COVID-19 Cases Among Congregate Care Facility Staff by Neighborhood of Residence and Social and Structural Determinants: Observational Study

Abstract

Background Disproportionate risks of COVID-19 in congregate care facilities including long-term care homes, retirement homes, and shelters both affect and are affected by SARS-CoV-2 infections among facility staff. In cities across Canada, there has been a consistent trend of geographic clustering of COVID-19 cases. However, there is limited information on how COVID-19 among facility staff reflects urban neighborhood disparities, particularly when stratified by the social and structural determinants of community-level transmission. Objective This study aimed to compare the concentration of cumulative cases by geography and social and structural determinants across 3 mutually exclusive subgroups in the Greater Toronto Area (population: 7.1 million): community, facility staff, and health care workers (HCWs) in other settings. Methods We conducted a retrospective, observational study using surveillance data on laboratory-confirmed COVID-19 cases (January 23 to December 13, 2020; prior to vaccination rollout). We derived neighborhood-level social and structural determinants from census data and generated Lorenz curves, Gini coefficients, and the Hoover index to visualize and quantify inequalities in cases. Results The hardest-hit neighborhoods (comprising 20% of the population) accounted for 53.87% (44,937/83,419) of community cases, 48.59% (2356/4849) of facility staff cases, and 42.34% (1669/3942) of other HCW cases. Compared with other HCWs, cases among facility staff reflected the distribution of community cases more closely. Cases among facility staff reflected greater social and structural inequalities (larger Gini coefficients) than those of other HCWs across all determinants. Facility staff cases were also more likely than community cases to be concentrated in lower-income neighborhoods (Gini 0.24, 95% CI 0.15-0.38 vs 0.14, 95% CI 0.08-0.21) with a higher household density (Gini 0.23, 95% CI 0.17-0.29 vs 0.17, 95% CI 0.12-0.22) and with a greater proportion working in other essential services (Gini 0.29, 95% CI 0.21-0.40 vs 0.22, 95% CI 0.17-0.28). Conclusions COVID-19 cases among facility staff largely reflect neighborhood-level heterogeneity and disparities, even more so than cases among other HCWs. The findings signal the importance of interventions prioritized and tailored to the home geographies of facility staff in addition to workplace measures, including prioritization and reach of vaccination at home (neighborhood level) and at work.

Mobility changes following COVID-19 stay-at-home policies varied by socioeconomic measures: An observational study in Ontario, Canada

“…However, the small magnitude of difference in mobility reduction by socioeconomic characteristics, especially after the second restriction, suggests that differential mobility may be insufficient to explain the difference in SARS-CoV-2 cases by socioeconomic characteristics in the region. The implication would be residual risks of exposures and transmission that were not addressed by the restrictions in 2020, including onsite workplace exposures intersecting with high-density and multigenerational households [1, 30]. The findings surrounding extant but small differences in mobility change alongside large disparities in SARS-CoV-2 cases suggests the need for additional, tailored approaches to address residual risks, such as outreach testing and comprehensive isolation support, vaccination, and changes in policies such as paid sick leave [31, 32].…”

Challenges facing Canadian Long-Term Care Homes and Retirement Homes during the COVID-19 pandemic

“…The impact of COVID-19 on long-term care and retirement homes was devastating. LTCH/RH staff were at increased risk of becoming sick with COVID-19, not only through workplace exposures, but because they often resided in neighborhoods with lower household incomes, higher rates of ‘essential/frontline’ workers, and higher rates of COVID-19 (Ma et al, 2022). Nearly one year into the pandemic, we conducted 91 key informant interviews with LTCH and RH leadership in 47 homes to assess their experiences navigating the pandemic and to define the challenges faced by LTCH and RH.…”

The predictable crisis of covid-19 in Canada’s long term care homes

“…Unregulated workers who provide 80-90% of direct LTCH care often work part time in multiple settings to make a living wage, frequently without benefits 2930. Compared with other healthcare workers, LTCH staff diagnosed with covid-19 were more likely to live in lower income areas, with a higher household density, and live with other essential services workers 33. Throughout the pandemic, low waged essential workers were at highest risk of covid-19 and its consequences.…”

“…29 30 Compared with other healthcare workers, LTCH staff diagnosed with covid-19 were more likely to live in lower income areas, with a higher household density, and live with other essential services workers. 33 Throughout the pandemic, low waged essential workers were at highest risk of covid-19 and its consequences. This raises questions about how the intersection of ageism (towards residents), sexism (LTCH residents and staff more likely to be women), and racism impacted LTCHs and pandemic response.…”