One country, two pandemics: what COVID-19 reveals about inequality in Canada
We're learning some uncomfortable facts about how we share the risks. Will we remember them?
We are still all in this together. But after three months, it's getting easier to draw differences and point fingers.
A new analysis conducted by CBC News of cases in Montreal, for instance, found strong correlations linking higher rates of COVID-19 infections with low-income neighbourhoods and neighbourhoods with higher percentages of Black residents.
Limitations on available data may hide the full extent of what happened as COVID-19 spread across the country, but a similar analysis conducted by Global News of neighbourhoods in Toronto found "a strong association between high coronavirus rates and low income, conditions of work, visible minority status and low levels of education."
Public health officials in Ontario reported last week that the rates of infection and death from COVID-19 were disproportionately higher in the province's most ethnically and culturally diverse neighbourhoods.
"After adjusting for differences in the age structure between neighbourhoods, the rate of COVID-19 infections in the most diverse neighbourhoods was three times higher than the rate in the least diverse neighbourhoods," officials reported, taking into account cases reported through May 14.
Low income equals high risk
The rate of hospitalizations in those hard-hit communities was four times higher. The rate of death was twice as high.
Earlier data from Toronto Public Health — looking at cases reported through April 27 — showed COVID-19 was disproportionately affecting low-income residents and recent immigrants.
There are several possible explanations for those differences, said Dr. Isaac Bogoch, an infectious disease specialist and researcher based at Toronto General Hospital. They include working conditions that leave people more exposed to the virus and smaller dwellings that may have more people living together.
"I think this infection magnifies the pre-existing inequalities," Dr. Bogoch said. "It's hard to find a silver lining in a pandemic. But if there is a silver lining in this pandemic, [it's that] this has highlighted some of the inequalities that we see and has highlighted many of the needs of marginalized populations."
Short-term measures can be implemented to counter those inequalities, he said, but those immediate steps should be building blocks toward establishing equity in health long-term. The "tragedy," he said, would be for governments to apply "band-aid" solutions and then "regress back to our old ways" in the months and years ahead.
Not everyone gets to be safe
The most recent modelling from the federal government contained only basic demographic data — women accounted for 57 per cent of infections — but officials also pointed to significant and specific vulnerabilities. Long-term care centres, of course, were first in that group.
But multiple outbreaks were also reported in other "congregate settings," such as prisons, food processing plants, work camps and shelters — places and people that often exist beyond the focus of political attention. In the days since that report came out, attention has shifted to the conditions on farms, where infections have spread rapidly among the migrant workers who come to this country each summer to gather crops.
Untold numbers of lives have been saved and incalculable amounts of suffering have been prevented by the massive collective effort to shut down large portions of Canadian society and restrict activity to a minimum of mostly essential activities. But not everyone has been afforded the same level of protection — and it seems the most vulnerable among us have been the ones more likely to suffer.
A report this week that 170 people in British Columbia died of drug overdoses in May — the highest monthly total in the province's history — also suggests that the unequal suffering of the last few months goes beyond the direct effect of the virus itself.
The economic pain hasn't been evenly distributed either.
In a working paper published this week, four Canadian economists reported that the employment losses in April were greater for younger, low-wage and non-unionized workers, with "public facing" sectors like retail and restaurants hit the hardest. Previous analyses have shown that women are being disproportionately affected.
"The labour market impact of the COVID-19 pandemic has been harsher on those workers who hold the least bargaining power," the authors wrote.
The reopening of the Canadian economy now risks exacerbating inequalities — either because people will be asked to return to jobs that leave them more exposed to the virus or because parents (mothers, mostly) will have to stay home with children for whom care is unavailable.
So much for solidarity
That reopening is already challenging the sense of solidarity that was supposed to define the public response to this crisis.
As the government moved to add new requirements and penalties to the Canada emergency response benefit (CERB), the president of the Canadian Federation of Business — the national lobbyist for small businesses — cheered and insisted reforms were needed to deal with reluctant employees.
"While some workers are worried about returning to work for health-related reasons, many are happy to take the summer off if their income needs are taken care of through CERB," Dan Kelly tweeted.
Perhaps it's strange for Canada's small business owners to advertise the notion that a significant number of people would rather collect $2,000 per month — the equivalent of earning $12.50 per hour working 9 to 5 each day — than work in their stores and restaurants. But Kelly is not the first to fret that the federal government's aid might provide workers with a better option.
Meanwhile, Loblaws announced this week that it would be ending the pay increase — $2 per hour — it had implemented for the frontline workers who did the vital work of keeping grocery stores open.
That work is no less essential now, but it is once again being valued at its pre-pandemic level.
But when this week began, the biggest controversy in federal politics concerned the large protest on Parliament Hill against anti-Black racism and the prime minister's decision to attend that demonstration.
Justin Trudeau was accused of being a hypocrite for having attended a large public gathering while telling Canadians to practise physical distancing. Conservative MP Pierre Poilievre suggested there was a contradiction between the protest being allowed to happen and the decision of an Ottawa bylaw officer to penalize an Ottawa pizzeria for serving customers on its patio.
There are some significant differences between wanting to eat pizza at a restaurant and wanting to publicly express opposition to systemic racism and the abuse of civil rights.
But such complaints over standards and contradictions are likely a preview of what will happen over the next several months, as more Canadians emerge from their bubbles and try to figure out how to behave in a new reality. Just a few weeks ago, there was great consternation over images of crowds gathering at a park near downtown Toronto.
The pandemic is showing us who we are
But if the spirit of "we're all in this together" seems to be flagging, the basic idea still seems true.
As COVID-19 spread across the country, it exposed weaknesses and vulnerabilities, like water seeping through every crack in the system. And as long as COVID-19 is present anywhere, it is a potential threat everywhere — not only to people's lives, but to the systems, communities and economies on which we rely.
What might unite the fight against COVID-19 with the protests against systemic racism is the message that a society is only as strong as its weakest link. And sometimes it takes a crisis for everyone to see the inequalities that were there all along.
The risks now are twofold: that the efforts of the last few months to suppress the virus will be squandered as the feeling of solidarity abates, and that the inequalities exposed over the last few months will be forgotten as the country tries to get back to "normal."
The challenge facing both governments and voters is to not only acknowledge Canadian society's shortcomings and take immediate steps to mitigate the harm, but to remember what the crisis has revealed about us — and make the sort of larger changes and investments necessary to ensure that the spirit of this spring is remembered as more than just a slogan.