Inner City Health Associates’ (ICHA) ongoing concern for and commitment to the health, safety and well-being of homeless and underhoused people in Toronto has intensified over recent weeks during the COVID-19 wave driven by the highly transmissible Omicron variant. 

With hundreds of cases of COVID-19 in Toronto’s shelter system, over 40 shelter outbreaks and sub-zero temperatures, it is critical that all public health, health care, homelessness services, shelter, drop-in providers and Municipal, Provincial and Federal governments do everything possible to protect those who are uniquely vulnerable to COVID-19 by virtue of not having peaceful, secure and dignified housing as is required by the human right to housing enshrined in the National Housing Strategy Act.

ICHA has provided specialized and dedicated care throughout the pandemic to homeless and underhoused people affected by COVID-19, including interdisciplinary clinical care in numerous preventive distancing hotels, encampments, substance use care for those displaced by COVID-related relocation, thousands of COVID-19 vaccines and, alongside hospital, community health, and social support agency partners, has provided care to homeless clients in COVID recovery shelter facilities for people needing additional health and social supports that is currently operated by the City of Toronto. 

ICHA has and continues to advocate both directly and publicly at all levels and in the most impactful ways for interventions that are effective in protecting the health, safety and well-being of homeless and underhoused people. 

An effective response to the COVID Omicron variant requires the following actions:

1. Housing/Individual Units: The immediate funding and deployment of as many housing options, individual room shelter-hotels and rent supplements without restrictions as are possible.  Individual units or rooms are a precondition for the equitable preventive public health safety from, and isolation for, COVID-19.  These units should be converted, or clients transitioned, to rapid, affordable and supportive housing units at the earliest possible opportunity thereafter as part of the National Housing Strategy

While the above fundamental actions are underway, the homelessness services sector will require:

2. N95/KN95 Masks: Both shelter and drop-in staff and clients require masks with adequate fit, function and filter to prevent COVID infection given Omicron’s heightened transmissibility. The most appropriate masks include either KN95 and N95 types.  
3. Shelter Outbreak Management: Municipal Public Health Units are the responsible authorities for communicable disease control in shelters.  As the most responsible agency, Toronto Public Health must assume direct oversight, support and management with public health personnel as required for all outbreaks in the shelter system.  
4. Rapid Antigen and PCR Testing: Rapid Antigen Tests (RATs) will be necessary in sufficient numbers for clients and staff in shelters and homeless drop-ins. RATs permit the rapid identification of cases and outbreaks in shelters for timely responses. Such testing also permits work-home isolation for shelter and drop-in staff to preserve staffing capacity during surge periods when many staff may likewise be exposed or infected through community or work-acquired transmission.  In addition to RATs, COVID-19 testing centres, hospitals and community health agencies should continue PCR testing of all those in high-risk settings, including shelters and drop-ins.  While Ontario’s formal provincial guidance provides this direction, there has been limited and inconsistent access to PCR testing made available to homeless and underhoused people and staff working in the homelessness services sector.
5. COVID Vaccination: Despite significant immunization campaigns and efforts throughout the pandemic involving public health, hospitals and community health agencies including ICHA, homeless and underhoused people in Toronto have inadequate vaccine protection, particularly with respect to third doses. Ongoing COVID immunization efforts must continue and expand to meet the urgent need for higher third-dose vaccination rates to provide the fullest protection possible from COVID infection and serious illness.
6. Overdose Prevention: A poisoned drug supply and inadequate drug policy and funding has led to high numbers of overdoses among homeless and underhoused people in Toronto that has caused significantly more harm and deaths than COVID-19 during the pandemic. The risks of overdose are increased with COVID-19 isolation, which requires a comprehensive public health approach taking into account all health risks and substantial additional support for harm reduction, risk mitigation and safer-supply opiate programs, and opiate substitution and treatment programs.
7. Encampment Eviction Prevention and Supports: ICHA has consistently supported and advocated for a human rights approach to encampments, which prohibits forced evictions and focuses on identification of individual health, social support and housing needs to support people’s fulfilment of the right to housing. While significant efforts have been made to support this direction, it can be expected that encampment numbers will increase as a result of COVID outbreaks in shelters and it will be necessary to ensure that individuals are not forcibly evicted for living in encampments. Given the sub-zero temperatures, additional survival supplies and supports are required for those living and sleeping outdoors and sufficient warming centres and other indoor spaces are required to prevent environmental cold injuries and freezing.
8. Housing Eviction Moratorium: In light of the heightened risk of acquiring COVID in the shelter system, homelessness prevention efforts are necessary to avoid predictable and preventable morbidity and the maintenance of system capacity for indoor spaces. A provincial moratorium on evictions for arrears should be put into effect immediately to reduce the risk of harm to those otherwise becoming homeless through evictions.
9. Homelessness Sector Funding Support: The homelessness sector in Toronto is facing significant strain on staffing, operations, supplies, and infrastructure to adequately respond to the needs of clients and staff impacted by COVID. The Federal and Provincial governments should urgently provide significant low-barrier relief funding to agencies impacted by COVID-19 to ensure their sustainability over the coming months, including pandemic pay supports and interventions focused on staff well-being.
10. Health Human Resources: Health human resource supports, including interdisciplinary primary care, mental health, substance abuse, population health, palliative care and specialized medical services to homelessness services sectors across the province remain underfunded and inconsistent across municipalities. There is an urgent need to mitigate this long-established inequitable access to adequate health care for people who are homeless and underhoused

These essential actions fall across Federal, Provincial and Municipal mandates as well as local health care system responsibilities and require urgent and simultaneous action at all levels.  This is about the equitable protection of some of the most vulnerable people in society to avoid disproportionate infection, illness and mortality, increased outdoor encampments at the most dangerous time of year and the overwhelming of public services including emergency departments and hospitals.  ICHA will continue to work with all collaborating agencies locally, regionally and nationally and with all levels of government so the fullest possible supports are made available to protect and care for homeless and underhoused people in Toronto.