WATERLOO REGION — The second wave of the pandemic has deepened inequities across Black and poor communities.
Data shows COVID-19 infections tend to rise in neighbourhoods where more people are Black and tend to fall where more people are white.
“I was the first one who got it. Then my family got it a week after I came out of my room,” said Muna Hagi, 24, a Somalian immigrant who contracted COVID-19 last month in the second wave.
Hagi does not feel the public health department did enough to help her family understand what was happening.
Too sick to get out of bed, she lost her part-time job at Tim Hortons. She self-isolated for two weeks but the disease still infected her extended family, who live with her in a small house on Paulander Drive in Kitchener.
Their Victoria Hills neighbourhood has been infected with the virus at more than twice the regional rate.
“My grandma has diabetes, she got it. My baby sister, she’s two years old and she got it. My whole family, even one of my cousins who’s our neighbour, we all got it,” Hagi said.
She worries about a younger brother who is vomiting and coughing. When she called public health for help, she said they told her to see a doctor.
“How am I going to go to the doctor if I’m carrying COVID?” Hagi asked. “They said ‘Don’t worry you’ll figure it out.’”
Mona Loffelmann says older Black adults living with grandchildren or older children are especially terrified.
“People felt that public health did not care,” said Loffelmann, founder and executive director of African Family Revival Organization, a grassroots group that offers social services for Black families.
“I definitely think that the Black seniors are isolated at home. They don’t have a connection with public health. Public health did not reach out, especially to those neighbourhoods.”
Black immigrants in hard-hit neighbourhoods did not receive adequate public health outreach, Loffelmann said. This includes her cousin who self-isolated after arriving from Ethiopia.
Public health told her cousin they would connect with her to offer ongoing support.
“She was devastated when they didn’t call her back. They did not connect with them. They didn’t tell her what to do. They didn’t check on her or her mom,” Loffelmann said.
She knows of other families whose entire households became infected. Language and cultural barriers made them feel disconnected and less likely to reach out to public health.
“Seniors don’t feel like they’ve been protected or know what to do when their loved ones get sick,” she said.
Medical officer of health Dr. Hsiu-Li Wang pledged to look into complaints. She invited feedback, saying public health needs to do more outreach.
“What are some specific ways the Black community would like us to reach out to them?” she asked.
Wang said poorer people and racialized people “can very well can be at higher risk” of infection based on provincial evidence. She has yet to see enough local evidence to support targeting special measures to specific neighbourhoods.
“I do believe that the pandemic has accentuated the systemic inequities that were already present in our society,” she said. “They’ve made the impacts worse.”
Laura Mae Lindo, opposition New Democrat MPP for Kitchener Centre, argues it is “literally a human rights violation” for governments to allow disease to spread unequally across neighbourhoods.
“I would say 110 per cent it is a failure in government,” said Lindo. “The first wave taught us lessons that the government has chosen not to protect us from.”
An analysis shows infections tend to rise where overcrowded homes lack enough bedrooms to help keep people apart.
“I suspect that the housing density is a strong part of the uneven distribution of cases across neighbourhoods,” said Chris Bauch, a University of Waterloo mathematician who studies the spread of infectious disease. “It is more difficult to keep physically distant.”
A home is considered unsuitable if it has more than two persons per bedroom and is without a separate bedroom for parents, couples and single adults, according to a national housing standard.
The hard-hit Kitchener neighbourhood of Vanier/Rockway, with a Black population almost twice the regional average, has a community infection rate for COVID-19 that is nearly triple the regional rate.
One in 11 homes is overcrowded in the immigrant-heavy neighbourhood near the Fairview Park mall, census data shows. That’s double the regional rate for unsuitable housing.
Other neighbourhoods with overcrowded homes and high infections include areas around Grand River Hospital in central Kitchener, suburbs in southwest Kitchener, and the Columbia/Lakeshore area of Waterloo.
The Record examined 824 non-outbreak infections across 18 neighbourhoods and compared them to neighbourhood demographics from the 2016 census. These areas are home to 330,300 people, just over half the regional population, and collectively have a community infection rate 20 per cent higher than the regional rate.
Data suggests the second wave that launched in September is accelerating uneven impacts, illustrated by five central Kitchener neighbourhoods. The neighbourhoods have 85,300 people. Household incomes are one-third below regional incomes.
By July 27 after the first wave petered out, the neighbourhood’s collective infection rate exceeded the regional rate by 57 per cent. The neighbourhoods then captured an even greater share of second-wave cases. By Oct. 15 their infection rate surged to 62 per cent above the regional rate.
Health planners warned in 2011 that these five neighbourhoods are at greater risk of poor health because of social factors such as higher poverty, less education, lower employment, and the recent settlement of immigrants who tend to be poor.
“It is not public health if we only keep part of the population healthy,” Bauch said. “I think more could be done to prevent uneven impacts.”
He wants stronger support for public health programs that teach people in close-contact jobs how to protect themselves and their families.
Solutions must be co-ordinated beyond the health sector into areas such as housing, welfare, job safety and education, said Craig Janes, who directs the School of Public Health at UW.
“Government is clearly failing to do this, and these uneven rates should be read certainly as a failure,” Janes said.
Perhaps governments could provide hotels for people from overcrowded homes to self-isolate, said Zahid Butt, a public health professor at UW. That’s already being done in this region for people without homes.
“There needs to be an increased focus on these high-risk populations and neighbourhoods,” Butt said.
MPP Lindo cites stronger rent control, longer bans on evictions, and more taxpayer-assisted housing as ways that governments could ease overcrowding that connects to higher infections.
Wang said public health will look into providing self-isolation shelters for people whose homes are too crowded.
The department hopes to resume neighbourhood-based health outreach that it suspended in reassigning staff during the first wave, Wang said. Mobile testing could be targeted to specific neighbourhoods if enough data points the way.
“I just don’t think we have a clear target,” Wang said. “We may get those signals soon.”
She pleaded with employers to support sick workers who are asked to stay home to contain disease, but who can’t afford to leave jobs that provide no sick pay. “I would ask that employers please try to be as flexible as they can,” Wang said.
Infectious diseases nearly always flow along society’s fault lines, Janes said.
Poor living conditions, crowding, substandard nutrition and the need to take high-risk jobs exposes people to infections “at higher rates than those in more privileged circumstances who can social distance and work at home,” he said.
Wang said public health is examining social determinants that undermine health and is working with partners on long-term actions.
Fitsum Areguy, Local Journalism Initiative Reporter & Jeff Outhit is a Waterloo Region-based general assignment reporter for The Record, Waterloo Region Record