Amid COVID-19, the safest place is often your own home — until the virus finds a way in
Crowded apartments, multi-generational housing create added challenges in Toronto
By late April, it had been weeks since Ashley Comrie had last travelled anywhere beyond her roughly 950-square-foot apartment.
The 37-year-old social worker worried she was at a higher risk of catching COVID-19 since she's on medication that suppresses her immune system.
So, as the pandemic dragged on, she stayed put indoors — while her husband, 48-year-old Kirk Comrie, made rare but necessary trips to the grocery store wearing both a face mask and gloves.
From a public health standpoint, the couple did everything right: They stayed apart from others. And, as much as possible, they stayed home.
But like many households in Toronto, there was little they could do to steer clear of each other in their one-floor Wychwood-area unit while sharing the same bed, bathroom, and apartment entrance.
In early May, just days after one of Kirk Comrie's grocery runs, both he and his wife felt feverish and started coughing. The store wound up being the site of a COVID-19 outbreak. The Comries soon tested positive for COVID-19.
In Ashley's case, she has been hospitalized for the last month — ever since getting tested — which included a nerve-wracking stint in intensive care.
"Even when you think you're controlling it, you can't control it," she says in a conference call from her hospital room.
"If it decides it's coming home with you, it's coming home with you."
'Impossible' for some to self-isolate
Early on in the pandemic, the message from Dr. Eileen de Villa, Toronto's medical officer of health, was: "If you can stay home, do."
Since then, there's been growing awareness that while hunkering down can keep you safe, households are also COVID-19 transmission zones once one person gets infected — particularly in a city like Toronto where crowded apartment units and multi-generational housing is a common facet of life in certain neighbourhoods.
"We see patients coming to the ICU from the same apartment complex, from the same unit, from the same area," says Dr. Michael Warner, medical director of critical care at Michael Garron Hospital.
"And most of these people that we care for are people who do not have the ability to go to the cottage, to use the third-floor bedroom, to self-isolate in their own home."
Recently-released data from the city shows high case counts in many neighbourhoods known for apartment communities, which are often home to essential workers who face a two-fold dilemma: Their jobs may expose them to COVID-19, and they may in turn expose entire households.
"It's absolutely impossible in a 600-square-foot apartment with one bathroom and six people to protect your family," Warner stresses.
There's also a growing consensus among researchers that spending time in close quarters in a variety of indoor settings, from workplaces to restaurants, helps facilitate the transmission of COVID-19.
How can people stay safe at home?
So what can people do to protect themselves at home in a densely-populated city like this?
Dr. Abraar Karan, a clinical fellow at Harvard Medical School and an internal medicine doctor at the Brigham and Women's Hospital, says it's crucial to remember how easily the virus can spread between people in close contact.
"Low-risk situations can turn into high-risk situations quite fluidly and easily," says Karan, who's also working on the state's response to COVID-19 in Massachusetts.
With that in mind, health experts say you can do your best to take precautions by maintaining space if one member of the household has a high-risk job where they could be exposed to COVID-19 on a regular basis.
Dr. Isaac Bogoch, an infectious disease specialist with the University Health Network, says it could even be beneficial to wear personal protective equipment in your own home.
"If someone's infected in the home, and you know that they're infected, wearing a mask would be very helpful in that setting," he explains.
But Warner says what's more crucial is better support on a broad scale for people who can't isolate safely in their households.
"That could be COVID hotels. That could be food delivery. That could be child and elder care," he said.
For people in high-risk workplaces who don't have a separate place to stay away from family or roommates, Warner adds that strategic testing could help pinpoint positive cases early so those people can take precautions faster — and keep their loved ones safe.
'Stressful' weeks of illness
Meantime, Ashley and Kirk Comrie aren't sure they could have done anything else to protect themselves.
What was clear, both agree, is how the illness wreaked havoc on their lives once it arrived in their home.
"It remains very stressful and emotional," Kirk says during a call from the couple's apartment, where he's been living alone since Ashley was admitted to the hospital in early May.
Kirk's respiratory illness lasted a little over two weeks, but he's still struggling with fatigue, even when doing basic tasks like video editing at his desk.
Ashley's experience was even rockier.
Her illness led to major breathing difficulties, which required time in the ICU on oxygen, where she also suffered a double lung collapse and started coughing up blood.
Though Ashley is still testing positive for the virus, she's finally on the mend at Bridgepoint Health's rehabilitation centre, where she's trying to resolve lingering cognitive and balance issues.
She's hoping that, soon enough, she'll be back home with Kirk.
"For not leaving my house, I really got the COVID bingo card full of stuff," she says.