No consultation: two public health units respond to Ontario postal code hot spots

HAMILTON – Last week, the province reserved selected areas for priority access to COVID-19 vaccines, saying people who live in postal codes identified as “hot spots” are at above-average risk of COVID- 19.

The movement encountered a largely positive response – but also raised questions. On what basis were these postal codes selected? Why haven’t others with higher case numbers been given priority status? These questions were difficult to answer in Hamilton and Niagara as the local public health units themselves were not consulted.

“I think it would be helpful for us to understand in more detail how they were selected so that we can better explain why these are red light districts. I think that’s the part that’s a little frustrating, ”says Acting Niagara Medical Officer of Health Mustafa Hirji, adding that he has not received any explanation beyond what has been shared with the public. .

When asked if Hamilton had been consulted about the zip code prioritization, a spokesperson for the public health unit simply said “no”.

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

According to a statement from the Prime Minister’s Office provided to by the Ministry of Health, “these hot spots were identified based on an analysis conducted by the COVID-19 Scientific Advisory Table, which relied on data from Public Health Ontario and was confirmed by the non-partisan vaccine working group. Their analysis specifically looked at criteria such as hospitalizations, epidemic data, low testing rates and deaths during the second wave of the pandemic. This work applied an anti-racist lens to ensure Ontario protects vulnerable communities. Regions in the top 20 percent, he says, “were identified as hot spot communities” and “regions in the top 30 percent that faced additional barriers, including socio-demographic, have also been included ”. (The ministry did not respond to a question from about whether it had consulted with public health units.)

Hirji said he would classify L2G, the code identified by the province as Niagara, as possibly the third hardest hit. “When you look at critical illnesses, hospitalizations, and deaths, it’s a little lower than the top and maybe a little above average.” The CBC reported that, in fact, five postal codes declared as hotspots in Ontario have rates of COVID-19 cases, hospitalizations and death below provincial averages, while seven postal codes with above-average impacts were not included.

In Hamilton, the province has identified two postal codes – L9C and L8W. On April 9, public health confirmed it was designating three more and expanding eligibility to people aged 50 and over. The city’s medical officer of health, Elizabeth Richardson, had publicly called on the province to add the postal codes, saying his team was basing their call on more up-to-date information.

In the end, the PHU made the trip itself. The City of Hamilton Public Health Departments have identified their hot spots by identifying areas with increased COVID-19 case rates, high test positivity rates, low COVID-19 test rates as well as data on racialized populations, marginalized populations and the fact that these community members continue to be disproportionately affected by the pandemic, ”a spokesperson told via email.

The new postal code areas, Richardson said at an April 12 press conference, are “where many of our mobile clinics are going to be targeted over the next few weeks as we move forward. The province has used factors that would tend to identify things that had happened in wave one and wave two, which led to identifying places where there were more older people who would have suffered these consequences of hospitalization and death . ”In Hamilton, she added,“ we already have good vaccination rates in our elderly population that has continuous transmission. [also] is happening among our younger population, and we’re seeing more deaths now as we go along. This is why we wanted these hot spots to be included in our vaccine deployment. “

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

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

The CBC had reported the day before that four of the below-average postal codes designated by the province as hot spots were represented by Progressive Conservative MPs and that the seven above-average postal codes excluded were represented by opposition MPs. . When asked to comment on the possibility of political motivation for choosing certain zip codes, Elliot said: “Absolutely no political motivation.” A statement from the Prime Minister’s Office provided to by the Department of Health states: “Over the past few days, the opposition has spread disinformation and dangerously politicized the province’s efforts to vaccinate 114 neighborhoods at high levels. risk.

Locally identified hotspots, such as those in Hamilton, are not added to the provincial reservation portal, which means the path to book a vaccination differs depending on the organization that identified their area as a hotspot. “Community members 50 and older residing in locally identified hot spots (L8L, L8N, L9K) should make an appointment for a vaccine through the City of Hamilton Public Health telephone reservation line.” , a public health spokesperson told via email.

Hirji says his team is considering adding new zip codes but has two reservations. The first is that it is difficult to choose a threshold. “The other part,” he said, “is that we don’t really know what the real practical benefit is in designating an area as a hotspot. While people over 50 can get vaccinated in hot spots, people 55 and over outside hot spots can be vaccinated at pharmacies in the area, Hirji said. Lowering that five-year age threshold in more regions might not be as beneficial as what Niagara is currently focusing on, which is trying to use the risk of an outbreak as “a guide to who should get vaccinated,” says Hirji.

“We decided that people who work in agriculture, people who work in education – these 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 we’ll probably prioritize those groups as well to go sooner. “

Hirji encourages anyone eligible in the L2G zip code to get vaccinated, adding that public health does not plan to hold geographic pop-up clinics like the ones the Toronto and Peel area are running for people 18 and over. more in hot spots.

Regarding the province’s original selection of hotspots, Hirji said, “I think the bottom line is that I just wish there was more clarity on exactly how these were selected, in the absence of consultation. But, he adds, “in different ways we have really seen the sense of the province that we are okay with deviating a bit from strict adherence to provincial priorities to incorporate local risk and local knowledge.” – as long as we are making sure that we get the vaccines into people’s arms as quickly as possible. “

Ontario hubs are made possible by the Barry and Laurie Green Family Charitable Trust and Goldie Feldman.

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