Dr. Jeffrey Kwong from the University of Toronto contributed to a recent publication in the Annals of Epidemiology that illustrates the disproportionate toll COVID-19 has taken among individuals who self-identify as visible minorities and who live in the lowest income areas of Toronto. It revealed that per-capita rates of COVID-19 cases and deaths were 3.3-fold and 2.5-fold higher, respectively, in neighborhoods with the highest versus lowest concentration of essential workers.

The population that continued to serve the essential needs of Torontonians throughout the early days of the pandemic experienced a disproportionate burden of transmission and death.

Key Points:

  • The areas with the highest concentration of essential workers included the highest proportion of the population who self-identify as a visible minority, reside in multigenerational households, and report the lowest income.
  • Cumulative per-capita rates of COVID-19 cases and deaths were 3.3-fold and 2.5-fold higher, respectively, in neighborhoods with the highest versus lowest concentration of essential workers.

Not all workers were able to abide by stay-at-home mandates that were central to the COVID-19 response strategy in Toronto. Those employed in essential services – including manufacturing, processing, shipping, and curbside pick-up of goods; agriculture; mining; retail and wholesale of food; gas stations; pharmaceutical services; kitchen services for take-away or delivery by restaurants and food facilities; telecommunications and information technology; transportation providers; and essential health care services – had no option but to work in person throughout the pandemic.

Using individual data on COVID-19 community cases and deaths and linking them with census data for neighborhood-level attributes (ie: socioeconomic characteristics and racialization), the authors were able to estimate rates of COVID-19 cases and deaths from January 23, 2020 to January 24, 2021. For the sake of accuracy, researchers broke neighbourhoods down to the smallest geographic unit for which data on occupation is available, known as dissemination areas (DA).

The authors recommend active intervention strategies in conjunction with restrictive measures in order for COVID-19 responses to be equitable and effective. They suggest that COVID-19 response programs need:

  • Policies and programs that actively protect workers in occupations that require in-person work, in the context of lockdowns, such as:
    • Paid sick leave;
    • Rapid on-site testing;
    • Symptom assessments; and
    • Improved ventilation.
  • Prevention techniques to be considered are:
    • Isolation;
    • Mass testing; and
    • Reducing interaction between essential workers and others.
  • Higher level prevention strategies to limit outbreak-related mortality include:
    • Temporary housing systems to avert transmissions to households.

Rao A, Ma H, Moloney G, Kwong JC, Jüni P, Sander B, Kustra R, Baral SD, Mishra S. A disproportionate epidemic: COVID-19 cases and deaths among essential workers in Toronto, Canada. Ann Epidemiol. 2021 Nov;63:63-67. doi: 10.1016/j.annepidem.2021.07.01. Epub 2021 Jul 24. PMID: 34314847; PMCID: PMC8435380.