Pandemic preparedness and response in service hub cities: lessons from Northwestern Ontario

Rebecca Schiff (Department of Health Sciences, Lakehead University, Thunder Bay, Canada)
Bonnie Krysowaty (Department of Health Sciences, Lakehead University, Thunder Bay, Canada)
Travis Hay (Humanities Department at Mount Royal University, Calgary, Canada)
Ashley Wilkinson (Department of Health Sciences, Lakehead University, Thunder Bay, Canada)

Housing, Care and Support

ISSN: 1460-8790

Article publication date: 3 September 2021

Issue publication date: 14 December 2021

117

Abstract

Purpose

Responding to the needs of homeless and marginally housed persons has been a major component of the Canadian federal and provincial responses to the COVID-19 pandemic. However, smaller, less-resourced cities and rural regions have been left competing for limited resources (Schiff et al., 2020). The purpose of this paper is to use a case study to examine and highlight information about the capacities and needs of service hub cities during pandemics.

Design/methodology/approach

The authors draw on the experience of Thunder Bay – a small city in Northern Ontario, Canada which experienced a serious outbreak of COVID-19 amongst homeless persons and shelter staff in the community. The authors catalogued the series of events leading to this outbreak through information tracked by two of the authors who hold key funding and planning positions within the Thunder Bay homeless sector.

Findings

Several lessons may be useful for other cities nationally and internationally of similar size, geography and socio-economic position. The authors suggest a need for increased supports to the homeless sector in small service–hub cities (and particularly those with large Indigenous populations) to aid in the creation of pandemic plans and more broadly to ending chronic homelessness in those regions.

Originality/value

Small hub cities such as Thunder Bay serve vast rural areas and may have high rates of homelessness. This case study points to some important factors for consideration related to pandemic planning in these contexts.

Keywords

Citation

Schiff, R., Krysowaty, B., Hay, T. and Wilkinson, A. (2021), "Pandemic preparedness and response in service hub cities: lessons from Northwestern Ontario", Housing, Care and Support, Vol. 24 No. 3/4, pp. 85-92. https://doi.org/10.1108/HCS-04-2021-0012

Publisher

:

Emerald Publishing Limited

Copyright © 2020, Emerald Publishing Limited


Introduction

Pandemic events place significant stress on the capacity of cities to provide and coordinate services for people experiencing homelessness. Research in several Canadian cities conducted during and following the influenza A virus subtype (H1N1) pandemic revealed homeless persons as a particularly vulnerable population and identified the need for more resources to support pandemic preparedness and pandemic planning for homelessness service providers (HSPs) (Buccieri and Schiff, 2016; Leung et al., 2008). Subsequently, homeless persons were identified by the Canadian Government (Public Health Agency of Canada, 2018) and researchers (Babando et al., 2021; Perri et al., 2020; Tsai and Wilson, 2020) as a unique and vulnerable sub-population in the context of pandemic preparedness and response. Despite this identification, few resources were dedicated to supporting the Canadian homeless sector with planning for future pandemics – which left many HSPs struggling to respond during the COVID-19 pandemic.

Despite the lack of pandemic preparedness in the sector, many HSPs were able to access funds provided by the Canadian Federal Government to address the vulnerabilities and needs of homeless persons during the COVID-19 pandemic. Much of the resources provided were directed towards large urban centres, whilst smaller cities and rural areas received fewer monetary and material supports (Schiff et al., 2020; Baggett et al., 2020) which may have affected the ability to control infection and outbreaks within homeless populations. Prior research on pandemic response has lacked attention to the experiences of smaller cities and northern/remote locations, as well as to the experiences of Indigenous peoples who are often overrepresented in homeless populations in Canada (Gaetz et al., 2016).

