For those of us who work in education, whether directly or indirectly, this time of year often feels like a New Year. Like many new beginnings, it is a time for both reflection and renewal, a time when we look back and forward seemingly at the same time. In the best of times, we do so with excitement, optimism and anticipation. This year, though, we are confronted with concerns about COVID-19 – with what means for us as individuals, as a city, and as a society. In fact, this is the most unprecedented and most unusual autumn any of us have ever faced. Beyond beginning to learn about how the global pandemic is affecting us in our respective communities, its long-term impact is beginning to settle in all around us.
The distribution of COVID-19 cases across the City of Toronto, “as suggested by their home address,” tells us what many of us who live and work in poor, working-class and marginalized communities in Toronto already knew: COVID-19 cases are most concentrated in the areas where poor, Black and racialized people live. These are also the communities where those we now call “essential workers,” who are mostly Black and racialized women, reside.
These data – like many research reports – tell the stories of communities like Jane and Finch, Malvern and similar others, without any historical context. For some of that history, I turn to our recent past, when much of what we are living pertaining to COVID was foreseen through SARS. This forces us to grapple with a very difficult reality – that so much of the death, difficulty and despair we are experiencing could have been avoided.
When the Severe Acute Respiratory Syndrome appeared on the global stage in 2003, there were two primary outbreaks in Toronto. Most of the reported cases affected health-care workers, patients and hospital visitors between 18 and 64 years old. The first reported “index case” in Toronto became ill on Feb. 27 and presented to the index hospital on March 7. By March 25, “the Ontario government designated SARS as a reportable, communicable, and virulent disease under the Health Protection and Promotion Act.” As we are all more aware now, the Emergency Management Act grants the provincial government special powers, some of which include directing and controlling local governments and facilities to ensure that necessary services are provided.
According to physician and public health specialist Vivek Goel, “Outside of Asia, Toronto was probably the hardest hit place in the world.” Between 2003-04, there were 438 suspected cases of SARS and 44 deaths, three of them among healthcare workers. While these numbers pale in comparison to the pandemic we are currently facing, the two viruses do share common elements – they are both highly contagious respiratory illnesses transmitted through droplets.
SARS should have taught us that personal-support and home-care workers in long-term care and retirement homes are the main vectors for viral transmission. In fact, after SARS, a National Advisory Committee on SARS and Public Health was established with the mandate to provide a “third-party assessment of current public health efforts and lessons learned for ongoing and future infectious disease control.” Following its main report, Learning from SARS: Renewal of Public Health in Canada, many public commitments were made. These included creating more coordination among local and regional health units, increasing hospital capacity, and revamping the long-term residential care sector. Fast forward to 2020: four in every five COVID-19-related deaths in Canada have been linked to long-term care and retirement homes.
SARS also should have taught us that the most densely populated communities and neighbourhoods are usually the ones with high-rise towers and publicly funded housing, and as such are the most vulnerable to the transmission of respiratory illnesses. The SARS report indicated that our ability as a country, province or city to fight a pandemic is “tied more closely to the specific strengths of our public health system than to the general capacity of our publicly-funded personal health services system.” It was noted that our public health system should be “population-focused, and include functions such as population health assessment, health and disease surveillance, disease and injury prevention (including outbreak or epidemic containment), health protection, and health promotion.” The report called for a “comprehensive renewal of both the public health system in general, and the nation’s capacity to detect, prevent, understand, and manage outbreaks of significant infectious diseases.”
The lessons we claimed to have learned from SARS are echoed in the lessons we claim to be learning now. Public health infrastructure, particularly in working-class, low-income, Black and racialized communities, remains as fractured and disparate as it was in 2003. Qualitatively, housing, quality of life and access to health services in Toronto’s poorest communities remain virtually unchanged, and with the onset of COVID – a more intensified and magnified global pandemic – these same communities remain the most vulnerable.
If we are to claim that we have learned lessons from SARS, and that we will honour those we lost during this difficult time, it means we must break from the incremental modifications our governments are so prone to making and do what is required. It means facing head-on the kind of structural neglect and disinvestment that marginalized communities are so often provided and enact more fundamental changes to the city spaces that are already precarious.
The choice is clear and it is stark: either we radically invest in our most vulnerable communities or we continue to let people die.
Sam Tecle is community-based worker with Success Beyond Limits and Jane Finch Action Against Poverty (JFAAP) as well as an Assistant Professor at New College at the University of Toronto.
