Dr. Jeff Turnbull is the medical director of Ottawa Inner City Health and a member of the Royal Society of Canada Task Force on COVID-19.
COVID-19 has been labelled “the great equalizer,” affecting all groups within society. While it’s true that the impact of the pandemic is widespread, there are individuals and communities that are more affected than others. The frail and elderly, those in crowded conditions while incarcerated, remote Indigenous communities and those who are homeless, suffering from mental illness, addiction, and poverty will suffer the consequences of COVID-19 more than others. Physical distancing, self isolation, good hand hygiene and access to high-quality health care are beyond the grasp of these and other vulnerable and disadvantaged communities.
For example, physical distancing is an abstract instruction for homeless people sleeping in a 70-bed shelter room and lining up with hundreds of others for communal meals. Good hand hygiene may not register for those with addictions and mental illness. Fever, cough and shortness of breath are a daily occurrence in homeless injection drug users – these symptoms are not even recognized as out of the norm. Self isolation is not seen as necessary or possible given the realities of their addiction and mental health and the facilities available to them. They merely wait for the inevitable, vulnerable as a result of their numerous chronic illnesses and unable to protect themselves or those around them.
While the homeless represent a unique community, they share the same vulnerability as other groups that lack the necessary infrastructure and resources to ensure resilience at the time of a pandemic, environmental catastrophe, or economic collapse. The marginally employed, many of whom work in the service industry as personal support workers and cleaners, also find themselves vulnerable, earning minimum wage and often putting themselves and their families at risk daily.
As we reopen after the pandemic our thoughts should naturally turn to rebuilding our communities. We should do this in a thoughtful way that will permit us to withstand future crises. This must include those communities that will bear the greater burden of the next catastrophe, the disadvantaged, the vulnerable, the isolated and of course, the poor.
Discussions must extend beyond personal protective equipment and vaccine-readiness to policies and strategies to redress vulnerability, which is often a consequence of a lack of access to the usual entitlements that we all have come to expect: adequate housing, income stability, access to good nutrition, hygiene and quality health care, to name a few.
The populations mentioned have been disproportionately victimized by the COVID-19 pandemic. We have always known what is required to fix these problems: homes for the homeless, clean water for everyone, addiction services, abundant mental health services, space for the incarcerated, care and support for the elderly.
Now is the appropriate time to think of strategies to build healthier, resilient communities to lessen the impact for those least capable of protecting themselves. These communities must be engaged in meaningful solutions for them and on their terms.
We need to work with Indigenous governments to address systemic barriers to ensure clean water, housing, employment and education on reserves. We must reduce neglect and poverty of our elderly, provide supportive housing for the homeless and re-examine our approach to mental health and addictions. We also need to provide a guaranteed minimum income and income security for those who have truly been the front line in this time of crisis.
None of these initiatives are new; however, perhaps there is now an opportunity for action to allow all of us to better weather the next storm.
COVID-19 and its catastrophic impact will pass. We will return to our families, friends and communities, restaurants and jobs. The homeless, on the other hand, will not escape their mental health issues and addictions nor the violence and poverty that is often a part of their lives. A positive legacy of COVID-19 must be the building of resilient communities founded on the principles of fairness, equity and social justice.
The Globe and Mail
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