Item - 2020.HL22.1

The Board of Health recommends that:

1.  City Council urge the Federal and Provincial Governments to mitigate the impacts of COVID-19 on groups that have been disproportionately affected by COVID-19 by funding and accelerating the implementation of existing strategies related to the social determinants of health, including affordable housing, eliminating homelessness, poverty reduction, food security, overdose prevention, anti-Black racism, and Indigenous health and well-being, as recommended in Attachment 1 to the report (October 14, 2020) from the Medical Officer of Health.

2.   City Council call on the Government of Ontario to increase the availability and accessibility of pop-up COVID-19 testing in neighbourhoods disproportionately affected by the pandemic.

3.  City Council call on the Government of Ontario to:

a.   restore "Pandemic Pay" for frontline workers, which expired in early August 2020, recognizing the ongoing second wave resurgence of COVID-19 cases in Ontario and the continuing risk and sacrifice of frontline workers during the pandemic;

b.  collaborate with partners, including municipalities, to streamline the administrative requirements and delivery of "Pandemic Pay" to frontline workers in a timely manner; and

c.  explore options to recognize public health workers, many of whom are not eligible for "Pandemic Pay", to receive some form of compensation for significant additional hours that will be required on an ongoing basis to respond to the pandemic throughout the winter months.

4.  City Council urge the Ontario Ministry of Health to ensure that the new provincial software, Case and Contact Management (CCM), meets all of the needs of Toronto Public Health, as determined by the Medical Officer of Health, and facilitates cluster identification to target interventions and restrictions.

5.  City Council urge the Ontario Ministry of Health to conduct case control studies using the data collected by public health units across the province to inform decision-making through the pandemic going forward.

6.  City Council direct the City Manager, in consultation with the Medical Officer of Health, to make City facilities available for the distribution of the flu shot in the fall of 2020, where they can be safely accommodated, in partnership with the Government of Ontario, including consideration of establishing drive-through flu shot stations.

7.  City Council request the Deputy City Manager, Community and Social Services, in consultation with the Medical Officer of Health, to build on COVID-19 resurgence plans and the findings from the data and consultation with groups that have been disproportionately affected by COVID-19 to prepare a Toronto COVID-19 Response Equity Action Plan that consolidates existing advice, strategies, and initiatives and includes for each recommendation or action the status, timeline, lead division or agency, and requests of other governments.

8.  City Council request the Deputy City Manager, Community and Social Services, in consultation with the Medical Officer of Health, to report to the Board of Health in 2020 with an update on the Toronto COVID-19 Response Equity Action Plan in Recommendation 7 above.

The Board of Health:

1.  Called on the Government of Canada, the Government of Ontario, and the City of Toronto to immediately develop COVID-19 Response Equity Action Plans to eliminate the unequal impact of the pandemic experienced by many communities.

2.  Urged the Federal and Provincial Governments to mitigate the impacts of COVID-19 on groups that have been disproportionately affected by COVID-19 by funding and accelerating the implementation of existing strategies related to the social determinants of health, including affordable housing, eliminating homelessness, poverty reduction, food security, overdose prevention, anti-Black racism, and Indigenous health and well-being, as recommended in Attachment 1 to the report (October 14, 2020) from the Medical Officer of Health.

3.  Called on the Government of Ontario to increase the availability and accessibility of pop-up COVID-19 testing in neighbourhoods disproportionately affected by the pandemic.

4.  Called on the Government of Ontario to suspend residential evictions throughout the COVID-19 pandemic.

5.  Urged the Ontario Ministry of Health to ensure that the new provincial software, Case and Contact Management (CCM), meets all of the needs of Toronto Public Health, as determined by the Medical Officer of Health, and facilitates cluster identification to target interventions and restrictions.

6.  Urged the Ontario Ministry of Health to conduct case control studies using the data collected by public health units across the province to inform decision-making through the pandemic going forward.

