What does a community approach to COVID-19 testing look like?

As the second wave hits the province, experts are calling for a community-driven strategy that takes testing out of hospitals — and into the heart of hot-spot neighbourhoods
By Priya Iyer - Published on Oct 20, 2020
Black Creek Community Health Centre and its partners arranged a pop-up COVID-19 testing event in northwest Toronto. (Courtesy of Michelle Westin)

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Most Septembers, Kellie McIntosh and her daughter, Dana, help organize the annual back-to-school community barbecue at their social-housing complex in the Jane and Finch neighbourhood, in northwest Toronto. This year, they had a very different task: helping the Black Creek Community Health Centre and its partners arrange its first pop-up COVID-19 testing event: the nearest assessment site, run by the local hospital, has moved to an online-booking system and is two bus rides away.

Both educators — Kellie a teacher, and Dana a special-needs assistant — the McIntoshes say they’ve been advocating for residents for more than 20 years. “Many who live here are single mothers, personal support workers,” says Kellie. “This neighbourhood has one of the highest rates [of COVID-19], so it’s important to know whether or not you have it. If you’re a carrier, you should be aware.”

People like the McIntoshes are a crucial part of a community-driven strategy aimed at taking COVID-19 testing out of hospitals and into the heart of neighbourhoods whose residents are facing disproportionate impacts from the pandemic, advocates say — and, as the second wave hits the province, they’re calling for funding and more responsibility for the hot-spot communities most in need of support.

Northwest Toronto has seen the highest rates in the city. According to data from Toronto Public Health, the per cent positivity rate (the proportion of tests that are positive) may be as high as 9.6 per cent in some neighbourhoods, while the city average is 3 per cent. In McIntosh’s neighbourhood — where 70 per cent of residents are racialized, about 47 per cent of households make less than $50,000 annually, and around 40 per cent live in large apartment complexes, most built over three decades ago — the case rate is 1,891 per 100,000. 

“We were hearing of the disproportionate impact of COVID-19 on racialized and vulnerable communities,” says Safia Ahmed, executive director of the Rexdale Community Health Centre. Through conversations with community leaders, “it became evident that people were unable to access hospital testing sites,” Ahmed says, citing such barriers as long wait times and lack of access to a car. “We needed a different strategy.” Though some parts of the city had rolled out community responses earlier, it wasn’t until May that work began in earnest in the hard-hit northwest region; the first pop-up was held in July.

Advocates of the approach say it involves more than testing. “The strategy is meant to bring down the numbers — it’s not just to get as many tests as we can done,” says Sophia Ikura, executive director of the Health Commons Solutions Lab at Sinai Health. It’s been working closely with the north Toronto cluster table, a group of 33 local community organizations that includes Ontario Health Team members. What’s needed, both Ahmed and Ikura say, is a targeted approach of surveillance and mitigation in communities experiencing high transmission rates and facing disproportionate risks because of inequities — poverty, precarious work, high-density housing, and racial or language barriers. “It’s to identify when people get sick and help them isolate,” Ikura says. “All to contain the virus.”

The community-led approach would cost between $250,000 and $300,000 and enable communities such as Rexdale to run both a fixed and mobile testing team, along with outreach and case management, Ikura says, adding that relying only on pop-ups limits the ability of communities to respond: “It’s a drop in the bucket. Giving communities the authority and ability to make these decisions is important.”  

Currently, provincial funding flows from Ontario Health to hospitals for testing and assessment, and hospitals then determine how to allocate it. “We didn’t get any extra funding to do community testing,” Michelle Westin, quality and risk senior analyst at Black Creek Community Health Centre, told TVO.org via email. “We were able to use our current resources to support it and worked with partners to use free space in the community.” Advocates say that, in COVID-19 hot spots, the money should flow directly to the communities so that organizations can coordinate their own testing and case-management strategy. “Moving forward,” Westin wrote, “there does need to be some sort of investment in resources long-term if more of these testing clinics are to be provided in the community.”

A spokesperson for Ontario Health told TVO.org via email that "community testing is a critical piece of Ontario’s pandemic response and essential to supporting those at greatest risk. Ontario Health works with local public health and partners to provide access to testing. Decisions about community testing are informed by a variety of inputs, including geographical data showing where there is a high prevalence of cases and public health information." 

Black Creek community-outreach worker Daljit Padwal has fielded calls from community residents throughout the pandemic and been working to tackle misinformation. “Every time people hear the news, they call,” she says. “Lots of community members are Punjabi: I help translate. Because I’ve been working long time here, they know me — they feel more comfortable asking questions.”

“People, including myself, were misinformed about testing ” says Kellie. “They were afraid to get tested.” Mother and daughter took the test, Dayna says, to help show residents that it’s safe.

Ikura notes that some residents are concerned about the ramifications of testing positive: “We would hear of families dropping off the radar, afraid if people found out, if they got tested, that everybody would stay away.” That’s why wrap-around management is important, she says. The cluster table helped broker an isolation hotel for the husband and main breadwinner of a multi-generational family who became ill with COVID-19 just as his wife was being discharged after cancer treatments. When there’s a positive case in the community, the strategy is “to go to the household, ask the family, ‘What do you need?’” Ikura says. “Communities understand what’s happening on the ground.”   

“The basic principle of equity is understanding that one size doesn’t fit all,” says Ahmed. “People are feeling that the system is not there for them. We need to ensure these vulnerable communities are not left behind.”

On the morning of the pop-up test, the McIntoshes woke early to set up tents, tables, and chairs — all physically distanced. This year, there were no bouncy castles or face-painting, although they did help collect donations of school bags and supplies for kids and bring in a DJ.  “There’s a lot of things we can’t do due to COVID,” Kellie says. “But even with less face-to-face, we will continue to advocate for our families.”  

This article has been updated with comment from Ontario Health.

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