On March 11 2020, the World Health Organization declared COVID-19 a pandemic. One year later, the global death toll is ~2.6 million and counting. COVID’s second wave has hit Toronto’s homeless population with a much stronger force than the first, and the easily transmittable variant strains is getting our patients where they live – literally. The viruses will find a hospitable home in the congregate settings where most of our clients settle every night. Now that vaccine supplies are flowing, ICHA is trying to mitigate that risk, working collaboratively with its partners to ensure vaccination campaigns are both timely and effective.
This latest line of work is, like those launched early in the pandemic and expanded throughout wave one and two, guided by our goal of delivering the highest standards of excellence in homeless health service delivery. Since the start of the pandemic ICHA has evolved in real-time, transforming from a physician-only organization to one offering inter-professional models of care.
New clinical nursing services were rapidly integrated to meet patients’ needs and remain a critically important part of our response. Over the summer and fall, ICHA took on new responsibilities, providing clinical services and programs for the homeless community at a growing number of sites across the city. Nurse Practitioners and Registered Nurses have been addressing clients’ complex health needs in hotel sites – recovery and physical distancing hotels — with support from our remote physician on-call team. ICHA is also providing primary care outreach in encampment sites through our SCOUT team (Street Clinical Outreach for Unsheltered Torontonians) where nurses are helping people experiencing homelessness, many of whom have been disconnected from their community and health supports.
In a move that would prove prescient, ICHA established a Population Health portfolio in late 2019. The team developed the CARE tool which was released in early April 2020. Since then, the team has provided shelter providers and others with information to help them determine service and support levels that match clients’ varying needs. Using CARE, the team has informed outbreak prevention, testing and immunizations. So far, the CARE program has assisted 170 sites and over 3600 people living in Toronto’s shelter system.
The pandemic has presented researchers with a surfeit of questions to investigate about the nature and the medical, social and economic consequences of COVID-19 on individuals, populations, systems and institutions. Researchers dove into pandemic-related data as soon as it became available and continue to try to quantify and qualify the pandemic’s impact.
It is neither unknown nor novel that systemic issues harm, sideline and paralyze individuals and groups facing multiple forms of discrimination. But COVID showed the results so starkly, giving new life to old ideas such as social determinants of health, human rights or health disparities. The pandemic has disproportionately disadvantaged women while demanding the most from them. Those who take on “caring work”, paid and unpaid, are predominantly female. Long-term care workers are overwhelming female, and at-home schooling and extended family caregiving goes largely to women.
Reports on how marginalized populations – members of racialized and LGBT2 communities and low-wage earners, for instance – have fared during COVID compared to the rest of the population echo those findings across jurisdictions. In May 2020, the world watched in horror as a white police officer murdered George Floyd, a 45-year-old Black man from Minnesota, galvanizing the Black Lives Matter movement around the globe. In Toronto, data show that Black people are disproportionately arrested, charged, and subjected to use of force by police services. Reports from various sources, including Toronto Public Health, show that BIPOC communities have suffered the burden of COVID-19 in disproportionate numbers.
Important research examining the homeless population has also produced valuable findings that should inform policies and practice. One study has quantified how much risk Ontario’s homeless population faces when compared to the rest of the public: over 20 times more likely to be hospitalized for COVID-19, over 10 times more likely to receive intensive care, and over five times more likely to die within 21 days of a positive test.
ICHA’s inception springs from the inextricable link between housing and health. That is the anchor idea behind the Recovery for All campaign, which CAEH launched in May with ICHA’s full endorsement and participation. ICHA continued its advocacy with its open letter campaign urging Toronto’s elected officials to address the housing and health crisis in our city.
Over the past year, ICHA has emerged as an organization capable of nimbly recalibrating programs to meet the needs of people experiencing homelessness wherever they are, even during a global emergency that so harshly exposes their vulnerabilities. As ICHA works towards its vision, a healthy end to homelessness, it is guided by its goals – addressing and advocating for the social determinants of health and achieving excellence in the delivery of homeless health services. The many and mercurial changes that ICHA made over the past year only serve to strengthen the organization’s ability to meet those goals.
A Thank You to Staff and Members:
This past year has challenged us and inspired us in unimaginable ways. Our staff and members have shown courage, resilience and incredible goodwill in serving our patients. When we began this work, we never could have predicted the transformation that ICHA was undergoing. We feel so incredibly fortunate to have you all on this journey with us. Our gratitude for your service is immeasurable. Our determination to see a healthy end to homelessness is unstoppable.
We could not have supported our community without the support of our partners, the City of Toronto SSHA, Parkdale Queen West CHC, The Neighbourhood Group, University Health Network, and Unity Health Toronto, whom we thank and acknowledge for their invaluable contributions.