In this article, we draw on the experience of Thunder Bay – a small city in Northern Ontario, Canada which experienced a serious outbreak of COVID-19 amongst homeless persons and shelter staff in the community. In particular, we use this example to demonstrate pandemic preparedness challenges for small, service centre cities. We begin with a broad overview of the factors shaping homelessness in the city before cataloguing the homeless sector response that began in March 2020. We catalogued this series of events through information tracked by two of the authors: one who holds a key funding and planning position within the Thunder Bay homeless sector and another who is closely involved with homeless systems planning committees and research in Thunder Bay. The positions of these authors provided unique access to information and insight on the experience of the Thunder Bay homeless sector during the first two waves of the pandemic. Our case study identifies several factors that contributed to a severe outbreak amongst HSP staff and people experiencing homelessness in February and March 2021. It also identifies the communications and planning advantages of operating in a smaller city, as well as lessons that may be useful for other cities nationally and internationally of similar size, geography and socio-economic position. We suggest a need for increased supports to the homeless sector in small service–hub cities (and particularly those with large Indigenous populations) to aid in the creation of pandemic plans and more broadly to ending chronic homelessness in those regions.

COVID-19 and pandemic preparedness in the Canadian homeless sector

As Schiff et al. (2020) identified, responding to the needs of homeless and marginally housed persons has been a major component of the Canadian federal and provincial responses to the COVID-19 pandemic. However, the majority of funding has followed traditional pathways of homeless sector funding in Canada, where large cities receive the majority of funding and smaller, less-resourced cities and rural regions are left competing for limited resources (Schiff et al., 2020). This is particularly concerning for service hub cities in the provincial and territorial Norths that act as administrative and service centres for large portions of rural and remote Canada. Service hub cities also often have large homeless populations, with over-representation of Indigenous peoples, who migrate within their catchment areas and have unique needs for homeless service provision (Kauppi et al., 2017; Schiff and Brunger, 2015; Waegemakers Schiff et al., 2015). The overrepresentation of Indigenous peoples in homeless populations and associated migration between service hubs and smaller centres is experienced across the provincial and territorial Norths in Canada, as well as in remote regions of the USA, Australia and New Zealand (Christensen et al., 2017; Peters and Christensen, 2016). During the second wave of the COVID-19 pandemic (January–March 2021) a service hub city in Northern Ontario (Thunder Bay) experienced a serious outbreak of COVID-19 amongst homeless persons and shelter staff in the community. Understanding the situations that led to this outbreak – and the pandemic response within the homeless sector in the city – may provide important information about the needs of service hub cities during pandemics.

Homelessness in Thunder Bay

Homelessness is a significant social concern in the city of Thunder Bay. Thunder Bay is a small city of approximately 110,000 people (Statistics Canada, 2017) yet has a relatively large homeless population: according to 2018 coordinated, national Point – in – Time counts, 0.43% of the population of the city of Thunder Bay was experiencing homelessness (Lakehead Social Planning Council, 2018). This is more than double the rate of homelessness in large Canadian cities: by comparison, only 0.22% of the population of Calgary, 0.29% of Toronto residents and 0.08% of those living in Vancouver were homeless in the 2018 Point – in – Time count (7 Cities on Housing and Homelessness, 2018; City of Toronto, 2018; Urban Matters CCC & BC Non-profit Housing Association, 2018). The city also services a vast, predominately rural region of approximately 526,000 square kilometres which includes 49 First Nations and other Indigenous communities (Ontario Chamber of Commerce, 2016). Indigenous peoples are profoundly overrepresented in the homeless population of Thunder Bay. According to the 2016 census and Point – in – Time count, Indigenous peoples represented 12.7% of the population of Thunder Bay but made up 73% of the homeless population (Statistics Canada, 2017; Lakehead Social Planning Council, 2018).

