‘What about us?’ Internal presentation shows Scarborough Health Network has most COVID patients in Toronto

Scarborough Health Network has more COVID-19 patients than any other GTA hospital and roughly 14 per cent of swabs at its testing centres have been coming back positive, according to an internal presentation seen by the Star.

One presentation slide said the hospital’s three testing sites are swabbing about 1,100 patients a day and based on the positivity rate, this means Scarborough is seeing 154 new positive cases every day — which, if true, would account for more than a quarter of the new daily cases reported by Toronto Public Health on Monday.

The hospital is also assisting with “multiple school outbreaks” and received four requests for school testing on Nov. 9 alone, according to the presentation. Of the 24 school outbreaks listed on TPH’s website, six are in Scarborough.

The slide noted that Scarborough is seeing confirmed or suspected outbreaks in at least 13 long-term-care homes, and attempts to move patients “externally” from the hospital were being “thwarted by COVID outbreaks” at seniors’ facilities.

The data was presented to hospital staff Monday, the same day a new analysis revealed 30 GTA neighbourhoods with the province’s highest percent positivity rates. Six are in Scarborough and have rates of 10 to 15 per cent, meaning that’s the percentage of tests coming back positive.

Altogether, these statistics paint an alarming picture of the COVID situation in Scarborough — a region that some feel is being under-recognized as a hot spot in need of significantly more attention and resources.

“We’ve been hearing about Brampton, we’ve been hearing about the northwest part of Toronto … we haven’t heard much in the media about Scarborough,” said a health worker at SHN who asked to remain anonymous because they were not authorized to speak to the media. “But a lot of us feel like: What about us? We need help.”

“I think it’s very significant and very serious,” said Suzanne Sicchia, an associate professor in the department of health and society at the University of Toronto Scarborough Campus. “I don’t believe Scarborough is getting the coverage it warrants.”

Sicchia acknowledged that it is misguided to speak about “Scarborough” as monolithic. The region stretches from the multimillion-dollar homes along the lake to Steeles Ave. in the north, and covers all of Toronto from Victoria Park Ave. to Pickering — a swath that contains a “tapestry of really diverse neighbourhoods and communities,” she said.

But within Scarborough, many neighbourhoods struggle with the same socioeconomic challenges of hard-hit neighbourhoods in Brampton and Toronto’s northwest corner, she said.

While infection rates have been staggeringly high in those other hot spots — and rightfully attracting headlines and government attention — Sicchia would like to see similar attention paid to pockets of Scarborough also showing serious signs of trouble.

“If you live in Scarborough, and you work in Scarborough, you see and hear what’s going on,” she said. “But I don’t know why it’s been neglected by media.”

The SHN employee who spoke with the Star said many staff are worried about speaking to the media for fear of repercussions if they discuss what they’re seeing inside the hospital.

Scarborough Health Network declined the Star’s request to interview doctors at its hospital but said in a statement it disagreed Scarborough has been “flying under the radar” as an area with worrying COVID transmission. The Star also contacted several community health centres in Scarborough but did not receive a response.

“Our community is an explicitly acknowledged hot spot, and has been for some time,” spokesperson Leigh Duncan said in an email. “This is a known issue and has been receiving support through Scarborough Health Network, Public Health and Ontario Health. Resources to support testing, Long-Term Care and increased hospital capacity are aligned with the high community prevalence.”

Duncan said the 14 per cent positivity rate at SHN’s testing centres has shown a “slight decline” in recent days. She added that the hospital is supporting 20 of Scarborough’s long-term-care and retirement homes and focusing on “optimizing regional resources” when local resources are at capacity.

One of the presentation slides shown to staff at SHN, titled “The Third Pillar,” described plans for “the timely transfer of medical patients who are not critically ill to regional partner hospitals from SHN, when necessary.”

Duncan did not respond to the Star’s question about whether the hospital was already needing to transfer patients to other hospitals — a position that William Osler Health System recently found itself in when it a surge of patients forced it to move patients into other health centres for the first time during the pandemic.

An internal dashboard of COVID statistics showed that SHN currently has 84 patients with COVID-19 at its three hospital sites, 19 of whom are in critical care units. Last week, the Scarborough hospital was treating 24 per cent of all COVID-19 patients hospitalized in Toronto and Peel, the province’s two biggest hot spots, according to Ontario Hospital Association data.

In an interview in late October, SHN’s chief of ICU Dr. Martin Betts said his hospital has been treating roughly 20 per cent of the province’s COVID-19 patients requiring critical care — a proportion similar to what he saw early in the first wave.

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“What we’ve talked about internally is what does it tell us about Scarborough, what does it tell us about our health services, about our population, what does this mean?” he said. “I wish I had the answer for you.”

Betts speculated that his hospital network has seen sicker COVID patients because its community has always had a disproportionate burden of chronic health issues that can tip people into needing critical care. He pointed out that Scarborough’s dialysis program is one of the country’s largest.

He also said many patients he’s seen in his ICU are essential workers living in large households — he recently had multiple members of two families being treated for COVID in his critical care units.

“If you speak to the family members of these people, they have such high personal responsibilities for their jobs and providing for their families that they have to go to work, it’s their spirit that keeps them going there,” he said. “But also, this is my speculation, they probably have less control over their work environments, and fewer options for taking personal leave if they’re ill.”

One factor that may be contributing to high positivity in some Scarborough areas is low testing rates.

Since the beginning of the pandemic, the “Scarborough North” region — which covers the area between Steeles Avenue, Markham Road, Hwy. 401, and Victoria Park Avenue — has had the city’s lowest testing rates. In October, about 50 tests were done for every 1,000 residents, compared to west Toronto, which had the highest rate, 80 tests per 1,000.

But testing rates in the two neighbourhoods that now have Scarborough’s highest positivity rates have been on par with the rest of the city — pockets within Rouge and Malvern, both of which are showing percent positivity rates of about 15 per cent.

According to census data, more than 80 per cent of people living in these neighbourhoods are visible minorities, with high percentages of people who are Black or South Asian — two racial groups that have been disproportionately impacted by COVID-19.

Both areas also have some of Toronto’s biggest households. Rouge has the city’s largest proportion of households with five or more people (24 per cent) and Malvern ranks number four in this regard, with 22 per cent of households with five or more people in the home.

Both communities also have some of the city’s largest proportions of essential workers in fields like manufacturing, retail and health care, with a high percentage of nurses and nurse aides.

“It’s all the intersections of these different kinds of factors and conditions of living in these different neighbourhoods that create an elevated risk,” Sicchia said.

“I’d like to see a lot more investments in Scarborough, I’d like to see more attention, I’d like to see people think about these challenges,” she continued. “I’d like for people to notice.”

With data analysis by Andrew Bailey

Jennifer Yang

TORONTO STAR