Fundamental employees in Toronto bear a disproportionate burden of COVID-19

Toronto, Canada’s largest city, has reported 94,943 cases of COVID-19 and 2,614 deaths related to this pandemic to date. Toronto has a population of over 2.7 million people, 51.5% of whom identify as a visible minority. Shelter-in-place ordering and non-essential business closings are the main non-pharmaceutical interactions used as part of the Toronto COVID-19 response.

However, many important companies and services have stayed open to support society. According to Public Safety Canada, “essential workers” include workers in one of ten critical infrastructure sectors, including health, transportation, food and manufacturing. It is estimated that around 40% of the Canadian workforce is employed in occupations that are unsuitable for remote work. A large proportion of these workers belong to lower-income households. This suggests that protection mandates may not be enough to protect key workers from COVID-19 and its associated mortality.

Comparing the per capita rates of COVID-19 cases and deaths in Toronto neighborhoods, by proportion of the main workforce

Recently, a team of researchers from Toronto, Canada compared the per capita rate of COVID-19 cases and related deaths in neighborhoods of Toronto by the proportion of people working in key frontline services. The study will be published on the preprint server medRxiv *.

The team used Contact Management Solutions (CCM) + individual-level data on laboratory-confirmed cases of COVID-19 (N = 74,477) and related deaths (N = 2319), as well as data from Statistics Canada 2016 census data for neighborhood-level parameters. The study population included reported cases and deaths in the Toronto community (excluding long-term care residents) from January 23, 2020 through January 24, 2021. The city’s 3702 distribution areas were divided into tertiles and ranked according to the proportion of the population in each city engaged in essential services such as health, transportation, commerce, manufacturing, equipment, utilities, services, sales, and agriculture.

Daily COVID-19 Cases Per Capita (A) and Deaths (B) by Neighborhood Essential Workforce Share in Toronto, Canada (Jan 23, 2020 to Jan 24, 2021). The daily per capita rate is shown as a 7-day moving average. Layer 1 represents neighborhoods with the lowest percentage of the population working in essential services, while Layer 3 represents neighborhoods with the highest percentage of essential workers. In cases and deaths, nursing home residents are not included. Essential services include: health, trade, transportation, equipment, manufacturing, supply, sales, services, agriculture. The closure of non-essential jobs is indicated by (a) at the beginning of the first lockdown on March 17, 2020 until reopening on May 18, 2020 (b) and (c) by the start of the 2nd main restriction on November 23 to (d ) A stricter lockdown will begin on December 26, 2020.

Neighborhoods with the highest proportion of vital labor had a 2.5 times higher per capita rate of COVID-19 mortality

The analysis found that the cumulative per capita rates of COVID-19 cases and mortality in areas with the highest essential labor population were three times higher than in areas with the lowest essential labor concentration. The results suggest that the essential working population who served the essential needs of society throughout the pandemic carried a disproportionate burden of COVID-19 transmission and deaths.

Many of these lower-income professions are often performed by contract workers and lack clear labor rights or traditional benefits, including paid sick leave. The poor financial conditions of these people limit their bargaining power to demand safe working conditions and adequate personal protective equipment from employers. This signals a gap in prevention with the current shelter-in-place rules.

The results highlight the need for active intervention strategies to optimize the equity and effectiveness of COVID-19 responses

This study shows that the risks and consequences of COVID-19, borne by residents of neighborhoods with a greater percentage of vital labor, were disproportionate to the arrangement of housing. These results are in line with previous studies that showed that these professions are unsuitable for remote working, and therefore, despite the restrictive measures, these individuals may experience sustained contact rates.

“Public health and workplace health strategies could include primary prevention aimed at keeping the SARS-CoV-2 virus out of the workplace, including through paid vacation, which makes it easier for people to stay home when they are Have symptoms or known exposure. “

According to the authors, public health and workplace health strategies could aim to keep SARS-CoV-2 out of the workplace and offer paid sick leave to help workers with symptoms or those exposed to safely isolate themselves at home. Overall, the results underscore the need for active intervention strategies in addition to the restrictive measures currently in place to optimize the equity and effectiveness of the city’s COVID-19 responses.

“Moving forward requires policies and programs that actively protect workers in jobs that remain under lockdown.”

* Important NOTE

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be considered conclusive, guide clinical practice / health-related behavior, or treated as established information.

Journal reference:

  • A disproportionate epidemic: COVID-19 cases and deaths among key workers in Toronto, Canada, Amrita Rao, Huiting Ma, Gary Moloney, Jeffrey C. Kwong, Peter Juni, Beate Sander, Rafal Kustra, Stefan D. Baral, Sharmistha Mishra, medRxiv, 2021.02 15.21251572; doi:,

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