Poverty and COVID-19: More data would help explain the connection

It is another busy day for Will Prosper.

“I’m not even done. My day starts at nine in the morning and finishes at about 12 at night,” says the co-founder of Hoodstock, a local initiative in Montreal North, about his quest to save lives in the community.

The borough is one of the poorest on the island of Montreal. And there’s emerging evidence that it has become one of the city’s hot spots for COVID-19 infections, according to an analysis by the Institute of Investigative Journalism’s Project Pandemic, a collaborative mapping effort mobilizing journalists across the country using Esri ArcGIS technology.

(On the map, seen above, confirmed COVID-19 cases are represented by grey dots.
Median household incomes are mapped by colour. Click anywhere to interact with the map and keep scrolling for more.)

As of Monday, cases in Montreal North reached 1,791, nearly 10 per cent of the city's total, according to Montreal's public health department.

Canada’s National Observer and CTV News teamed up to use this map to tell a story about the pressure building on the country’s politicians and public health authorities to find out why COVID-19 is wreaking such havoc in communities such as Montreal North.

Prosper says he knows why.

He grew up in Montreal North. He knows about the poverty, the substandard living conditions of people crowded into high rises, and the workers who barely make ends meet by working in places that have now become known collectively as the front lines: long-term care homes and grocery stores.

Montreal North has the lowest average after-tax household income -- $45,909 -- of all Montreal's 34 boroughs, according an analysis of 2016 census data that Statistics Canada conducted for National Observer. (You can download the spreadsheet that contains the numbers by clicking here.)

“The reality is, when you live in a high-density population, you’re close to your neighbour. You’re close to everybody else. You don’t have the right protection. Of course, you’re going to contaminate yourself.”

This is why he and other advocates at Hoodstock have turned that anger and frustration into something they believe is more positive: delivering masks, hand sanitizer and other protective equipment to keep people safe.

“It’s just the frustration of knowing that nothing is being done and seeing people around you dying.”

It’s not just in Montreal

This map you’re telling me about from Montreal “will shine a light on something that academics and physicians broadly have known for years,” says Dr. Jonathon Herriot, after learning about the map detailing the concentration of COVID-19 infections in Montreal North.

Herriot is a family physician and HIV specialist in downtown Toronto and former co-chair of Health Providers Against Poverty, a non-partisan coalition of health providers.

Through his medical training, Herriot says he had mentors who stressed the ways in which factors such as income, education and housing impact health.

“COVID-19 will thrive when you don’t have the resources to physically distance from one another, whether that is crowded housing, living in a rooming house, living in a homeless shelter, or having to use public transit.

“Low-income people tend to be in more precarious lines of work: front-line, minimum-wage workers who had to continue working through the coronavirus pandemic. And being more low-income to start with can lead you to take on more precarious work.”

He says that if low-income neighbourhoods continue as COVID-19 breeding grounds, then communities outside those hot spots will never be safe, because the virus ignores borders.

Contamination hot spots in Ontario are emerging from the data Laura Rosella has compiled. She’s an epidemiologist and an associate professor in the Dalla Lana School of Public Health at the University of Toronto, faculty member in the Vector Institute for Artificial Intelligence, and holds scientific appointments at ICES and Public Health Ontario.

Her research, which maps socio-economic data shows results similar to those of Montreal — high infection rates in poor neighbourhoods.

“So, 26 per cent of the cases are coming from low-income areas, versus 13 per cent of the cases from high-income areas.

The same differential plays out for deaths in those neighbourhoods: 22 per cent versus 11 per cent, respectively.

Given this emerging evidence out of Ontario and Montreal, Dr. Herriot from Health Providers Against Poverty says he is heartened to hear health authorities talk about collecting more data.

“We don’t know when COVID-19 is going to be resolved. This might be something impacting Canada for years and impacting those in more vulnerable positions like low income disproportionately for years. In order to keep everyone safe, we have to protect our most vulnerable.”

Health authorities vow to take action

On May 5, Toronto’s Medical Officer of Health Dr. Eileen de Villa echoed the concerns of Dr. Jonathon Herriot, Laura Rosella, Will Prosper and other advocates, who suspect that socio-economic conditions such as income, housing and race are factors in the spread of COVID-19.

“Today, Dr. de Villa explained preliminary findings suggesting COVID-19 may be disproportionately affecting certain people in our city,” read the news release.

“Toronto Public Health preliminary analysis suggests that people living in areas that have the highest proportion of low-income earners, recent immigrants and high unemployment rates had higher rates of COVID-19 cases and hospitalizations.

