This episode focuses on COVID-19 and disease spread in vulnerable populations, featuring Dr. Naheed Dosani, Palliative Care Physician and Medical Director, Region of Peel COVID-19 Homeless Response.
This episode focuses on COVID-19 and disease spread in vulnerable populations, featuring Dr. Naheed Dosani, Palliative Care Physician and Medical Director, Region of Peel COVID-19 Homeless Response.
OMA Podcast Episode 16: COVID-19 and Vulnerable populations with Dr. Naheed Dosani
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Voice Over: In this podcast the Ontario Medical Association looks at current health issues that are on everyone’s mind. Spotlight on Health gives you the straight talk. We’re Ontario’s doctors and your health matters to us.
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Anne Marie Flanagan: I’m Anne Marie Flanagan. I’m the Director of Media Relations and Social Media for the Ontario Medical Association.
Dr. Naheed Dosani: I’m Naheed Dosani, and I’m a palliative care physician.
Flanagan: We’re here today to talk about disease spread in vulnerable populations.
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Flanagan: Dr. Dosani, you work with vulnerable populations like the homeless or people living in a shelter. How has COVID affected your work?
Dr. Dosani: I never really thought pre-pandemic that I’d be involved in some of the things that I’m involved in now. I’d probably say that my work has changed quite drastically in three ways.
Previous to this, I was working and continue to work as a palliative care physician who provides healthcare to people experiencing homelessness, but when COVID-19 started there were various call outs for help and support in different ways, and so I’ve actually been working in one of the regional assessment centres, diagnosing and testing people who have COVID-19.
More recently, I've been hired as the medical director for the Region of Peel’s COVID-19 homeless response, while maintaining the work around palliative care. I've become quite involved around pandemic planning in our communities, but particularly for people who experience structural vulnerabilities like homelessness.
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Flanagan: More vulnerable people in our society sometimes can be more impacted by disease and disease spread. What kinds of things do you think need to be done to help limit that and to keep those folks more safe?
Dr. Dosani: Well, I think it goes without saying that the COVID-19 pandemic is definitely devastating for our communities, but it is disproportionately impacting communities who have a lower income background, racialized communities, and people who experience homelessness, for example, among many others. And so one of the strategies to deal with that is to collect data, and I know there's been a lot of discourse and dialogue around the kind of data we’re collecting.
And there's been assertions in certain circles that pandemics treat all people equally and that's actually not true. The H1N1 pandemic showed us that the indigenous populations were 6.5 times more likely to end up in the ICU. In the United States, we’re seeing that African-American individuals are two times as likely to die as their white peers. Pandemics do not treat all people equally, race matters, for example.
The experiences of homeless individuals in our cities and in our communities, this is a very unique situation because social distancing is truly a privilege. How can you socially distance yourself when you live in a shelter? Or you sleep in a space that's less than two metres away from someone. You dine communally, you bathe communally, your hygiene is difficult to keep up to par. Really, how can you mount a defense against the pandemic when the burden of poverty is so high?
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Dr. Dosani: I was working in one of the assessment centres, and I had an individual come in and the recommendation was for him to self isolate. And he said, “But doctor, I live in a shelter. I can’t self isolate. So I’m going to go sleep on the streets so that my friends in the shelter can stay healthy and stay safe.” And while I was very moved by his concern, I was devastated at the inequity.
Just to bring it home for our listeners, these are the real-life experiences of people who are on our streets and in our shelters and we have to make moves to do the right thing. History will judge us by our actions.
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Flanagan: You bring up some really good points, and points that we don't think about as much. People are upset, they're complaining a little bit about being stuck at home, and being stuck at home is hard, it's true, but it's also a privilege to have that safe place that's your own.
Is there anything you can think of that would really help? Are there ways that people living in shelters, or rooming houses, or communal situations like that, can help keep themselves a little bit safer?
Dr. Dosani: What colleagues and I have been thinking about is four phases and four approaches that can really help a community, and this is the approach that we've been using in the Region of Peel. The first is to prevent, so actually moving people out of the shelter system and moving them into hotels and spaces so that actually there is social distancing that occurs. And we’ve had some success with moving around half of homeless people in Region of Peel into these spaces.
The second is scaled up, on-site testing. So making testing mobile, and accessible, to a population that often has a distrust of the healthcare system due to stigmatization and marginalization.
The third is having sites for isolation for people who are awaiting their test results.
And finally a space where people who are COVID positive who experience homelessness to be, to recover. Not just from COVID, but to recover around mental health and to potentially have pathways to housing.
When you look at it though, I wonder in the future how we’ll think of this when the pandemic is over because we’re going to have all these people in these temporary accommodations. What are we going to do, send them back to the streets? I certainly hope not.
We’re at a juncture in our history where we have some difficult conversations to have as a society about what we can do to actually do to end homelessness. And I think the time is now.
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Flanagan: When you think of groups like homeless or under-housed, they’re folks that generally have had a distrust of the medical profession, the government, the system in general. Do you think this situation will help them have more trust or do you think it will hurt that?
Dr. Dosani: I think that’s a really great point you bring up. Without a doubt there’s a well-documented distrust of the healthcare system among people who experience homelessness. And that’s because of years and decades of structural stigma and marginalization in our communities. Not having access to care in a way that meets their needs around mental health, around care for their substance use disorders, or their physical health as well.
And so the answer to that question is: how we choose to respond. I mean, if we choose to respond in a way that is equity-informed—preventing further spread of disease by offering accommodations in hotels for example, on-site scaled up testing for example; that recognized that people from this community may not want to present to the Regional Assessment Centres, that are often hospital-based, because of a distrust—then maybe we can achieve something here.
If we don't approach these issues with that kind of sensitivity then I don't think we will inspire change. There's a lot of focus on staying at home and physical distancing—and these are very important safe public health concepts—but I'm so glad to see that we’ve moved the needle to talk about issues around inequity in our society and give that the podium it needs.
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Flanagan: Diseases and pandemics like this affect, not just homeless people, but affect people of lower economic segments, people of certain races more. Are you aware of any numbers that we have on that here? Do we track those numbers in Canada?
Dr. Dosani: Unfortunately the discourse has been, provincially at least here in Ontario, is that there has not been a direct action towards collecting race-based data. And there's been quite a bit of criticism by colleagues, appropriately so, in the media around that, and I think if we don't collect race-based data and data like that we will not understand how pandemics like COVID disproportionately impact these specific communities.
We did learn, for example yesterday in the provincial press conference, that communities living in lower-income neighbourhoods are being hardest hit by COVID.
We know some of that, but we need to be collecting this information because if we don’t collect this information it makes an assumption that all people are being impacted by this equally. And we know that that’s not true.
That’s the difference between equality and equity. In equality, people get the same things to be happy and healthy; and equity, in an equity-based approach, people get what they need to be happy and healthy.
And I think that’s a nuance that is somewhat getting lost in the discourse.
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Voice-over: This podcast is brought to you by the Ontario Medical Association. It is produced and edited by Jodi Crawford Productions. This podcast is not intended to provide medical advice for specific situations and is for general educational purposes only. Please consult your doctor if you have symptoms or questions about your health.
For more information, please visit our website at oma.org.
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