Toronto population health team helps homeless shelters contain COVID-19 outbreaks

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by The CMA Foundation staff

When Toronto’s largest homeless shelter reported a cluster of COVID-19 cases last month, staff and residents were already under tremendous strain. How to contain the virus among a population who often can’t self-isolate or physically distance? How to protect the most vulnerable? So Seaton House turned to a local health team for help.

“COVID-19 is stressful and scary in terms of health and everyday operations. The strengths and skills to respond and recover are there in the community. We use data to find and build on those strengths,” said Dr. Aaron Orkin, a family, public health and emergency physician, and instigator of the COVID-Alert Risk Evaluation and Management (CARE) program.

For outbreaks like the one at Seaton House — which has escalated to more than 40 cases — Dr. Orkin’s Population Medicine Team at Inner City Health Associates (ICHA) helps shelter staff use what they know about their clients to serve the most vulnerable residents, taking factors such as age and underlying medical conditions into account. By identifying at-risk individuals during an outbreak, while also providing onsite support, the program helps shelters reduce deaths and serious health complications from the virus.

The CARE program received funding through the first round of the COVID-19 Pandemic Response and Impact Grant Program, supported by a $5 million contribution from the CMA Foundation.

“The CARE program has provided valuable on the ground support and tools to equip our frontline staff to help protect the very vulnerable individuals we work with and reduce the spread of COVID-19 in our shelter system.”

— Laural Raine, director of service planning and integrity, City of Toronto

ICHA Population Medicine Team member Tina Kaur, RN, said the program tries to provide clarity on how to respond to an outbreak while also collecting important data on the entire shelter population. Understanding an individual’s risk and medical history allows the team to triage people to the right supports. For example, knowing that a shelter client has asthma and diabetes — which puts them at higher risk for serious COVID-19 complications — can help to ensure that they get the testing and support that they need if there is an outbreak.

“People experiencing homelessness are facing the threat of COVID-19 without the resources to protect themselves in a home of their own, such as isolation and physical distancing,” she said, adding shelters and health partners are doing a tremendous job to protect clients, including with new shelter spaces and emergency isolation facilities for the pandemic.

The CMA Foundation contributed $5 million to the Foundation for Advancing Family Medicine (FAFM) COVID-19 Pandemic Response and Impact Grant Program. This program is helping family physicians innovate to provide care during the pandemic.

So far, Dr. Orkin’s program is collaborating with more than 170 sites across Toronto, serving more than 3,600 clients, with a focus on facilities with 150 or more clients.

“The demand is extraordinary,” he said, noting the program could be expanded to a variety of settings. “The exact same approach could be used to plan better immunization strategies, address the threats of the opioid epidemic and improve supportive housing.”