“To better understand and strengthen capacity to address these issues, Toronto Public Health is adding socio-demographic questions to the case and contact tracing management process. Beginning soon, staff will be asking all people who test positive for COVID-19 about their race, income, household size, Indigenous identity, and First Nation status.”

The next day, Ontario’s chief medical officer of health, Dr. David Williams, told reporters that the province would widen its data collection to include vulnerable residents who live in what he called “congregate settings.”

Apart from singling out Indigenous Peoples and those who live in homeless shelters, neither Dr. Williams nor the province’s associate chief medical officer of health, Dr. Barbara Jaffe, provided further details about when officials would begin collecting this data.

The same day, Dr. Horacio Arruda, Quebec’s top doctor, said the province would begin collecting race-based data. “Yes, this information will be collected,” he assured reporters.

This is the kind of announcement that the Montreal-based Centre for Research-Action on Race Relations (CRARR) has been waiting to hear.

“Certainly, we need more of that cross-tabulation of all kinds of data,” says the centre’s executive director Fo Niemi.

“Medical associations in the United States and United Kingdom have come up to call for greater data (to) better measure the rate of infection among different … groups. The Canadian medical establishment and public health establishment have to act quickly on this issue.”

Laura Rosella from the Dalla Lana School of Public Health, who began publishing her findings last month, says she's doing her best to act quickly. She also points to the lessons Canada can learn from other jurisdictions that are experiencing second waves of the pandemic and the disproportionate effect on people living in low-income neighbourhoods.

This is why she would like to see health officials in this country pay closer attention to the research that epidemiologists are doing.

“We can’t be flying blind. We need to understand what happened and what is happening. Who this is affecting and why?”

Look to long-term care facilities for context

Experts like Rosella say additional context is important as politicians and health authorities begin to weigh the significance of what’s happening in low-income neighbourhoods because they endure similar structural deficits as long-term care homes, especially overcrowding.

With nursing homes, it has become clear that in order to keep residents safe, long-term and possibly costly solutions will be necessary. Housing four residents to a room makes physical distancing impossible.

Low-income neighborhoods are dealing with problems similar to the ones in nursing homes.

In low-income neighbourhoods, substandard housing conditions create breeding grounds for the virus.

Health officials report that long-term care home residents become infected by personal support workers who must work in more than one facility in order to cobble together a living wage.

Officials also report that in low-income neighbourhoods, low-wage earners face risks by taking public transit and working at jobs where crowded conditions are impossible to avoid. They return to their homes and spread the virus.

The evidence is in the research emerging from Montreal and Ontario.

“Obviously, it has been horrific what’s happening in long-term care, says Rosella. “But as people have grappled with it, what have they been saying? Well, they’ve been saying, ‘There are systemic issues. There are structural problems.’ It’s not that different (with poverty).”

Meanwhile, back in Montreal North

Hoodstock’s Will Prosper is eager to continue on with the task at hand in Montreal North. In addition to handing out masks, gloves and hand sanitizers, which he gets from donations and from the city, he spends a lot of his time trying to educate people about the need to protect themselves and others.

“Some businesses are afraid that customers would be scared and not want to buy food from establishments where workers are wearing masks”, he says, his voice rising in disbelief.

“And we said, ‘No, it’s exactly the opposite. People are more reassured when they see you with a mask because you are taking care of them.’”

Prosper and the other volunteers operate in pairs on either side of a neighbourhood street, carrying bags of protective equipment in large sacks. And when people descend from their apartments, they distribute the masks and gel. “And we have lots of conversations.”

Once the sacks are emptied, he checks to see that there are enough masks for the morning.

On this particular day, he has a task that deviates from his normal routine: a meeting with volunteers about making a video that will promote wearing a mask as something that is “trendy.”

He says education is key because people need to understand the risks and measures they should be taking to stay safe. The way those messages are delivered is also important, which is why video is the vehicle of choice.

But in order for people to take the message seriously, Prosper wants to make sure that the production is not too “cheesy.”

Making sure the message hits home could be a matter of life and death.

“Project Pandemic: Canada Reports on COVID-19” is a national collaboration bringing together journalists and journalism students from news organizations and universities across Canada to gather information as a public service. The consortium draws on data gathered by governmental health authorities, journalists and the non-profit platform Flatten.ca. This project is coordinated by Concordia University’s Institute for Investigative Journalism, with the support of the Canadian Association of Journalists. For the full list of credits, please visit concordia.ca/projectpandemic.