Late last week, like many other stakeholders in the province’s health system, we were encouraged to see the Ontario government modify its COVID-19 Response Framework to lower thresholds for putting public health restrictions in place in different regions.

The Alliance and its members remain very concerned, however, that not nearly enough is being done by the Ontario government to coordinate and resource local responses to support marginalized people during the pandemic. For those at higher COVID-19 risk -- including front-facing workers, racialized people, people living on low incomes and in crowded living conditions, people experiencing homelessness, and those dealing with addictions issues and the overdose crisis -- a robust community-based response strategy is needed from provincial leaders. One-size-fits-all public health messages and directives – such as telling people to work from home, physically distance from people outside your household, get your food/meals delivered, get tested if you have symptoms, isolate for 14 days – when many of these directives are near impossible for marginalized people to follow, is ineffective, inequitable and unjust. The result of the government’s continued inaction to support marginalized communities has been a direct and stark correlation between existing health inequities in Ontario and the worst impacts of COVID-19. Ontario’s marginalized communities, the least supported during the pandemic, are being forced to bear the brunt of the consequences of this continued inaction and lack of local supports.

People in higher risk groups face challenges such as housing and food insecurity, mental health concerns, increased stigma and distrust of the health system, often due to racism, and lower or loss of income due to the pandemic. Unfortunately, the current Ontario COVID-19 response framework and messaging from the Chief Medical Officer of Health continues to be focused on individual responsibility ahead of systemic strategy, interventions and supports. We’ve seen criticism in recent days of the focus on “individual responsibility” as ineffective given the lack of clarity and consistency in messaging from the province in the last two months. For people already at higher COVID-19 risk due to social and economic factors, the lack of a systemic response focused on health equity goes from ineffective to being (avoidably) tragic.  

COVID-19 has made (and continues to make) health and economic disparities worse; this pattern will continue unless action is taken to support marginalized communities and the organizations responding to their needs. The need for an equity-focused COVID-19 response is the key thesis in the Chief Public Health Officer of Canada’s annual report From Risk to Resilience: An equity approach to COVID-19, released in October.

Just last week, community health leaders pointed again to trust and local support as the key missing elements of Ontario’s COVID-19 response plan. While Community Health Centres in Ontario hotspots such as northwest Toronto, Peel, Ottawa and across the province have worked diligently with partners to provide testing and other supports to marginalized populations where positive COVID-19 test rates are the highest, messaging, outreach and community level supports need be resourced, coordinated and more robust. Local lines of trust and support are critical now to infection prevention and control, and the same lines of community-built trust will be vital to the successful uptake and distribution of a COVID-19 vaccine.

A common and widely understood response framework is important in Ontario’s COVID-19 efforts, but it can only be one piece of a robust strategy. For marginalized people and communities, targeted and tailored approaches are needed to ensuring local needs are being met, unique barriers to staying healthy and safe are mitigated, and that people at higher risk of COVID-19 are not left behind. As experts in community health have pointed out again and again, including those at Black Creek and Rexdale Community Health Centres in Toronto, Thunder Bay, Ottawa, and elsewhere, the province needs to support an equitable and coordinated response – both during the pandemic to help people prevent and control infections, but also crucially during the vaccine and recovery phases. The health and wellbeing of everyone in Ontario depends on it.