Toronto, Canada's largest city, has reported 94,943 cases of COVID-19 and 2,614 related deaths so far during this pandemic. Toronto has a population of over 2.7 million people, of whom 51.5% self-identify as a visible minority. Shelter-in-place orders and shut down of non-essential businesses are the primary non-pharmaceutical interactions deployed as part of Toronto's COVID-19 response.
However, many essential businesses and services have remained open to support society. According to Public Safety Canada, "essential workers" include workers in 1 of 10 critical infrastructure sectors, including health, transportation, food, and manufacturing. As per estimates, around 40% of Canada's working population are employed in jobs that are not amenable to remote work. A good portion of these workers belongs to lower-income households. This suggests that shelter-in-place mandates might not be sufficient to protect essential workers from COVID-19 and related mortality.
Comparing per-capita rates of COVID-19 cases and deaths across Toronto neighborhoods by proportion of essential workers
Recently, a team of researchers from Toronto, Canada, compared per-capita rates of COVID-19 cases and associated deaths across Toronto neighborhoods by proportion of people working in essential frontline services. The study is published on the preprint server, medRxiv*.
The team used Contact Management Solutions (CCM)+ person-level data on lab-confirmed cases of COVID-19 (N=74,477) and related deaths (N=2319), and data from Statistics Canada 2016 Census for neighborhood-level parameters. The study population included reported community cases and deaths in Toronto (excluding long-term care residents) from January 23, 2020, to January 24, 2021. The city's 3702 dissemination areas were stratified into tertiles and ranked by the proportion of the population in each dissemination area working in essential services such as health, transport, trades, manufacturing, equipment, utilities, services, sales, and agriculture.
Daily per-capita COVID-19 cases (A) and deaths (B) by neighborhood-level proportion of essential workers in Toronto, Canada (January 23, 2020 to January 24, 2021). The daily per-capita rate is depicted as a 7-day rolling average. Stratum 1 represents neighborhoods with the smallest proportion of the population working in essential services, while stratum 3 represents neighbourhoods with the highest proportion essential workers. Cases and deaths do not include residents of long-term care homes. Essential services include: health, trades, transport, equipment, manufacturing, utilities, sales, services, agriculture. Closure of non-essential workplaces are indicated by (a) at start of first lockdown on March 17, 2020 to the re-opening on May 18, 2020 (b), and (c) indicating the start of the 2nd -major restriction on November 23 to (d) the start of a more stringent lockdown on December 26, 2020.
Neighborhoods with the highest proportion of essential workers had a 2.5-fold higher per-capita rate of COVID-19 mortality
The analysis showed that cumulative per-capita rates of COVID-19 cases and mortality were three-fold and 2.5-fold higher, respectively, in neighborhoods with the highest population of essential workers vs. the ones with the lowest concentration of essential workers. The findings suggested that the essential worker population who served the essential needs of society throughout the pandemic shouldered a disproportionate burden of COVID-19 transmission and deaths.
Many of these are lower-income occupations are often held by contract employees and have no clear labor rights or traditional benefits, including paid sick leave. These people's poor financial conditions limit their bargaining power to demand safe working conditions and adequate personal protective equipment from employers. This signals a gap in prevention with current shelter-in-place rules.
Results highlight the need for active intervention strategies to optimize the equity and effectiveness of COVID-19 responses
This study shows that risks and consequences of COVID-19 borne by residents of neighborhoods with larger proportions of essential workers have been disproportionate in the context of shelter-in-place orders. These results agree with earlier studies that showed that these occupations are not amenable to remote work, and hence these people may experience sustained contact rates despite the restrictive measures.
"Public and occupational health strategies could include primordial prevention aimed at keeping SARS-CoV-2 virus out of the workplace including through paid leave facilitating people to stay home if they have symptoms or a known exposure."
According to the authors, public and occupational health strategies could be aimed at keeping SARS-CoV-2 out of the workplace, offering paid sick leave to help workers with symptoms or those exposed isolate themselves safely at home. Overall, the results highlight the need for active intervention strategies in addition to restrictive measures currently deployed to optimize the equity and effectiveness of the city's COVID-19 responses.
"Moving forward necessitates policies and programs that actively protect workers in occupations that remain active in the context of lockdowns."
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.
- A disproportionate epidemic: COVID-19 cases and deaths among essential workers in Toronto, Canada, Amrita Rao, Huiting Ma, Gary Moloney, Jeffrey C Kwong, Peter Juni, Beate Sander, Rafal Kustra, Stefan D Baral, Sharmistha Mishra, medRxiv, 2021.02.15.21251572; doi: https://doi.org/10.1101/2021.02.15.21251572, https://www.medrxiv.org/content/10.1101/2021.02.15.21251572v1