Lisa Salamon-Switzman, an emergency room doctor in Toronto, had already worked through two deadly surges of the coronavirus pandemic when a new batch of patients recently began arriving that left her unsettled because of their low oxygen levels – and their age.
“They’re younger than what we saw earlier and they don’t really understand how sick they are,” she said of patients who are in their 40s and 50s. “And now it’s become this huge, huge wave.”
Doctors and epidemiologists in Canada’s most populous province have been warning for weeks that the loosening of restrictions, a lack of sick pay for essential workers –and the arrival of infectious new coronavirus variants would usher in a devastating third wave.
On Thursday, as cases and ICU admissions spiralled, Ontario premier Doug Ford was forced to reverse plans to reopen and instead announced a one-month shutdown.
The move comes as health officials warn that rapidly spreading variants of the coronavirus have put the province at risk.
“As variants spread, Covid is killing faster and younger,” said Dr Adalsteinn Brown, co-chair of Ontario’s Covid-19 science advisory table.
The variants – essentially mutated versions of Covid-19 that can infect more easily and are believed to be more fatal – have become a growing problem in a number of provinces across the country.
In British Columbia, the P1 variant, which was first discovered in Brazil, has spread quickly, and in recent days, the province has recorded their highest case load since the pandemic began more than a year ago.
Quebec, which has long resisted shutting down schools, announced a lockdown in three cities this week as variants power an exponential outbreak of the virus.
But in Ontario, the country’s economic hub, the province’s latest outbreak has become emblematic for the way in which the virus has disproportionately impacted essential workers in factories and warehouses, many of whom are low-income members of ethnic minorities.
While the province’s restrictions are expected to blunt overall case growth, new modelling suggests nearly 800 patients are expected to be in the province’s ICU beds at the end of April – nearly double today’s rates.
New cases have climbed steadily upwards in recent weeks, in tandem with the gradual re-opening of restaurants and schools.
“What’s striking is that our hospitalization numbers don’t seem as high as they were in wave one or two. But our ICU numbers are as bad, if not worse. Patients are coming in sicker and going directly to the ICU,” said Salamon-Switzman. “It’s like the original Covid strain, but on steroids.”
For doctors, the changing demographic of patients has exposed the deep inequities of the virus.
“We know that the racialized populations impacted by Covid-19 far outweighs anybody else. And we know that the majority of these populations are essential workers who are working in factories but haven’t been given the opportunity yet to be vaccinated,” said Salamon-Switzman.
While Canada secured one of the highest per-capita supplies of the vaccine, the rollout has been too slow to halt the virus’ rapid spread. Deaths in long term care have largely disappeared, the result of an early push to ensure the country’s most vulnerable residents were protected.
“If the current situation is described as a race, the variants are ahead by a mile,” said Eileen de Villa, Toronto’s medical officer of health.
Many of Salamon-Switzman’s patients who contract the virus in workplace settings have underlying health issues such as diabetes, heart and lung disease. These conditions make them high risk, but not yet able to qualify for a vaccine under the province’s guidelines.
The mounting cases have also exposed the difficult choices workers must make. The province doesn’t offer guaranteed paid sick leave, and temporary or gig workers don’t often qualify for employee benefits.
“Workers have to make a tough choice: either you stay home sick and not get paid, or you go to work,” said Gagandeep Kaur, an organizer with the Warehouse Workers Centre. “And because so many are parents as well, they have to worry that their kids might come home sick and infect them.”
At the same time, the high cost of living in the city means many workers often live in shared apartments, says Kaur, amplifying the spread of the virus. And in regions hardest hit, many are temporary workers and don’t qualify for employer benefits.
Until workers are given better access to vaccines and the chance to stay home if sick, Kaur worries the situation will continue to worsen in the coming weeks.
“We keep talking about these essential workers. We call them leaders, heroes and providers,” she said. “But whatever we call them, the way they’re treated doesn’t really reflect that at all.”