Trust, support are missing ingredients in curbing COVID-19 in Toronto's hardest-hit areas, experts say

Cooped up inside her North Etobicoke home in the early months of the pandemic, Romy Munoz could feel the walls beginning to closein.

Munoz, like so many Torontonians, found herself locked down. Home with a four-year-old and a 14-year-old, her husband's work closed for six weeks, the isolation was taking its toll.The park behind the high-rise in their densely-populated neighbourhood was one of few bright spots.

Immigrating from Chile less than three years ago, Munoz was still puttingdown her roots in a new city when the world seemed to come to a screeching halt.

But once or twice a week, in what would become a lifeline, her phone would ring. On the other end, familiar voicesfrom the nearby community health centre would ask her how she was holding up.

Was her husband back to work? How wasDiego, her little one?

"I feel comfortable, I feel good because one or two people always call me," she told CBC News.

"I don't feel alone."

Northwesthome to some of the worst-hit wards

Much has changed since those early months. The city reopened, then partially shut down again and is set to once again open up in a matter of days, even as it sees record-highdaily case counts of COVID-19.

But as officials continue to urge careful adherence to public health measures like physical distancing, mask wearing and testing, some experts warn that messaging isn't good enough for the hardest-hit communities and that the cracks will only widen unless community organizations that have earned residents' trust getthe support they need to help.

On Friday, Toronto reported eight neighbourhoods with a per-cent positivity rate higher than the province's 10 per cent threshold for tightening restrictions to the red level, many in the city's northwest corner, where residents are largelyBlack or people of colour, often in lower incomefront-line jobs.

Among the worst hit: Black Creek at 15.5 per cent, Rustic at 12.8 per cent, Thorncliffe Park at 12 per cent, Mt. Olive-Silverstone-Jamestown at 11.3 per cent and Glenfield-Jane Heights at 11 per cent.

Of those infected with COVID-19, Toronto Public Health said Friday, 79 per cent identified with a racialized group and24 per cent are among Black people, who remain over-representedin COVID-19 cases. On top of that, it noted, 48 per cent lived in households considered low-income.

"Individuals who live in this community are the front-facing individuals,"Althea Martin-Risden, director of health promotion at Rexdale Community Health Centre, told CBC News.

"They don't have the luxury of, say, an individual who lives in Oakvillewho can, say, work from home ...Those things for our families are not possible."

'Standard messages don't work'

"They're the ones working in the restaurants; they're the ones working at senior's homes;they're the ones who can't self-isolate because they live in a small apartment with an extended family," she said.

"You can't tell people to self isolate; those standard messages don't work."

That disconnect is something Sophia Ikura, executive director of Health Commons Solutions Lab, spent months looking at, beginning late spring.

If I test positive, how will I pay may rent...? There is no one coming to help me.- Interviewee quoted by Health Commons Solutions Lab, August 2020

Speaking to about 130 residents, community organizations and staff, her team found an "unequal burden" of COVID-19 across the city, noting public health strategies didn't adequately address key systemic issuesinNorth Etobicoke, like food and housing insecurity, transportation challenges, lack of internet access, and cultural or language barriers.

With a lack of supports tailored to their needs, residents relied heavily on trusted networks for information, word-of-mouth and volunteers to fill the gapwhere possible, the August report found.

"The feeling of being left behind has earned a sense of neglect and mistrust for the government," the report said, describing a reluctance to be tested for fear not only of economic or health impacts, but social ones, too.

Fear has given rise to 'a lot of misinformation'

"If you are a single mom and you test positive, what will be there to make sure that your family will be taken care of while you self-isolate?" the report quotes one participant as saying.

"If I test positive, how will I pay may rent, how will I feed my family? No good can come from it. There is no one coming to help me," another respondent told the researchers.

In many cases, says Ikura, residents understand what they need to be doing in terms of following public health measures, but their circumstances make it difficult to do so.

In others, she says:"Because the cost of COVID is so high for households, there's a lot of fear in the community. And that fear has given rise to a lot of misinformation and myths that are hard to combat."

One group fighting that is the Somali Women and Children's Support Network, she says, which has been using existing channels of communication, like the online messaging tool WhatsApp,to help get out crucial information in the Somali language on things like testing and available supports.

"Those are the mechanisms and tools that we think are going to make a big difference here," Ikura said.

"Without strategies that directly respond to the needs and experiences of these communities, recovery plans will be insufficient to manage the spread of the virus in potential future waves," the report notes.

'Not a new story,' says city's medical officer of health

Last week, Toronto's Medical Officer of Health Dr. Eileen de VillanotedHumber River-Black Creek, York South-Weston and Etobicoke North, three wards representing about four per cent of the city's population, saw COVID-19 rates 70to 120 per cent higher than Toronto did overall.

"This is not a new story, just the latest chapter in a troubling one," she said.

De Villa addedthe city's COVID-19 Outreach Rapid Response Team has used neighbourhood-specific data to identify areas most in need of better access to testing.

That's led to initiatives like testing at community recreation centres, malls and a church, she noted "testing where people are living their daily lives."

De Villa also noted the city's board of health has called on the province to increase the availability of testing in the northwest sector.

In addition, the its outreach team has deliverednearly 140 presentations in the area and beyond and provides services in 28 different languages, with COVID-19-related informationtranslated into approximately 30 languages.

Ontario Health Minister Christine Elliott recently saidthe province has identified areas in Toronto and hard-hit parts of Peel Region for mobile or pop-up testing.

Still, says Ikura, empowering the community organizations that already have relationships with residents like Munoz is key to stopping the virus's spread.

"The community partners that are on the ground,they have relationships with people in the buildings ... They're best able to carry information into the community in the languages that are most appropriate, with the messaging that are most important," she said.

"The province or levels of government coming in to provide support should really be supporting these organizations rather than trying to supplant or replace that effort."