On March 20, I learned that one of my worst fears in the pandemic had taken place: a homeless person had tested positive for COVID-19 in Toronto.
I remember that day vividly. A medical team zoomed in to do testing at the respite shelter. I was relieved by the speed of the response and naively thought this would be the norm. After all, testing and contact tracing are paramount in a pandemic.
When another homeless person tested positive in a different shelter, I remember asking the medical team there if testing had happened yet. It was three days after the known positive result. No testing had taken place yet, nor was it scheduled. This pattern kept repeating. Even the 180-plus person outbreak at the Willowdale Welcome Centre shelter did not seem to spark timely, integrated action between the city and the province.
By early April, Toronto Public Health officials identified that shelters were sites they would like to prioritize for testing. The province agreed. In numerous media conferences, these sentiments were repeated by politicians. It took a long time for these promises to be realized.
Finally, by the end of June, all shelters had been offered onsite testing and a mobile outreach team was developed to test at encampments.
From the beginning of this pandemic all levels of government have exhibited disregard to this high risk population. In Toronto, front-line workers have been forced to advocate on:
- The city's arduous movement of people from shelters into safe physical distancing sites,
- The inadequate supports provided in these sites (food quality, harm reduction, health care),
- The refusal of the city to order the two-metre separation of shelter beds and to discontinue use of bunk beds (they had to be taken to court to ensure it),
- The city's denial of basic public health measures such as water and toilets to rapidly growing encampments,
- The frequent brutal and harassing manner of eviction of people from encampments,
- The limited public health communication on shelter outbreaks, location of outbreaks, shelter capacity, testing schedules and COVID cases in the homeless population who are not in shelters.
As I write this, at least 637 homeless people have been infected in over 42 Toronto shelter outbreaks, several of which are on their second outbreak. That's about a nine per cent infection rate. There have been five deaths by my count.
In August, there was a period of uneasy calm: no outbreaks in the shelter system for a period of four weeks. I actually felt comfortable to start working on the issue of kids' safe return to school.
Then a shelter worker sent me a city memo. It read:
"As part of Toronto's response to COVID-19, the City of Toronto recently enacted by-law 541-2020, which requires all members of the public to wear masks or other face coverings when in enclosed or indoor public spaces. Shelters and respite services and other indoor congregate living settings are not considered enclosed/indoor public spaces under this bylaw, therefore clients are not required by this by-law to wear Masks. However, all shelter and respite staff and essential visitors are required to wear medical masks in the workplace for the duration of their shifts or visits, as outlined in SSHA's COVID-19 Information Sheet for Staff: Use of Personal Protective Equipment (PPE) In Homelessness Services Settings.
Shelters and respite service settings may encourage mask use by clients while in common spaces. SSHA does not supply shelters or respite sites with face masks or coverings for client use, however sites may receive donated masks from the public or other sources.” [emphasis added]
I suspect much of this advice came from the city's lawyers -- the same folks that have been arguing against the legal coalition on physical distancing in the court case.
In a state of emergency such as a pandemic the medical officer of health and mayor have tremendous authority to issue orders and fast track efforts to protect the public and businesses. We've seen them do it numerous times: expanded patios, bike lanes, modular housing.
Then why not direct mask wearing in congregate settings such as shelters?
"My mask protects you and your mask protects me" is the often-repeated mantra of Toronto's medical officer of health Dr. Eileen de Villa. It's a good one, and across the country it is being incrementally and widely embraced: on public transit, in camps and schools, in grocery stores, in restaurants. The future of mask-wearing will likely carry on well into 2021.
The culture and science behind mask-wearing have evolved from the early days when national public health figures dismissed their value.
But public health policy discrimination continues. There are two populations being neglected when it comes to mask-wearing: people incarcerated in jails and prisons, and homeless people in shelters and daytime drop-ins.
If you've never been in a shelter (good), take it from me: they are indeed equivalent to public indoor places where people have no control on physical distancing or who they encounter, as one would in private spaces such as a home. Toronto's mask by-law was even recently expanded to include common areas in apartment buildings. I know of nothing more "common" than inside a shelter, whether it is the TV room, a lounge, hallway or eating areas.
People have told me: "Oh we can't force homeless people to wear masks."
Authorities have realized they can't police and ticket on this issue, with a few exceptions (the big beach parties). We understood that people may have a health or other reason to not wear a mask. No one would expect mask use to be forced on people in shelters and at least thanks to the legal settlement that enforces physical distancing, one can presume they can sleep safely two metres away from the next person, and unmask at night.
Should homeless people have to use sparse pocket change to buy masks in a local dollar store? That's what's happening.
This week, the four-week hiatus in shelter outbreaks ended. We have another outbreak.
Cathy Crowe is a street nurse, author and filmmaker who works nationally and locally on health and social justice issues.
Image: Cathy Crowe
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