Coordinated, systems-level planning has been a feature of the Thunder Bay homelessness sector for many years. For decades the federal government has provided dedicated annual funding to address homelessness in specific “designated communities” across the country, including Thunder Bay. Alongside this funding, the network of HSPs in Thunder Bay has maintained collaborative planning committees: an Indigenous and a designated committee – also known as community advisory boards or CABs. In addition to networking, the Thunder Bay CABs provide decision-making support to community entities (CEs), which distribute federal funding and manage the mandated homelessness plans in designated communities. In Thunder Bay, the Lakehead Social Planning Council (LSPC) is the Designated CE and the Thunder Bay Indigenous Friendship Centre (TBIFC) is the Indigenous CE. Both CEs work closely together and host regular meetings to share information and coordinate activities. The Indigenous CAB plays the main role in networking and planning for Indigenous and culturally – safe homelessness programming in the city. The non – Indigenous CAB is also known as the Thunder Bay Housing and Homelessness Coalition (HHC) and plays a major role in coordination, knowledge sharing and systems-level planning amongst Indigenous and non – Indigenous HSPs. The District of Thunder Bay Social Services Administration Board (TBDSSAB) is a designated provincial body that also plays a major role in addressing homelessness and in the delivery of provincial social services funding.

Although federal homelessness programmes have brought monetary and material supports to the City of Thunder Bay and there has been some limited support for systems-level coordination, the amount of funding and planning support has been disproportionate to the high rates of homelessness in the city. These gaps in both service-level funding and support for systems-level planning contributed to significant challenges in containing or managing the spread of COVID-19 amongst the homeless population and HSP staff in Thunder Bay.

The information on the Thunder Bay response to COVID-19 was collected by co-authors 1 and 2. Author 1 is a member of the Thunder Bay Housing and Homelessness Coalition and for the past seven years has been involved with communications and regular meetings of the organisation. Author 2 is the coordinator of the non – Indigenous CE in Thunder Bay, plays a lead role in system-level homelessness planning in the city, and works closely with homeless shelters and Indigenous service providers. The information provided below and the associated “lessons learned” were derived from internal documents, communications and meetings of the CABs and CEs; communications between authors and HSPs and; documentation between March 2020–March 2021 of local media coverage related to the COVID-19 pandemic and outbreak in amongst the homeless population.

COVID-19 in Thunder Bay: a chronology

On 13 March 2020, the City of Thunder Bay began communications with the public regarding the expected arrival of COVID-19 in the city. On 24 March, the first case emerged in the city and was the result of a male in his sixties who had recently returned to Thunder Bay from Florida (Thunder Bay District Health Unit confirms first case of COVID-19 in the city, 2020). Many city departments, provincial and federal government offices, non-profit organisations and businesses advised employees to work from home, where possible. The City of Thunder Bay (municipal government) did not have a pandemic plan which addressed the needs of people experiencing homelessness; what is more, the collective of HSPs (CABs and CEs) also did not have pandemic plans to coordinate response and care for this vulnerable population. The lack of pandemic plans for the homeless sector and for HSPs is not unique to Thunder Bay and is an issue that was also identified in previous research on pandemic preparedness and homelessness in large urban centres (Buccieri, 2016; Buccieri and Gaetz, 2015).

HSPs in Thunder Bay recognised the seriousness of the arrival of COVID-19 in the city for their clients and were on immediate alert – beginning in March 2020 the Thunder Bay HHC dedicated a significant proportion of its monthly meetings to discussing COVID concerns and possible strategies to support social distancing, provide isolation facilities and access personal protective equipment (PPE) for HSPs.

On March 29, the federal government announced $157.5m in COVID relief funding to address the needs of HSPs and persons experiencing homelessness (Prime Minister of Canada, 2020). The Province of Ontario also announced $200m for social service providers – including those working with the homeless population (Office of the Premier, 2020). As a designated community under the federal homelessness strategy, Thunder Bay received a dedicated amount of funding for COVID preparation. The TBDSSAB also received funding directly from the provincial government for homelessness and social services preparations. Together, the TBDSSAB, LSPC and TBIFC determined that the most immediate need in the city was an isolation shelter to ensure that quarantine would be possible for homeless persons with symptoms or diagnosed with COVID-19. The majority of provincial and federal homelessness COVID relief funding was directed towards isolation facilities, as well as purchasing PPE for service providers. Hotels were used as an isolation shelter and an emergency shelter provided staff, supported transportation and other services for persons in isolation.

