‘Inequalities persist’: Hamilton’s COVID-19 pandemic is an echo of 1918

More than a century apart, two pandemics revealed similar fault lines in the city — and that has advocates calling for change now and for any future pandemics
By Justin Chandler - Published on Mar 31, 2021
The Ballinahinch Relief Hospital, in Hamilton, served as a temporarily relief centre during the 1918-1919 flu pandemic. (Hamilton Public Library, Local History & Archives)



HAMILTON — For much of the 20th century, Ann Herring says, academic literature described the 1918 influenza pandemic as a “democratic” disease, meaning it affected the rich and poor more or less equally. But that theory didn’t reflect the reality of the global-health crisis. “It just didn't make sense based on what we know about epidemics in the past and in the present,” the retired McMaster University anthropology professor explains. “Infectious diseases always flow along the fractures in society.”

Researchers began putting such claims to the test. When, in the early 2010s, Herring and epidemiologist Ellen Korol analyzed death records from the influenza pandemic’s first wave, they found that some areas in Hamilton had been harder hit than others. In 2020, experts began to see similar social and geographic patterns repeating in the city during COVID-19 — and that has many calling for changes that they say will stop history from repeating itself yet again.

According to Herring, people living in Hamilton’s poorer northern neighbourhoods were up to twice as likely as people in Hamilton’s wealthier southern neighbourhoods to die of influenza during the 1918 pandemic. “There are always people who are more vulnerable for a whole host of reasons, but one of the biggies is poverty,” she says. “People who struggle to make ends meet are more likely to have crowded housing; if you have crowded housing and if there is an infection, it's more likely to pass easily from person to person … A lot of people also just had to go to work. There was no CERB or anything like that. You'd have to go because your wages were dependent on that.”

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The COVID-19 pandemic produced similar trends: according to an August 2020 report from the Social Planning and Research Council of Hamilton, neighbourhoods in the city “with higher concentrations of people living on low incomes and people who identify with a racialized group have higher rates of COVID-19.” The rate of infections per 100,000 people in the poorest neighbourhoods, the report found, was nearly double that of the wealthiest, and the rate in the most-racialized neighbourhoods was more than double that of the least-racialized. (Hamilton public-health data also suggest that racialized communities have been disproportionately affected.)

Neighbourhoods grouped according to the ON-Marg Material Deprivation Index. (Social Planning and Research Council of Hamilton)

While the relative positions of north and south have shifted as Hamilton has expanded, the northern half of the city — particularly the core — still contains Hamilton’s poorest wards, and the southern half encompasses its wealthiest, according to 2016 census data. And, as in 1918, the north saw more deaths.

This came as no surprise to Richard Harris, a professor in McMaster University’s School of Earth, Environment, and Society: “In the simplest terms, it just shows that inequalities of income persist — that's not news.”

Jim Dunn, the chair of the university’s Department of Health, Aging, and Society, agrees, saying that Hamilton remains a divided city. “Land markets are very powerful — what I call 'socio-spatial sorting mechanisms' — they sort people of similar socioeconomic status into similar parts of the city.” That’s why, he notes, health outcomes, such as life expectancy and susceptibility to disease, differ by neighbourhood, a trend that the Hamilton Spectator’s Code Red investigation reported in 2010. And, just as in 1918, he says, lower-income groups today “are less able to control the conditions of their exposure.”

So what could be done to change such trends in Hamilton — now and for any future pandemics? Dunn says that two policy changes in particular could make a big difference for vulnerable people: isolation housing and paid sick days. He says that publicly funded shelter for people exposed to COVID-19 who can’t properly quarantine at home (which some jurisdictions already provide) would reduce spread. And paid sick days, he says, would prevent people with suspected or confirmed cases from coming to work for fear of losing income. “If we were doing this really well, we would have rapid testing,” he says. “As soon as somebody tested positive, we'd basically be saying, ‘Here's how we're going to replace your income for the next two weeks when you're in isolation … and we're going to give you the opportunity to go to this isolation hotel.’”

COVID-19 incidence rates by neighbourhood. (Hamilton Public Health Services)

A spokesperson for Labour Minister Monte McNaughton tells TVO.org via email that “through the Safe Restart Agreement we negotiated with the federal government, anyone in Ontario who is ill or needs to self-isolate has access to paid sick days” — and that the province will not implement an Ontario-specific program, as doing so would duplicate the federal one, but will work with Ottawa to maximize its program’s effectiveness.

Hamilton’s director of housing services, Edward John, tells TVO.org in an email that the city has an isolation program “focused on providing isolation spaces and shelter for vulnerable population” and that the city’s COVID Response Vulnerable Supports Team offers eligible vulnerable people a subsidy for hotel space and options to isolate within special facilities.

Dunn is hopeful that the COVID-19 pandemic will shift how governments address long-standing social issues. “We've hopefully turned a little bit of a corner on the cost of not addressing homelessness and housing precarity. There's a motivation to do something there because we've seen that it is doable,” Dunn says. “Governments did the kinds of things that people had been saying for ages just couldn't be done — and it was in a heartbeat.”

What remains to be seen, obviously, is how the COVID-19 pandemic will be regarded by generations to come — and what lessons society will take from it. “A number of historians have really emphasized the fact that pandemics … really bring out the cleavages or the fault lines that already exist in society,” says Magda Fahrni, an associate professor of history at the Université du Québec à Montréal and the co-editor of Epidemic Encounters: Influenza, Society, and Culture in Canada, 1918-20, the collection in which Herring and Korol’s research appears. “In 10 or 20 years, what will we remember as a society? Will it be the ‘all in it together’ message that prevails as an entire generation becomes the generation that lived through COVID-19? Or will we remember that some people — health-care workers, people of poorer neighbourhoods, the homeless — had a much tougher pandemic than others?”

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