Ontario's homeless 5 times more likely to die of COVID-19, study finds

A study published Tuesday in the Canadian Medical Association Journal is painting a stark picture of how COVID-19 has impacted Ontario’s homeless population.

Those without homes also more likely to test positive, suffer complications

The pandemic has hit Ontario's homeless hard, resulting in a higher rate of hospitalization and death. (Evan Mitsui/CBC)

A study published Tuesday in the Canadian Medical Association Journal is painting a stark picture of how COVID-19 has impacted Ontario's homeless population.

Following nearly 30,000 people with a recent history of homelessness over a six-month period, the researchers found that they were more likely to become infected with the novel coronavirus, be hospitalized, experience complications, and die. 

"Individuals recently homeless were over 20 times more likely to be hospitalized for COVID-19, over 10 times more likely to receive intensive care, and they were over five times more likely to die within 21 days of a positive test," said principal author Lucie Richard in an interview with CBC Toronto.

A man sleeping on Bank Street in Ottawa in December. The study used records from hospitals from around Ontario to get an accurate province-wide picture of how COVID-19 was impacting people without homes. (Brian Morris/CBC)

The study was conducted by the Lawson Research Institute and the Institute for Clinical Evaluative Sciences (ICES), where Richard is a research analyst. 

The researchers also found that once testing became available to all Ontarians, people who were recently homeless had a dramatically higher positivity rate — with their tests coming back positive more than 75 per cent more frequently than people with housing. 

Drawing from hospital data 

To get a bird's eye view of how being homeless was affecting COVID-19 rates, Richard and her fellow researchers used data from hospitals across the province. 
Lucie Richard, a principal author of the study. (Submitted by ICES)

"Whenever somebody visits the hospital, information is routinely collected," she said. "One of the things that is collected is housing status." 

Through the same mechanism, the researchers were also able to gather information about the age, sex, and health condition of the two groups they were comparing. 

Among the homeless, "the co-morbidities are higher than in the general population," Richard explained, including a "much higher rate of respiratory conditions, and a higher rate of diabetes."

Those health issues were compounded by precarious living situations, which made it difficult to adequately physically distance. 

"High population density in shelters and high rates of morbidity [have] put them at increased risk from COVID-19," said Dr. Salimah Shariff, another senior author on the study, in a news release. 

Shelters vs. tents

Dr. Andrew Boozary, the executive director of social medicine at the University Health Network and a co-lead of the Toronto Region Homelessness Response, isn't surprised by the study's findings. 

"We've known for a very long time about worse health outcomes for people who are underhoused or experiencing homelessness," he said.

"It's the failure to act that's really damning."

Boozary says the situation in shelters led many to make the decision to live outside in tents —  a choice John Cullen knows well.

Homeless on-and-off for the last two decades, he spent much of the pandemic sleeping in a tent in Toronto parks before finally finding a subsidized apartment this fall.

Cullen told CBC Toronto he avoided shelters, preferring to be outdoors where air circulation was better. 

"They're not a very healthy environment to begin with, and with the virus being here it brings up the intensity more," he said. 

'Health and housing are inextricably linked' 

Boozary says one short-term solution to the dramatically higher rates of COVID-19 among the homeless are the hotel recovery sites being set up in some municipalities. 
'Housing and income are the primary social determinants of health,' says Dr. Andrew Boozary. (Submitted by the University Health Network)

"Ensuring that everyone who wants a room or housing can access [that]," he said, "it's also really important to ensure in the short-term that this isn't just about the hotel room but the community supports." 

Providing adequately distanced shelter has been a regular call during the pandemic, including from a group of 300 doctors and health care workers who asked for the government to open more hotels and student residences back in April. 

Long-term, Boozary says there's only one way to move forward: a major investment in housing. 

"If we really want to see an improvement in public health that's lasting, we have to bring housing into the fold," he said. 

"Health and housing are inextricably linked."