In September 2020, the federal government announced additional funding to address the needs of persons experiencing homelessness and housing insecurity – $236.7m for homelessness services and $1bn to rapidly construct new affordable housing units (Canada Mortgage and Housing Corporation, 2020). The Thunder Bay CEs received $500,000 of this funding. Some of this funding was used to improve and expand isolation shelter capacity. There was also a need for increased overflow capacity. Prior to the COVID-19 pandemic, homeless shelters in Thunder Bay frequently operated at 150% capacity – sheltering overflow individuals with extra mats on floors when needed. The need for physical distancing brought on by the pandemic meant that fewer people could be accommodated in shelters – and further stressed the capacity of Thunder Bay homeless shelters to provide sleeping space for everyone. As such, some of the additional federal funding was used to add more support to an overflow shelter, which had been created to provide shelter over the winter months when other shelters are full. The funding was also used to purchase more PPE and directed to homeless shelters and support services to aid them in managing isolation and overflow demands. The designated CE also supported the hiring of 8 more social service navigators – adding to the two existing positions – to support rapid re-housing for persons experiencing homelessness.

Until early January the number of COVID-19 infections in the city of Thunder Bay had remained relatively low, compared to other regions of the province (Public Health Ontario, 2021). The situation in Thunder Bay took a turn for the worse when outbreaks of COVID-19 were declared at the Thunder Bay District Jail and Thunder Bay Correctional Centre on 10 January 2021 (Thunder Bay District Health Unit, 2021). Like the shelters in Thunder Bay, the jail and correctional centre often operate well beyond official capacity and have been the subject of media attention on the issue of over-crowding (McCleod, 8 October 2020). After the first cases were confirmed in early January, further testing revealed that 43 of 67 inmates at the correctional centre had contracted COVID-19 (Dunick, 2021). As a union representative for corrections officers at the jail explained, an infected inmate could not be meaningfully isolated: “We can’t keep them entirely separate. He’s in a separate cell, but sharing the same washroom facilities, shower facilities, as the other inmates in that isolation range” (Doucette, 2021, para. 18). Despite efforts to plan for safe transitions to the community, many who are discharged from the jail and correctional centre do not have housing and rely on homeless shelters and support services (Campbell et al., 2019; Doucette, 2021). An outbreak in the homeless shelters in Thunder Bay quickly followed the outbreaks at the jail and correctional centre. This led to a spread through many vulnerable populations in Thunder Bay and the declaration by the Mayor of a state of emergency for health and social services in the City (Prokopchuk, 2021).The shelters became overwhelmed – with a sudden surge to 60–80 people each day requiring isolation or overflow shelter. Many shelter and support services staff became infected – including those working in the isolation shelter system – which further reduced capacity to respond to the outbreak.

Several emergency committees were convened to address the outbreak amongst homeless persons and other vulnerable populations. This included a vulnerable populations committee, convened by the City of Thunder Bay, which met weekly and included a wide range of social service providers, as well as health care, police and other emergency services. An Isolation and Overflow Shelter Update committee was also created to facilitate information sharing and planning amongst those facilities. In late February, vulnerable populations – including homeless persons and HSP staff – were prioritised for the first dose of COVID-19 vaccines (Diaczuk, 2021). In March, Thunder Bay received an additional $2.4m which was used to further support and expand isolation shelter capacity (Hadley, 2021). Finally, on March 11, the outbreak at the jail was declared finished by the Thunder Bay District Public Health Unit – and by late March, the number of infections amongst homeless individuals and shelter staff began to decline. On March 29, the federal government announced $1.5m in funding for a self-isolation shelter, although this came too late to prevent the serious outbreak and many COVID-19 related deaths that had occurred in the previous two months.

