No consultation: Two public-health units respond to Ontario's postal-code hot spots

Many Ontarians have questions about how the province decided on its priority areas. Public-health units do, too
By Justin Chandler - Published on Apr 15, 2021
Elizabeth Richardson, Hamilton’s medical officer of health (left); Mustafa Hirji, Niagara’s acting medical officer of health. (YouTube)

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HAMILTON — Last week, the province earmarked select areas for priority access to COVID-19 vaccines, saying that people who live in postal codes identified as “hot spots” are at an above-average risk from COVID-19.

The move was met with a largely positive response — but also raised questions. On what basis had these postal codes been selected? Why had some others with higher case numbers not received priority status? Those questions have been difficult to answer in Hamilton and Niagara, because the local public-health units themselves were not consulted.

“I think it’d be helpful for us to understand in greater detail how they were selected so we could better explain why these are the hot-spot neighbourhoods. I think that’s the part that’s a bit frustrating,” says Niagara’s acting medical officer of health, Mustafa Hirji, adding that he hasn’t been given an explanation beyond what has been shared with the public.

When TVO.org asked whether Hamilton had been consulted about the postal-code prioritization, a spokesperson for the public-health unit simply responded “no.”

slide with a definition of COVID hot spots
Slide from the province’s revised Phase 2 vaccination plan, released April 13.

On April 7, the Ontario government announced that people 18 and up in postal-code hot spots would be eligible for shots, starting in Toronto and Peel. Reports in the Hamilton Spectator and St. Catharines Standard pointed out that the hot spots in Hamilton and Niagara were not the hardest hit in each respective region, according to local data.

According to a statement from the premier’s office provided to TVO.org by the Ministry of Health, “These hot spots were identified based on analysis conducted by the COVID-19 Science Advisory Table, which relied on Public Health Ontario data and were confirmed by the non-partisan vaccine task force. Their analysis specifically looked at criteria including hospitalizations, outbreak data, low testing rates and deaths during the second wave of the pandemic. This work applied an anti-racism lens to ensure Ontario protects vulnerable communities.” Regions in the highest 20 per cent, it states, “were identified as hot spot communities” and “regions in the top 30 per cent that faced additional barriers, including sociodemographic ones, were also included.” (The ministry did not respond to a question from TVO.org about whether it had consulted with public-health units.)

Hirji said he would rank L2G, the provincially identified code in Niagara as maybe the third-hardest hit. “When you look at severe illness, the hospitalizations and deaths, it is quite a bit lower than the top one and maybe a little bit above average.” The CBC has reported that in fact, five postal codes declared hot spots in Ontario have rates of COVID-19 cases, hospitalizations, and deaths below provincial averages, while seven postal codes with above-average impacts were not included.

In Hamilton, the province identified two postal codes — L9C and L8W. On April 9, public health confirmed it was designating three more and expanding eligibility for people within them age 50 and up. The city’s medical officer of health, Elizabeth Richardson, had publicly called on the province to add the postal codes, saying her team was basing its call on more up-to-date information.

In the end, the PHU made the move itself. “City of Hamilton Public Health Services identified its hot spots by identifying areas with increased COVID-19 case rates, high test-positivity rates, low COVID-19-testing rates along with data around racialized populations, marginalized populations and the fact these community members continue to be disproportionately impacted by the pandemic,” a spokesperson tells TVO.org via email.

The new postal-code areas, Richardson said at a media briefing on April 12, are “where a lot of our mobile clinics are going to be targeted over the coming weeks as we move forward. The province used factors that would tend to identify things that had happened in the first and second wave, which led to identifying places where there were more people who were older and would have suffered those consequences of hospitalization and deaths.” In Hamilton, she added, “we already have good vaccination rates in our older population that have ongoing transmission. That’s [also] happening amongst our younger population, and we’re seeing more deaths now as we move forward. That’s why we wanted to see those hot spots included in our vaccine rollout.”

According to an April 13 update to Ontario’s vaccination plan, public-health units may determine other hot spots to prioritize “and have the flexibility to set up mobile/pop-up clinics in those areas,” as Hamilton did.

That same day, Health Minister Christine Elliot told the media that “the hot-spot areas were originally identified on the basis of historic data where there had been an acceleration in the number of cases” and that designations will be reviewed regularly by the chief medical officer of health, local medical officers of health, and the public-health-measures table.

The CBC had reported the day before that four of the lower-than-average postal codes provincially designated as hot spots were represented by Progressive Conservative MPPs and that all seven of the higher-than-average postal codes excluded were represented by opposition MPPs. When asked to comment on the possibility of a political motivation for choosing some postal codes, Elliot said, “Absolutely no political motivation whatsoever.” A statement from the premier’s office provided to TVO.org by the Ministry of Health states, “For the past several days, the opposition has spread misinformation and dangerously politicized the province’s efforts to vaccinate 114 high-risk neighbourhoods.”

Locally identified hot spots, such as the ones in Hamilton, are not added to the provincial booking portal — meaning that the path to booking a vaccination differs depending on which body identified one’s region as a hot spot. “Those community members 50+ residing in locally identified hot spots (L8L, L8N, L9K) must book a vaccine appointment through City of Hamilton Public Health Services’ telephone booking line,” a public-health spokesperson tells TVO.org via email.

Hirji says his team is considering adding new postal codes but that he has two reservations. The first is that it’s difficult to pick a threshold. “The other part,” he says, “is we’re a little unsure of what is the real practical benefit of designating an area as being a hot spot.” Whereas people older than 50 can get vaccines in hot spots, people age 55 and up outside hot spots can be vaccinated at pharmacies within the region, Hirji says. Lowering that age threshold by five years in more areas might not be as beneficial as what Niagara is currently focusing on, which is trying to use the risk of outbreaks as “a guide who should get vaccinated,” Hirji says.

“We decided that people who work in agriculture, people who work in the education sector — those should be other groups that we want to target for vaccination. And then we’ll continue to look at some of the next areas where we see outbreaks and probably prioritize those groups as well to go earlier.”

Hirji encourages anyone eligible in the L2G postal code to get vaccinated, adding that public health does not plan to do any geographically based pop-up clinics like the ones Toronto and Peel region are running for people ages 18 and up in hot spots.

When it comes to the original hot-spot selection by the province, Hirji says, “I think the main thing is, I would just wish there was more clarity on exactly how these were selected, absent the consultation.” But, he adds, “In a few different ways, we’ve really seen the sense from the province that we are okay to deviate a little from strictly following the provincial prioritization to incorporate local risks and local knowledge — as long as we’re making sure we’re getting vaccines into people’s arms as quickly as we can.”

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