COVID-19 cases among congregate care facility staff by neighbourhood of residence and social and structural determinants

A CITF-funded study published in JMIR Public Health and Surveillance found that compared with other healthcare workers, COVID-19 cases among facility-staff in long term care homes, retirement homes and shelters more closely mirrored neighbourhood-level heterogeneity and social and structural disparities. Some determinants (income, household density, other essential services) demonstrated greater inequality among facility-staff cases than community cases.

Toronto’s hardest-hit neighborhoods, comprising 20% of that city’s population, accounted for more than half of community SARS-CoV-2 infections in 2020. The findings of the study, analyzing the density of COVID-19 cases in Toronto among facility staff and healthcare workers (HCWs) according to their neighbourhood of residence, reflect broader social and structural determinants of health.

Key Points:

• 9% of community infections in Toronto were in the hardest-hit neighbourhoods (comprising 20% of the city’s population).
• 6% of long-term care home, retirement home, and shelter staff (“facility staff”) who had SARS-CoV-2 infections lived in Toronto’s hardest-hit neighbourhoods.
• 3% of hospital HCWs with an infection worked or lived in Toronto’s hardest-hit neighbourhoods.
• Facility staff cases were also more likely to be concentrated in lower income neighbourhoods, with higher household density, and with a greater proportion working in other essential services compared to community cases.

This study shows that COVID-19 cases among facility staff reflects the prevalence of infection within the neighbourhood where they live. These findings indicate the importance of addressing social and structural barriers and prioritizing vaccine coverage within the hardest-hit neighborhoods to reduce the risk of workplace exposure within the healthcare system.

This was a retrospective, observational study using surveillance data on laboratory-confirmed COVID-19 cases in the Greater Toronto Area between January 23 to December 13, 2020; prior to vaccination rollout. The number of confirmed COVID-19 cases at the neighborhood level during the study period were classified into three mutually exclusive subgroups: community (excluding facility staff, other HCWs, congregate facility residents, and travel-related cases), facility staff (workers or volunteers in long term care homes, retirement homes, and shelters), and other HCWs. Neighborhood-level social and structural determinants were derived from census data and Gini coefficientsIn a Gini coefficient a value closer to zero represents greater equality were used as a metrics of inequality.