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Brian Cleary has been in Toronto's shelter system for three years, Cleary is currently staying at a shelter hotel until he can find an apartment.

Fred Lum/the Globe and Mail

Amid rising COVID-19 cases and an outbreak of a new, more contagious coronavirus variant in Toronto’s shelter system, advocates for the city’s homeless are warning of a major crisis, akin to that in long-term care. And the key to averting disaster, they say, is to prioritize vaccines for this group, which is at greater risk of hospitalization and death than the general population.

While the number of new COVID-19 cases has generally declined in Toronto since the beginning of 2021, case counts have increased in shelters, where the latest data showed there were 135 active cases among 10 locations.

On Tuesday, the City of Toronto announced 13 additional cases of a new variant among shelter residents and those staying in encampments. That’s on top of 29 cases of a new variant reported as of Monday at the Maxwell Meighen Centre, a city-funded shelter run by the Salvation Army. Although the city did not identify which variant was detected, a memo to homelessness service providers from Toronto’s Shelter, Support and Housing Administration on Tuesday stated that a number of cases within shelter outbreaks have screened positive for the variant first identified in Britain.

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Faced with a more transmissible and deadlier virus, “the only way out of this is vaccination,” said Naheed Dosani, a Toronto palliative care physician and health justice activist. “We have to vaccinate this group as soon as possible.”

People who live and work in shelters are scheduled to be vaccinated in phase two of Ontario’s vaccine rollout, behind residents of long-term care homes and other residential facilities for older adults. The second phase is scheduled to start in April.

However, advocates have urged for shelter residents to be included in phase one, knowing that the shelter network was at great risk of variant outbreaks, said Andrew Bond, medical director of Inner City Health Associates, which serves Toronto’s homeless.

Those calls have gone unanswered, despite the fact that people experiencing homelessness have the same kind of risk exposures, outcomes and congregate living environment in shelters as those in long-term care, Dr. Bond said. “Unfortunately, the variants are now here, predictably.”

Brian Cleary, who has been using Toronto’s shelters for the past three years, put it more starkly.

People think “we’re homeless, we’re trash,” he said, noting there has been a lack of attention and resources devoted to keeping them safe from COVID-19. Considering how the pandemic has played out in long-term care, he said, “How do you think the homeless are going to come out of that?”

More than 6,800 people use Toronto’s shelter system on an average night. Many of those experiencing homelessness have chronic health conditions, which make them more vulnerable to severe COVID-19, and an estimated 10 per cent are older adults, said Diana Chan McNally, a training and engagement co-ordinator for the Toronto Drop-In Network.

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She pointed to a study, published in the CMAJ last month, that found people with a recent history of homelessness were 20 times more likely to be hospitalized for COVID-19, 10 times more likely to require intensive care and five times more likely to die from COVID-19 than the rest of the population.

“It’s really just a humanitarian crisis we’re on the brink of right now,” Ms. McNally said.

While the number of COVID-19 deaths among Toronto’s shelter residents has so far been relatively low – six have died – Ms. McNally noted 224, or roughly a quarter, of the total 898 cases recorded in shelters throughout the pandemic as of Tuesday have occurred within the past two months. And while there is one isolation and recovery centre serving the city’s homeless population, which has 148 beds, she said she is worried how people can self-isolate if that centre becomes full.

Dr. Bond, whose group runs the isolation centre, said all 29 individuals from the Maxwell Meighan Centre who tested positive for the variant were staying at the isolation centre. The site has not reached capacity yet. As of Tuesday morning, there were 103 people staying there, he said.

In an e-mail statement on Wednesday, the city’s Shelter, Support and Housing Administration, said the Maxwell Meighen Centre, which had previously reduced its capacity for 363 individuals to allow for physical distancing, is now housing 121 people, and that staff are working to spread them out even more using all available spaces. It said measures, such as staggering meal times and providing meals to rooms, are helping clients self-isolate. And all staff and clients are undergoing daily symptom screening and will be tested for COVID-19 every three to five days.

The city also announced it is implementing new measures in response to the emergence of variants in the shelters, including limits on movement between shelters, resources for improving indoor air quality and vaccine rollout planning.

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Mr. Cleary, however, said shelter clients like himself are often left in the dark about these measures, and find it hard to obtain the information, such as about outbreaks and testing, they need to keep themselves safe. The current outbreaks highlight a long-standing need to revamp the entire shelter system and implement supports to reduce homelessness, he added.

“The answers have been there for years,” he said. “It’s just the political will.”

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