Lessons learned: assessing pandemic preparedness in service-hub cities

The experience of Thunder Bay provides unique information regarding the approach to managing pandemics in the context of homelessness in small cities, that serve large homeless populations. Thunder Bay had several advantages and disadvantages leading to the COVID-19 pandemic. Some of the advantages of small cities can include the ability to more easily communicate and coordinate services. These advantages can be due to the geographical proximity of HSPs. It could also be due to the ease that may come with organising and communicating amongst a smaller group of providers (Schiff and Waegemakers Schiff, 2016). This ease of communication was critical and may have been key to quick coordination, planning and prevention of outbreaks during the first few months of the pandemic.

Despite these advantages, Thunder Bay also faced significant disadvantages and challenges which may be responsible for the severity of the outbreak during the second COVID-19 wave. Despite the high prevalence of homelessness in the city (compared to other Canadian municipalities), Thunder Bay does not receive a commensurate proportion of federal or provincial funding. This historic lack of adequate funding continued with the allotment of COVID-19 social services funding and placed the city in a precarious situation in terms of its ability to provide sufficient isolation spaces and ensure adequate numbers of staff. Thunder Bay also lacked a pandemic plan for the homeless sector – as did most other Canadian municipalities – which could have helped to prepare for and avoid some of the serious staffing, infection control issues and freezing death that arose in early 2021. Finally, there was a lack of regular communication channels between the homelessness planning committees and public health, corrections and some municipal offices. The lack of communication between public health, municipal services and the homeless sector was identified as an issue in other small cities during the H1N1 pandemic (Schiff, 2016) and must be addressed, not only in the context of pandemics but also more broadly in efforts to end chronic homelessness.

Given these advantages and disadvantages, the homeless and social service sector in Thunder Bay learned some important lessons through the first two waves of the pandemic and the severe outbreak amongst the homeless population. This included strengthened oversight and planning for use of financial resources at the systems/planning level, as well as the strengthened capacity to use funds collaboratively for shared goals such as the implementation of the isolation shelter. The outbreak also led to increased collaboration between several entities – such as the municipal government, emergency services and public health unit – which had previously operated somewhat independently from the CABs, CEs and homelessness planning committees.

Small, service hub cities such as Thunder Bay serve vast rural areas and may have high rates of homelessness. In Canada and other countries such as Australia and the USA, such cities also play an important role in providing services to remote and isolated Indigenous communities where Indigenous peoples are often overrepresented amongst the homeless population. The case study of Thunder Bay points to some important factors for consideration related to pandemic planning in the context of homelessness in service hub cities. These include a need for: increased recognition of the high prevalence of homelessness in these cities; increased financial, human resource and material supports to the homeless sector in those areas; improved communication channels between public health, municipal services and the homeless sector; increased collaboration between different levels of government; support for the creation of pandemic plans and, more broadly, increased support for ending chronic homelessness in those regions.

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Further reading

Turner, L. (2021), “At least five people have died in the streets of thunder Bay since christmas. Who's keeping track?”, CBC News, 5 February, available at: www.cbc.ca/news/canada/thunder-bay/at-least-five-people-have-died-in-the-streets-of-thunder-bay-since-christmas-who-s-keeping-track-1.5901714

Acknowledgements

This research was funded by a grant from the Social Sciences and Humanities Research Council of Canada by way of a Partnership Grant # 1004-2019-0007.

Corresponding author

Rebecca Schiff can be contacted at: rschiff@lakeheadu.ca

About the authors

Rebecca Schiff is based at Department of Health Sciences, Lakehead University, Thunder Bay, Canada

Bonnie Krysowaty is based at Department of Health Sciences, Lakehead University, Thunder Bay, Canada

Travis Hay is now in the Humanities Department at Mount Royal University, Calgary, Canada

Ashley Wilkinson is based at the Department of Health Sciences, Lakehead University, Thunder Bay, Canada

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