As COVID-19 cases in Canada continue to rise, with more restrictive measures expected to be announced in Ontario, there are still concerns around lack of supports for essential workers and people in COVID-19 hotspots.
Ontario infectious disease specialist Dr. Sumon Chakrabarti told Yahoo Canada that he believes a lot of the focus on COVID-19 spread tends to be concentrated on things that people can see, such as indoor dining and people gathering in parks, but it's really essential workplaces that are driving transmission.
"We’re seeing that [COVID-19] is really hitting congregate workplaces, congregate living settings...and then you're also seeing the people who live with these people getting it," Dr. Chakrabarti said.
He did say that opening indoor dining in some areas of Ontario, at this point in the pandemic, wasn't necessarily a "good move," but "indoor transmission is not happening in a restaurant where there's five people sitting from a household, it's happening in the invisible factories that we don't hear about every day."
"I think we need to kind of realize that a lockdown is not going to help this massive source of transmission," Dr. Chakrabarti said.
Dr. Naheed Dosani, a palliative care physician and health justice activist, told Yahoo Canada that there are contradictory messages being disseminated in Ontario, in particular.
"On one hand, you have a story that's very real about variants of concern that are devastating, causing more hospitalizations, impacting people who are younger and particularly low income essential workers," he explained. "On the other hand, you have a framework and policies that is allowing for indoor dining to occur, for example, and the public can get very confused."
"What we're hearing from the frontlines, anecdotally, and then recent evidence is showing that who's really being impacted are essential workers... The vast majority of the population is unvaccinated and beyond that, we're not providing the kinds of social supports to protect them and their families."
Messaging to younger adults
Recently, both nationally and on a provincial level, more COVID-19 cases have been detected in younger adults.
B.C. Premier John Horgan and Ontario's Premier Doug Ford both called out to younger populations in separate press conferences this week, telling them to follow COVID-19 measures.
"The cohort from 20 to 39 are not paying as much attention to these broadcasts and, quite frankly, are putting the rest of us in a challenging situation," Horgan said at a press conference on Monday. "My appeal to you is, do not blow this for the rest of us."
After an outbreak was reported at the University of Waterloo this week, Ford's message to the students on Tuesday was "don't be going out, don’t be hanging out, don't be gathering in groups."
"What happens when you go home to your parents, or go home to your grandparents and you just pass it on to someone, it's just not right," Ford said.
The Ontario premier has also notably urged people in the province to "stay at home" throughout the pandemic.
Dr. Chakrabarti identified that "abstinence-based messaging" and "blame-based messaging" is not the effective strategy.
"Think about being a 28-year-old working in a factory, working in a food processing plant," he said.
"Their work is what we're relying on to be fed, to have supplies, to have certain things that are essential, that we need, and they're being told to stay home... I think that is not the way that we should be giving the message about [COVID-19] to people."
Dr. Chakrabarti did applaud the approach of B.C.'s provincial health officer, Dr. Bonnie Henry, who, when announcing more restrictions across the province this week, gave "safe alternatives" for the public to socialize.
"She's still encouraging people to get outside in groups of 10 and I think that's a very, very good harm reduction strategy," he said.
In terms of public health strategy more generally, the infectious disease specialist said the sector of the workforce that is unable to stay home is "rarely" spoken about and needs to be targeted differently.
"It dismays me to this day that whenever we hear about the public health messaging, the first thing they always say is please stay home, please do your part, et cetera, et cetera," Dr. Chakrabarti said. "They very, very rarely talk about the sector and the reason I think it's important is because...you have to kind of target in a different way."
Paid sick leave isn't 'radical'
A core aspect of targeting those where COVID-19 is being spread and those at highest risk includes core supports that health experts and advocates have been calling for since the beginning of the pandemic, including paid sick leave.
"Lockdown doesn't address it, things like paid sick leave, targeted testing, isolation support, [those] types of things are important," Dr. Chakrabarti said.
In Ontario in particular, Dr. Dosani stressed that a provincial paid sick leave program during a pandemic isn't radical, adding that what he does consider "radical" is "denying your citizens of the right to stay healthy in a pandemic."
"I'm not really getting a sense that our provincial government is thinking about the safety and well being of those who are being hardest hit by COVID-19," he said.
"One really tangible example of that is paid sick leave, an upstream intervention, if applied, could not only help people so that they don't have to choose between their health and paying their bills, but it could also actually help reduce healthcare utilization, and therefore reduce healthcare costs."
The Ontario government has been questioned about a paid sick leave program in the province since the beginning of the COVID-19 pandemic.
The premier has repeatedly said that he will not “duplicate areas of support” when the federal government has the Canada Recovery Sickness Benefit (CRSB), which allows Canadians to receive $450 a week (after taxes withheld) for a maximum of four weeks. This is for employed and self-employed individuals who are unable to work because they are sick, need to self-isolate due to COVID-19 or have "an underlying health condition that puts them at greater risk of getting COVID-19."
Inequities in province's vaccine rollout
Inequities during the COVID-19 pandemic also extends to vaccine distribution.
"Staying home has been a privilege since the start of this pandemic and having the ability to get a vaccine is also a privilege at this stage of the pandemic," Dr. Dosani said.
For example in Toronto, as of March 31, the area of the city that have seen the most COVID-19 cases per 100,000 population is Humbermede. No pharmacies are administering the AstraZeneca COVID-19 vaccine in that neighbourhood.
"I think the vaccine rollout has not just been inequitable, it's not been logical," Dr. Dosani said, adding that these hardest hit communities, where essential workers, where racialized people live, should have received more supports.
"Someone who is younger but has to go into work as an essential worker, and then lives in a multi-generational household and can't be afforded the opportunity to go get a COVID-19 test if they're feeling sick because they don't have paid sick leave, that has real...ramifications."
Both Dr. Dosani and Dr. Chakrabarti believe there is merit in looking at a vaccine distribution strategy that takes into account the hardest hit areas of the province. The vaccine rollout in Ontario has been largely an age-based approach, with the addition of frontline healthcare workers.
"We obviously know that age is a huge risk factor but one other thing that...has been brought up is geographical, so looking at places that are hotspots like Toronto, Peel, Windsor-Essex, and going to the places where you're seeing the bulk of transmission and vaccinating those individuals, i.e. high-risk workplaces," Dr. Chakrabarti said.
"That would be, I think, one thing that we could do and target that would really, really change the trajectory of the pandemic in Ontario."
Phase two of the province's vaccine distribution, set to begin in April, is expected to include people who live and work in congregate settings, more essential frontline workers, individuals with high-risk chronic conditions and essential caregivers.
Dr. Dosani said the province needs to be considering health inequalities, including the reallocation of vaccine supply to hotspots and providing paid time off for individuals to go get a vaccine, something that has already been implemented in Saskatchewan.
"It's crucial that we prioritize people who are essential workers, who may be younger, for vaccination, particularly if they live and work in hotspot areas," Dr. Dosani stressed. "That's what an equitable approach to vaccination looks like and I think an age-focused approach, in isolation, will be problematic because it's just looking at one layer of vulnerability, when there are so many other layers of vulnerability to consider."