Mobile in-home vaccinations are "imperative" as Ontario looks to dampen the surge in COVID-19 cases, experts warn, noting more than a quarter of those aged 75 and up have still not received a single dose of a vaccine, nor have they booked an appointment to receive one.
The push is from Ontario's COVID-19 Science Advisory Table, which released a new briefing note on Wednesday evening. The team's analysis notes at least 75,000 Ontarians aged 65 and up rarely if ever leave their homes because of various medical, psychiatric, cognitive, social or transportation-related reasons.
The majority, the note continues, are aged 85 and older.
"Some people — a lot of people — may want to be vaccinated but simply cannot get to the clinic," said Dr. Nathan Stall, a geriatrician and advisory table member who is the lead author on the briefing note.
"And it's not a matter of convenience. It's a matter of impossibility."
As the number of bookings among Ontarians 75 and up decline and public health units begin to open vaccination sites to younger groups, the brief says a critical step will be finding "equitable distribution strategies" for those who face such barriers.
"In places like Toronto and Peel, you have the highest number of homebound individuals living in the highest risk neighbourhoods for COVID-19," said Stall.
"The fear is having some of the situations we've seen in the United States, where people who are at the highest risk of COVID-19 have the lowest rates of vaccination."
Toronto officials also said Wednesday the city has requested that the province allow them to lower the age threshold for those who can sign up for vaccinations and mass immunization sites to 60 years old.
A spokesperson for the Ministry of Health told CBC Toronto the province hopes to work with the city on "expanding the age eligibility as quickly as possible."
"Right now, we need to get shots in arms to the most vulnerable as quickly as possible," said Toronto board of health chair Joe Cressy during a city briefing on Wednesday. "That is how we save lives."
Neighbouring Peel and York regions have also begun allowing those 65 and older to book at their vaccination centres.
'A big logistical operation'
So how to identify who's in need of an in-home vaccine?
The new brief suggests these individuals should be identified by their primary care providers or long-term care homes; or that they be able to indicate their need when booking their vaccine online, for example.
Community outreach workers, home care providers and services like Meals on Wheels could further help to identify those who might not be able to access existing booking systems.
The province also recently made a financial commitment to supporting transportation for people who need to get to vaccination sites, Stall noted.
As part of its 2021 budget, Premier Doug Ford's government announced last week $3.7 million to help seniors and those with disabilities in need of transportation access their vaccines.
"So you hope you can get some of those individuals that way with support," Stall said. "But the ones who are truly homebound and cannot leave under any circumstances — it is a lot. It is a big logistical operation."
The City of Toronto is rolling out three homebound vaccination models, requiring coordination with Ontario Health, Toronto Paramedic Services, the University Health Network and local primary care teams among others. It's also activating a helpline to identify who might require in-home vaccines.
The report suggests Toronto's in-home vaccine model could be "effectively replicated' and "scaled up" across the province.
Ontario had 'inequitable vaccine rollout,' physician says
Getting vaccines into the arms of homebound adults, and younger populations, are both crucial strategies, said Dr. Naheed Dosani, a palliative care physician and social justice activist.
"We have seen pockets of excellence of mobile vaccine clinics, pop-up interventions, door-to-door interventions, but what we have not seen is the scaling up of these mobile options across the province," Dosani said.
"And I worry as a physician who provides health-care for people who are sick, who are frail, and who are often elderly."
So far, he added, Ontario's vaccination roll-out has missed the mark when it comes to targeting at-risk groups and ensuring available appointment slots get filled.
"We should dig deeper as to what's causing this, which includes an inequitable vaccine roll-out that focused heavily on pharmacies in a place like Toronto — pharmacies were not even placed in the hardest-hit neighbourhoods — and also a roll-out that featured a lack of support to family doctors, and primary care health teams who have long-lasting relationships and trust with communities," he said.
CBC News has previously reported on the perceived inequities of Ontario's pharmacy vaccination program, which didn't include any sites in Peel or Toronto's northwest end during its first round — despite both areas being hard-hit throughout the pandemic.
421 COVID-19 cases in ICUs
The briefing comes as new COVID-19 cases in Ontario threaten to outpace vaccinations.
The province marked a grim milestone Wednesday, as admissions of COVID-19 patients into intensive care surpassed the previous pandemic high — 421 in ICUs, exceeding the previous peak of 420 in mid-January during the height of the second wave.
Dr. Andrew Petrosoniak, an emergency physician in downtown Toronto, stressed those coming into hospital lately with symptoms of COVID-19 are now younger adults working and living in the community, with many requiring supplemental oxygen or admission to intensive care.
"It's frustrating to hear in media reports that there are vaccine spaces that are open that are not being filled," he added.
Petrosoniak said a multi-pronged approach will be crucial to getting shots out to various age groups, and suggested allowing emergency physicians the opportunity to vaccinate patients, or at the very least, giving them the ability to book people for appointments.
Given the shifting demographics during this third wave, Dosani said it will be crucial to approach ongoing vaccination efforts with innovation, and through a health equity lens.
Otherwise, he said, people at the highest risk of serious impacts from COVID-19 will be left out.
"People in the hardest-hit communities will get sicker," Dosani continued.
"People who are racialized, people who come from low-income areas, people who are essential workers — will die."