COVID-19 cases among workers in congregate facilities mirror neighbourhood disparities

This paper is available as preprint on JMIR Preprints.

Summary

Why did we conduct this study?

In cities across Canada, there has been a consistent trend of geographical clustering of COVID-19 cases. However, there remain limited data on how cases of COVID-19 among staff working in congregate settings (long-term are homes, retirement homes, shelters) reflect urban neighbourhood disparities, particularly stratified by the social and structural determinants of community-level transmission.

What did we do?

We compared the concentration of COVID-19 cases by geography and social/structural determinants in the following mutually exclusive subgroups: community; facility-staff (workers and/or volunteers at long-term care homes, retirement homes, shelters); and other healthcare workers (working in hospitals, etc.). The time-period of the study was before vaccine roll-out: January 23 to December 13, 2020.

What did we find?

Compared with other healthcare workers, cases in facility-staff more closely mirrored neighbourhood-level heterogeneity and social and structural disparities. Facility-staff cases reflected greater inequality by social and structural determinants than cases among other healthcare workers, and with some determinants (income, household density, other essential services) – greater inequality than community cases.

What do these findings mean?

  1. Information on neighbourhood disparities could be used in prediction models and early warning systems for facility outbreaks.
  2. Interventions should be prioritized and tailored to the home geography of facility-staff, in addition to workplace measures, including wrap-around services for staff to facilitate early and effective isolation and quarantine (including paid sick leave), and prioritization and reach of vaccination at home (e.g,. hotspot or neighbourhood-level) and at work.
  3. There is a need for long-term commitment and resources to comprehensively address social and structural barriers via integration across sectors (health, education, social services, public health, and labor).

The research was led by Huiting Ma and conducted as part of the Wellness Hub, and funded by the Canadian COVID-19 Immunity Task Force and Canadian Institutes of Health Research.

Figure. Magnitude of concentration by social and structural determinants in COVID-19 cases in the communityb, among facility-staffc, and among other health-care workers in the Greater Toronto Area (January 23, 2020 to December 13, 2020).

Heat map with the estimated Gini coefficient of cumulative COVID-19 cases by household income, % visible minority, % recent immigration, % not living in high-density housing, % multigenerational households, and % employed in other essential services.

*Gini coefficient above the line of equality is depicted in red and below the line of equality is depicted in blue.

aOther essential services include: trades, transport and equipment operation; sales and services; manufacturing and utilities; resources, agriculture, and production [27].
bExcluding residents of congregate settings and facility-staff (long-term care homes, retirement homes, and shelters), other health-care workers, and travel-related cases.
c
Including staff and volunteers who work in long-term care homes, retirement homes, and shelters and excluding all other health-care workers.

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