Winding through the basement of the hospital, past the spin studio that has been closed for a long time, I follow the snaking line of people. I stand on my designated dot on the floor, a reminder of the physical distancing measures we’ve all grown accustomed to this past year. I go through registration, and then into another line, multiple staff directing me at every turn, ensuring we respect the space and flow in this most circuitous of marathons. I sit down beside a nurse, who goes through the consent form one last time, as she picks up the needle that holds so much promise. This is it: I’m about to get my COVID-19 vaccine.
After, I call my mom as I wait the 15 minutes in a room of 40 other people, many taking selfies, and most sending messages like me. Currently, 1,000 people a day are being vaccinated at this specific site in Toronto. They hope this number will nearly double to 2,000 a day – that’s at least 10,000 people per week as soon as more vaccines are delivered. My mom cries, saying she was so scared for me this past year. I tell her now we just have to work on getting her vaccinated, something she promises to do as soon as she is eligible. Deep breath in and out. There’s a lot of work ahead of us. I walk out of the basement and into the sun. It feels like spring is finally here.
COVID-19’s impact on people who use drugs
It has been a devastating year. As headlines of COVID-19 restrictions and the failing economy dominate the news, I hear every week of another friend, colleague or acquaintance dying from overdose – that other public health emergency that was never acknowledged or given this level of resource mobilization. As COVID-19 infections rise, death by overdose skyrockets across Canada, more than doubling in Ontario among the homeless and the under-housed, with calls to paramedics for suspected fatal overdoses in Toronto increasing from last year to this year.
The physical distancing that is meant to keep us safe from COVID-19 is deadly for people using drugs from a toxic supply. As encampments in public spaces are cleared, people are being dispersed and dislocated from land and services, and pushed into single-occupancy rooms far from supervised consumption sites and community supports. Drop-ins and food banks are closed down or limited in whom they can serve and the hours they can operate, while people with financial stability hoard essential supplies, leaving shelves in groceries stores bare.
The COVID-19 pandemic highlights our failures, exposing over-crowded shelters, food insecurity and the hypocrisy of a government that can provide income support to those impacted by COVID-19, an amount that is twice the rate of Ontario Disability Support Program monthly payments. More and more, as people talk about “getting back to normal”, I hope for an entirely different future, one that doesn’t blindly ignore the teachings of present day.
Responding to outbreaks in shelters
In all this, I am constantly reminded of how lucky I am to work with the people I do, and to be supported by an organization that recognizes this interconnectedness of health. Early on, a large portion of my work at the South Riverdale Community Health Centre shifted from a focus on hepatitis C to an entirely new virus, and I became a part of a small group of individuals who respond to outbreaks in shelters, offering on-site testing and support. Over the last week, we have also been able to provide vaccinations to some of the people we serve.
Recognizing how effective a vaccinated population is at controlling COVID-19 outbreaks, we have worked hard to put in place multiple avenues for people to access vaccination. My workplace boasts that 85% of eligible staff already received the vaccine, and over 90% – and growing – have indicated their intention to be vaccinated. This commitment to keeping ourselves and our communities safe directly reflects our investment in collective health.
Moving from outbreak management to outbreak prevention
Over the past year, Zoom has become an outreach tool, something that I never would have foreseen. My colleagues and I have had multiple question-and-answer periods to discuss the transmission and prevention of COVID-19, vaccination and how it impacts other aspects of people’s lives.
With shelters in the east end we put together an outreach team and, days after approval was received, provided our first in-shelter vaccination clinic for staff and residents. Being able to move from outbreak management to outbreak prevention was an emotional moment, reminiscent of when hepatitis C evolved from a chronic disease to a curable infection. And just like with hepatitis C, there is a need to make sure treatment is available to everyone, especially those who are at heightened risk. We know how to do this advocacy work, and we do it because justice in health access is important. We do it because we care.
The roll-out of the vaccine
After another busy week this March 2021, we have offered first doses of the vaccine to all shelter partners in our Ontario Health Team, with plans to vaccinate more people in a month. Recognizing that one approach will never reach everyone, we are also putting together nimble teams that will be able to continuously offer vaccination as shelter populations turn over.
Drop-in and encampment vaccination efforts are next on our list, and we are constantly adjusting our work to figure out how to provide services in a respectful way. Extrapolating from experience with long-term care centres, we know high rates of vaccination significantly decrease COVID-19 cases and the health effects associated with infection. From our hepatitis C work, we know that respectful and trauma-informed care, built on trusting relationships, is central to high quality service, and we are committed to continually improving vaccine offerings.
As the news around shelter outbreaks and variants of concern continue to circulate, I am reminded that we still have a lot of work to do. We have missed a lot in this last year, and at every opportunity, we are doing what we can to make sure it is moments and not people that are missed when we return to community spaces together.
My mask, an extension of myself, will remain firmly on my face. But I’m smiling more often these days, even if it’s only my eyes that give it away.
Bernadette Lettner is a hepatitis C treatment nurse with the Toronto Community Hepatitis C Program in Toronto.