7.  Urged the Toronto Transit Commission (TTC) to continue to take all possible steps to facilitate safe physical distancing in transit vehicles with priority to services in neighbourhoods with a higher incidence of COVID-19 and requested the Chair, Toronto Board of Health, to communicate the Board's position to the TTC.

8.  Requested the Medical Officer of Health to review and action the full set of recommendations in Attachment 1 to the report (October 14, 2020) from the Medical Officer of Health, as appropriate, including:  

a.  consulting with City divisions and agencies to collaborate with community partners in order to plan and implement the short-term actions listed in Attachment 1 to the report (October 14, 2020) from the Medical Officer of Health, including:

1.  creating more accessible public health information;

2.  building community agency support;

3.  increasing community testing and health access;

4.  advocating for income supports and eviction protection;

5.  supporting effective isolation;

6.  overdose prevention and harm reduction; and

7.  supporting people experiencing homelessness;

b.  consulting with City divisions and agencies to collaborate with community partners in order to plan and implement the long-term actions listed in Attachment 1 to the report (October 14, 2020) from the Medical Officer of Health, including:

1.  comprehensive poverty reduction, including universal guaranteed basic income;

2.  safe, high quality, and affordable housing, including supportive housing;

3.  food security, including access to healthy and culturally appropriate food;

4.  better wages, benefits, and protections for workers, including migrant workers; and

5.  equity for Black and Indigenous communities, as well as other populations that experience systemic discrimination;

c.  collaborating with community organizations and health care partners in developing a "social needs assessment" process with appropriate funding and resources to ensure wrap-around supports;

d.  continuing to release disaggregated COVID-19 socio-demographic data and include information on how the City plans to take action in collaboration with impacted communities; and

e.  conducting additional consultation with the Indigenous Serving Organizations cluster table on the impacts of COVID-19.

9.  Requested the Medical Officer of Health to expand Toronto Public Health's COVID-19 Monitoring Dashboard to include equity indicators that inform decision-making on "reopening" or enhancing public health measures.

The Associate Director, Communicable Disease Control, Toronto Public Health, the Acting Manager, Surveillance and Epidemiology, Toronto Public Health, and the Medical Officer of Health gave a presentation on Response to COVID-19: Update on Resurgence.

At its September 21, 2020 meeting, the Board of Health received a report outlining Toronto Public Health's (TPH) plans for a resurgence of COVID-19 in the fall, including activities and recommendations required to strengthen readiness. Since that time, there has been a significant and marked surge in reported cases, focused among younger individuals who live and/or socialize in downtown neighbourhoods. This demographic shift compared to the first wave, has so far, resulted in limited increases in cases requiring hospitalization mitigating somewhat the strain on health care services. 

As part of the planning for the resurgence, TPH developed or adopted a series of epidemiological methods to gather the evidence for who is being affected by COVID-19, and on the risks identified in those cases for COVID-19 transmission. This report makes recommendations and identifies strategies for a targeted COVID-19 response based on this evidence. A brief outline of methods used to generate this information is also provided.

In addition to this work, at its July 2, 2020 meeting, the Board of Health requested TPH to consult with groups that have been disproportionately affected by COVID-19, identify the impacts being experienced by these groups, and recommend actions for the City of Toronto and its governmental partners to reduce these impacts. During the summer of 2020, TPH staff held a series of consultation sessions with Toronto's 13 COVID-19 Community Cluster tables where over 140 non-profit organizations were represented, including ten regional community tables, the Black Resilience table for African, Caribbean and Black serving organizations and the Indigenous Serving Organizations table. This report includes the recommendations resulting from these consultations. 

Finally, this report also provides updated modelling for the City of Toronto. The most basic indicator that can provide information on the growth of the outbreak is the effective reproductive number R(t). It represents the average number of new cases per current infectious case and is used to predict the growth of the outbreak. Toronto's current R(t) is 1.2, which suggests a significant acceleration of case growth without additional steps to respond and limit transmission.