Toronto is planning to set up accommodations for people who are instructed to self-isolate because of COVID-19 but don't have the space to do so — but its request to the province for help has been rebuffed.
Experts have been calling for "COVID hotels" to be established in Ontario for weeks, if not months, as it's become more clear that the coronavirus is disproportionally spreading in neighbourhoods where people are under-housed — with more people, often multi-generational families, living in small apartments.
For example, Dr. Michael Warner, a critical care doctor at Michael Garron Hospital, raised the issue in an interview with QP Briefing in May after he realized many of his COVID patients weren't able to isolate themselves from their families at home.
"How do you tell someone to self-isolate when they're in an apartment building with eight people and one bathroom — I don't even know what that looks like," he said at the time.
A recommendation from Toronto's Medical Officer of Health Dr. Eileen de Villa that the city request support for the plan from the federal and provincial governments is going before the city's Board of Health on July 2, but according to board chair Joe Cressy the proposal has already been floated with the higher orders of government.
"The federal government has indicated both a desire to see these accommodation facilities opened and a willingness to help partner with us and fund them," Cressy told QP Briefing. "We have also had conversations with the province. And while we have not heard the same commitment of funding, there is obviously a desire to see them."
According to a statement from the office of the Minister of Municipal Affairs and Housing, the city is free to use any of the money the province has already given it for homelessness prevention or COVID-19 on the COVID hotels program. "As the local service manager, the City of Toronto has the flexibility to decide how to use their funding, as they know their local needs best," said Julie O’Driscoll in an email, when asked if the province would help design or fund the program.
The city has said the $39-million payment it received in March is not enough to cover even its homelessness-related pandemic costs.
While the plans have not yet been fully developed, Cressy said the city could use hotels or another vacant setting to provide a private room, bathroom and meals to people who are required to self-isolate but can't do so at home. Jurisdictions including New York City and Chicago have similar programs based in hotels. Toronto is using hotels to allow homeless people to recover and isolate, but that program is more intensive and includes wraparound services, such as harm reduction and counselling, that wouldn't be required for the general population, Cressy said.
He said the province should help the city design the program and roll it out in other parts of Ontario.
At a press conference Wednesday afternoon, Mayor John Tory said he supports the plan and noted the city already has arrangements with hotels for favourable rates and staff available. "It would be something we could in a fairly straightforward manner move forward with and it doesn't have to be incredibly expensive relative to having these people healthy and stopping the spread of this virus, including to their own family members."
He also said the city is expecting federal support and said it probably couldn't afford to move forward with the program on its own.
The need for COVID hotels was made clear by the results of the city's data collection, which has shown that COVID-19 has "preyed on poverty," Cressy said. "And there is a clear link between these individuals, primarily racialized people working in frontline precarious jobs, who also are living in under-housed settings — and by that I mean, these are people who have a home, but it's a home where they are unable to physically distance at home from their relatives or roommates."
Cressy said this shows the importance of disaggregated data collection, collecting data on race, income and household composition — something Toronto is doing, but is not yet happening province-wide.
There is no timeline for when the COVID hotels will be up and running and Cressy said that will likely be determined by the co-operation of the other the levels of government. When asked if this kind of support should have been available sooner, he acknowledged that, and said he moved up the date of the board of health meeting by a week because of it — but said it isn't clear that it is Toronto's responsibility to push it forward in the first place.
"Who is responsible for the establishment of isolation accommodation facilities for the under-housed? Is that a federal, provincial, municipal responsibility? This is a brand new initiative. And so we have initiated those conversations," he said.
However, Cressy said he's confident that the initiative won't get stuck on the "interjurisdictional merry-go-round" and fail to move forward because the federal government appears to be a willing partner.
"There is there's a fierce urgency now, there was a fierce urgency yesterday," he said. "We are working as fast as we can to make sure that happens as quickly as possible."
Warner, when informed of the city's plans on Wednesday, said that the fact that the need for COVID accommodations is being recognized is a positive thing — but he thinks the problem should have been anticipated when public health officials first laid out the plans to beat back the disease through the testing, tracing and isolation of positive cases.
"When it comes to treating COVID we've had to improvise, we've had to respond to data in real-time," he said, explaining how medical care of COVID-19 patients has evolved with the latest research. "But when it comes to protecting people from COVID there are excuses like, 'jurisdiction,' or, 'we don't have the data.' Sometimes you actually have to think about things and what actually makes sense. Does it make sense that people who are living in an apartment can isolate? No, it doesn't make sense. They can't do that. So of course, they're going to get COVID preferentially, because they can't follow the instructions.
"So to create a system of public health advice, you have to make sure that every single aspect is covered — the testing the tracing, the isolation and the support, because without the support, the previous three measures really don't matter," he said. "And hopefully, people are coming to realize this gap. And I hope that this gap is closed sooner as opposed to later."