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The Maxwell Meighen Centre near Moss park, in downtown Toronto, is one of many locations across Toronto that are housing the homeless during COVID-19.

Fred Lum/The Globe and Mail

The vaccine rollout among Toronto’s homeless population has slowed significantly amid a rise in COVID-19 outbreaks in the city’s shelters, advocates say.

Although the uptake was initially brisk when people experiencing homelessness began receiving COVID-19 vaccines in early March, the pace of vaccinations has since petered, in part, because outbreaks in shelters have delayed visits from mobile vaccination clinics, said Doug Johnson Hatlem, a street pastor at the Christian charity Sanctuary.

“It’s really hit or miss – but more miss than hit – whether they can vaccinate places in outbreak, and so many places have been in outbreak,” he said. “A lot of these [mobile vaccination clinics] have been set up and cancelled because of outbreaks.”

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Outbreaks in shelters have jumped in the past two months. As of Monday, the city reported 220 active COVID-19 cases in 14 locations. That’s up from 135 active cases at 10 locations in late February.

A total of 10 people who stayed in the shelter system have died from COVID-19-related issues since the start of the pandemic. With more than 5,800 people using Toronto’s shelter system daily, that puts the fatality rate above the roughly one COVID-19 death per 1,000 people among the city’s general population, advocates say.

The majority of outbreaks are occurring in facilities that still operate as congregate living settings, where people often sleep in warehouse-like spaces, said Diana Chan McNally, a training and engagement co-ordinator with the Toronto Drop-In Network. Even in places where physical distancing is possible and plexiglass walls have been installed, there are insufficient measures to prevent airborne spread of the coronavirus, she said.

Moreover, the city’s data do not reflect the full extent of the outbreaks she hears about from outreach workers across Toronto.

“Some outbreaks don’t make it into their data until long after they started,” she said. “We don’t even really have an accurate picture of what’s going on – which for those of us on the ground, it’s really hard to understand the risk and then attempt to mitigate it.”

In an e-mailed statement, Dr. Vinita Dubey, Toronto’s associate medical officer of health, said that, as of April 30, more than 1,900 vaccinations had been administered to individuals experiencing homelessness. That’s about 33 per cent of the shelter population.

According to Toronto Public Health, it is difficult to calculate an accurate death rate among those using the shelter system, given the transience of this population.

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The city said in a separate e-mail last week that Toronto Public Health’s goal is to offer a first vaccine to at least 65 per cent of all people experiencing homelessness and the front-line workers who support them by May 31. It said the city has opened more than 25 new shelter and hotel locations and has introduced a number of measures to protect those in the shelter system, including two metres between beds and the mandatory use of masks for staff.

Linda Jackson, senior clinical director of community and primary care at Unity Health Toronto, said vaccine hesitancy among shelter residents is not likely any higher than among the general population. But one of the biggest hurdles is that residents are not always available, she said, so her hospital network plans to send smaller teams to conduct repeat visits.

Individuals who have tested positive for the virus or are symptomatic “are not suitable for vaccines,” Ms. Jackson said.

She said she hoped that single-dose Johnson & Johnson vaccines would be prioritized for people living in shelters, since they may have a harder time accessing the second dose other types of vaccines require.

Vaccinating the homeless population as quickly as possible must remain a priority, said Naheed Dosani, a Toronto palliative care physician and health justice activist.

“People who experience homelessness already face such significant health gaps in our communities,” he said. “If this community doesn’t have high uptake of the vaccine, this gap will only widen.”

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Meanwhile, Michael Eschbach, 60, who has been in Toronto’s shelter system for the past 10 years, said he was “elated” to receive his first dose of the Moderna vaccine several weeks ago, when it was offered at the hotel shelter where he’s staying. Mr. Eschbach was among several residents who tested positive and were asymptomatic in a shelter outbreak a year ago.

Mr. Eschbach said while he is mostly confined to his hotel room these days, he knows of others who tend to be more mobile.

“They wander all over the city all day long,” he said, noting if they don’t get their vaccines, they’re at risk of spreading the virus.

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