing issue?
In this 25-minute podcast, MAP Director Dr. Stephen Hwang talks about these challenges, and what St. Michael’s and MAP scientists are doing to address them.
“This is a real opportunity to do things differently… This is almost like a reset – we can think about all the things that we knew we should do, but now see all the more clearly that we must do, for the sake of everyone in our society.”
At 14:35 Dr. Hwang discusses some of MAP’s COVID-19 research projects in development – and tells a story at 21:06 about how MAP’s Navigator Project has provided rapid and extremely valuable support to patients who are homeless and waiting for COVID-19 test results.
Photo: Angela Robertson of the Parkdale Queen West Community Health Centre says she fears the lack of race-based data in Canada on COVID-19 means “the real health impact on Black community will be hidden.”
…hospitals and clinics don’t collect detailed demographic data including race as a matter of routine. Advocates have long railed against this lack of data, calling it harmful to Black women after research found they may be underscreened for breast and cervical cancer.
Andrew Pinto is a doctor at St. Michael’s Hospital. He is also the director of the hospital’s Upstream Lab — a research group that looks at interventions or remedies to the socio-economic factors that affect health.
The St. Michael’s Hospital Family Health Team, and other groups in Toronto including Toronto Public Health, was part of a pilot program to ask patients questions on income, race, gender, housing, religion, etc., and then use this data to identify health inequities, Pinto said. Researchers found doing such a survey was “feasible and acceptable.”
“Social factors are definitely associated with health outcomes,” he said. Many studies show income and race play a big role. “We lack the data that we need in Canada to really be able to pinpoint inequity by race. That’s what our work is trying to move toward.”
In Toronto, as in many other cities in Canada and the United States, the coronavirus crisis is twinned with a different crisis: homelessness.
Sometimes all it takes is one person to illustrate how the system is failing.
Miriam* has struggled with housing for years. A couple of years ago, when her landlord ended her lease, she was unable to find another apartment that she could afford. Despite days and days on the phone with central intake, she could not get into a city shelter in Toronto. She was eventually advised by a housing worker to go to London, Ontario (a city of about 400,000 two hours drive away) – where she still could not get a shelter bed. She spent several nights in a McDonald’s until she was taken in by a local church.
Public health officials escorted by armed police through the epicenter of an outbreak. Government officials, in an effort to contain an epidemic, announcing rules forcing people off the streets. City residents fearing for their lives as a new virus kills the frail and infirm among them. That same fear leads to widespread support for draconian public health measures as long as they keep people safe.
The spread of the coronavirus has reminded us of the darker side of epidemic control. These kinds of “security-forward” responses are among the most common ways we deal with epidemics. While the COVID-19 epidemic has made these scenes familiar to us all, the above description applies just as well to the disease epicenter of Wuhan, China, as it does to how authorities right here in the US have responded to both real and perceived local epidemics.
MAP Centre for Urban Health Solutions has launched 10 collaborative solutions networks with a common goal: to effect real-world social change by co-designing and demonstrating what works to address critical urban health challenges in our communities.
The 10 networks, made up of more than 170 scientists, community partners, policy makers, and people with lived expertise from across the country, came together March 2-3, 2020, for a symposium in Toronto.
About the Symposium
The Solutions for Healthy Cities Symposium was an important opportunity for network members to meet in person, share experiences, learn from each other, and mobilize to chart their paths forward. The agenda included a mix of working sessions in network teams, and time for discussion and learning as a full group.
The Symposium opened and concluded with remarks from Cat Criger, an Indigenous Elder, Traditional Teacher and Knowledge Keeper. Symposium speakers included:
Namaste Marsden & Leona Star: Advancing standards and processes for First Nations, Inuit and Métis engagement in research about them
Alisa Velonis: Tools for guided implementation
Sam Tsemberis: Reflections on innovation, advocacy and policy change
“It’s nice, and rare, to have an occasion for critical thinking. Symposiums and conferences are usually about self-promotion, but not this one!” – Network member
“Having the face to face time to get to know one another was so valuable. Not usually included in research funding but should be!” – Network member
The Keynote Reception
At the much-anticipated keynote event, Mayor Lori E. Lightfoot, City of Chicago, addressed network members and guests. MAP Director Dr. Stephen Hwang also spoke.
Mayor Lightfoot was then joined by Mayor John Tory, City of Toronto, for a fireside chat. The discussion was moderated by Dr. Pat O’Campo, senior MAP scientist and Executive Director of the Li Ka Shing Knowledge Institute.
Among the guests in attendance were two former premiers of Ontario, David Peterson and Kathleen Wynne, former deputy premier Deb Matthews, and former Mississauga mayor Hazel McCallion.
Co-designing for Real-world Impact: The National Solutions Networks
With the vision of creating “a healthier future for all,” the 10 solutions networks are taking on complex issues including chronic homelessness, intimate partner violence, the long-term effects of socioeconomic adversity in early life, and the links between traumatic brain injury and incarceration.
The networks’ cross-sectoral membership and partnered approach are the keys to ensuring that solutions are feasible, appropriate, and effective — and that they reflect the goals, priorities, and contexts of the communities they aim to serve.
The result will be 10 evidence-based solutions that are tested and ready for scale-up in cities across Canada.
Together, we can create a healthier future for all.
The Solutions for Healthy Cities Symposium was made possible in partnership with the St. Michael’s Hospital Foundation and thanks to the generous contributions of its visionary donors. We also wish to thank Jackman Reinvents for their incredible work bringing our message and work to life, and Spark Inc. for their superb event management.
For his work to improve the health of people experiencing homelessness and to make social justice and health equity central to medical practice, Dr. Stephen Hwang has received the University of Toronto President’s Impact Award.
A professor in the department of medicine and scientist in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Hwang is a world-renowned expert. His research and advocacy has elucidated the causes and risk factors for death among homeless people, the relationship between traumatic brain injury and homelessness, and the effects of homelessness on health status.
Hwang has played a pivotal role in advancing Canadian and international scholarship and advocacy related to homelessness. His work helped inspire the creation of the 100,000 Homes Campaign, which has mobilized officials in hundreds of cities across the U.S. to house thousands of long-term and medically vulnerable homeless individuals who were at increased risk of death.
“Homelessness affects hundreds of thousands of Canadians and takes a tremendous toll on health,” Hwang said. “Our work has shown that the Housing First approach ends chronic homelessness and should be widely implemented. This award will support our ongoing research on new interventions to meet complex health needs and improve well-being and social integration among people experiencing homelessness.”
…Stephen Hwang, MD, an internist, homelessness researcher, and director of [MAP Centre for Urban Health Solutions] at St. Michael’s Hospital in Toronto, said “living on the streets or in a shelter is a hazardous environment.”
He said neurologists treating homeless patients should be aware of the possibility that a history of TBI could be the cause of behavioral issues, seizures or unexplained cognitive deficits. He helped craft recommendations issued in October 2018 by the National Health Care for the Homeless Council that focus on the care of patients who are homeless and living with the effects of TBI. It includes recommendations for assessment of possible deficits, including which screening tools to use.
