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A airport airline limo driver waits for customers in a nearly empty Toronto Pearson International Airport during the COVID-19 pandemic in Toronto on Thursday, April 30, 2020. Rajinder Aujla, president of the Airport Taxi Association, estimates that about 20 drivers contracted the virus since April.Nathan Denette/The Canadian Press

When the public image of Pearson International Airport turned from travel hub to petri dish in March, Rajinder Aujla’s friends and colleagues felt they had no choice but to drive toward it every day, again and again. As airport taxi and limo drivers, this is their livelihood.

A month later, Mr. Aujla, president of the Airport Taxi Association, started hearing about what may have been the consequences of all those trips. By his count, 10 drivers have died in the past month, at least six of whom tested positive for COVID-19. One was Karam Singh Punian, a close friend of Mr. Aujla, who died May 4.

He estimates that about 20 drivers contracted the virus since April. Most of the 1,500 drivers who make their living ferrying passengers to and from the airport are immigrants from places such as India, Pakistan and Egypt, he said.

“They’re all self-employed. They don’t have access to health benefits,” Mr. Aujla said. “Some of the people are the only breadwinners. Some of them have others in their family working, but their spouses are mostly out of jobs now. Everyone is staying at home.”

Preliminary data support the idea that COVID-19 is hitting marginalized communities harder than others. The situation will only worsen as provinces reopen, according to front-line health care workers and experts who study health inequities.

Public-health messages about staying home, which are aimed at curbing the spread of COVID-19, have largely ignored the realities faced by low-income workers, people who are homeless or other at-risk groups, said Andrew Boozary, a doctor who is executive director of health and social policy at University Health Network. He also works with Toronto’s Inner City Health Associates, a group that provides care to people living on the street and in shelters.

“Physical distancing is a privilege by postal code,” he said. “We’re seeing a public-health message that is speaking to a certain part of the population. There’s a completely separate curve that is … facing most of the cases and deaths now.”

A recent Toronto Public Health analysis of COVID-19 cases in the city showed that neighbourhoods in Toronto with the lowest incomes, highest rates of unemployment and highest concentrations of newcomers consistently had twice the number of cases of COVID-19 and more than twice the rate of hospital admissions.

That analysis was based on COVID-19 cases tracked up until May 10. It looked at census tracts throughout the city and divided Toronto into five groups for each category of analysis: income, proportion of newcomers and unemployment.

While the lowest-income group had 205 cases of COVID-19 and 34 admissions to hospital per population of 100,000, the highest income group had only 94 cases and 15 admissions.

Neighbourhoods that had the highest concentration of immigrants recorded 194 cases of COVID-19 and 31 admissions per 100,000 people, compared with the ones with the lowest number of immigrants, which had 93 cases and 12 admissions.

The same pattern emerged when it came to unemployment: Areas with the highest levels of unemployment had 198 cases and 30 admissions per 100,000, versus those with the lowest unemployment, which had 98 cases and 15 admissions.

Toronto Public Health is now tracking demographic data (including race and income) to give an even more accurate picture of who is getting infected.

Arjumand Siddiqi, Canada Research Chair in population health equity, said many of the essential workers keeping society going during COVID-19, including janitors, long-term care workers, grocery clerks and transit operators, fall into the at-risk categories.

“They tend to be lower wage, and they tend to consist of black and brown people,” said Dr. Siddiqi, an associate professor at the University of Toronto’s Dalla Lana School of Public Health. “Every time we see a long-term care worker on TV, it’s almost invariably a black woman.”

In Montreal, Canada’s hardest-hit city, many of those workers live in Montréal-Nord, which has the highest concentration of COVID-19 cases and has become the epicentre of the outbreak.

This low-income enclave is a “springboard” for immigrants from places such as Haiti and North Africa, many of whom live in close quarters in high-rise apartment buildings and work in the vulnerable health and service sectors. All these factors have contributed to its high rate of infection, said Bochra Manai, executive director of Parole d’excluEs, a social-services organization that works in the neighbourhood.

The area had 2,593 cases per 100,000 residents as of May 21, by far the most of any borough and well over double the city average. (In part because of its government structure, made up of 19 boroughs, Montreal has more precise neighbourhood data on cases and deaths.)

In Canada’s largest cities, points out Kwame McKenzie, the CEO of health-policy think thank the Wellesley Institute, accommodation is expensive, "and we know that people with lower incomes tend to be in more concentrated or overcrowded places where it is more difficult to physically isolate.”

That was precisely the challenge Fahim Sultana Rigi faced in late April.

After breathing difficulties landed her in hospital and she tested positive for COVID-19, Ms. Rigi was told to self-isolate at home for two weeks.

This was no small feat: She shares a three-bedroom apartment in an 11-floor housing co-op in the densely populated St. Lawrence neighbourhood in Toronto with her husband, Emad Hussain, and four children. Her eldest son was temporarily moved to a room with a sibling, Mr. Hussain shared a room with two of his other children, and Ms. Rigi was in a room on her own.

As his two-year-old cried and begged to see his mother, Mr. Hussain tried his best to help maintain the quarantine. His work ground to a halt as he took on the job of parenting his children solo.

His wife is only 41 but had pre-existing health conditions – thyroid problems and diabetes – so he worried about her recovery.

Research suggests immigrants and low-income earners are more likely to suffer from diabetes, high blood pressure and other chronic illnesses, and those with these pre-existing conditions can face higher rates of hospital admissions and worse outcomes if they are infected with COVID-19.

Just a few days into isolation, Ms. Rigi woke early one morning struggling to breathe. She summoned her husband to her side and frantically gestured to call 911. After spending nine hours in hospital and receiving oxygen, Ms. Rigi was discharged again, continued to isolate and has since recovered – though she still suffers from body pain and exhaustion.

Still, Mr. Hussain can’t forget the fear he felt in those first days that spurred some grim research.

“If I got infected, or if I passed away or my wife passed away, how could we manage those children? Those were the legal things I was looking for,” he said.

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