Importance of Access to Personal Protective Equipment

JADE ROBERTS
STUDENT CASEWORKER, TICKET DEFENCE PROGRAM

In an attempt to reduce the spread of COVID-19, cities across Ontario and Canada, including Ottawa, have passed by-laws requiring that face masks be worn in enclosed public spaces. This includes any indoor space open to the public such as restaurants, retail establishments, churches, City Hall, as well as public transit property, including buses, trains, transit stations, platforms and shelters.^[1]City of Ottawa, by-law No 2020 – 186, Temporary Mandatory Mask By-law (15 July 2020).

Ottawa’s Temporary Mandatory Mask By-law requires that employers and business owners/operators enact policies which would require their employees and customers to wear masks. Business operators are expected to do their best to enforce their policies and deny access to the business if a person is not wearing a face mask.  For repeat offenders, the by-law can be enforced through penalties, such as ticketing.^[2]Ibid s. 9.

Although mandatory mask use is a step in the right direction in preventing the spread of COVID-19 according to the World Health Organization, it raises access issues for the approximately 7,530^[3]Homeless Hub, Community Profiles: Ottawa, https://www.homelesshub.ca/community-profile/ottawa. people experiencing homelessness in Ottawa. In order to comply with the by-law and for the mask to be effective, a person must have access to either a reusable mask ($12-$20), as well as facilities to wash/dry the mask, or must have consistent access to disposable, single use masks.

In response to questions about whether they would be providing masks to those who do not have the means to purchase them, a representative from the City of Ottawa Human Needs Task Force says they are depending on donations from community members, as well as from the United Way.^[4]Email from Katy Prusakowski, Human Needs Task Force, City of Ottawa, to Jade Roberts (15 July 2020). The City of Ottawa is also relying on their community partners, such as community health centres and community houses, to distribute masks to those in need. This method of ensuring access to face masks for street-involved people is problematic. Now that masks have become a resource that is necessary to participate in society, funding for masks ought to be provided by the local, provincial and federal governments to ensure street-involved people have regular access to masks.

This paper will discuss how the conditions of homelessness make it particularly important to ensure street-involved people have access to personal protective equipment (PPE), such as masks. It will also discuss the broader issues related to homelessness which contribute to the different ways in which street-involved people are impacted by the pandemic.

Importance of PPE for Street-involved people 

Wearing a mask, regularly washing your hands, and maintaining physical/social distancing are critical to preventing human-to-human transmission of COVID-19.^[5]World Health Organization. (‎2020)‎. Advice on the use of masks in the context of COVID-19: interim guidance, 5 June 2020. World Health … Continue reading However, the conditions of homelessness make it difficult to comply with infection prevention and control measures. Many street-involved people do not have regular access to shower facilities or hygiene supplies, and overcrowding at homeless shelters makes social distancing nearly impossible.

In addition, pre-existing ailments and conditions make people experiencing homelessness more susceptible to severe symptoms of COVID-19. People experiencing homelessness have a high prevalence of heart disease, respiratory conditions,^[6]Melissa Perri, Naheed Dosani & Stephen W. Hwang, “COVID-19 and people experiencing homelessness: challenges and mitigation strategies” (2020) 192: 26 CMAJ 716 at 716. liver disease, hepatitis, and HIV/AIDS.^[7]Kristy Buccieri & Rebecca Schiff, Pandemic Preparedness and Homelessness: Lessons from H1N1 in Canada, (Toronto: Canadian Observatory on Homelessness Press, 2016) at 144. According to the Centre for Disease Control, people with these conditions are (or are likely to be) at an increased risk of severe illness from COVID-19.^[8]“People with certain Medical Conditions” (30 July 2020), online: Center for Disease Control and … Continue reading In the context of COVID-19 the vulnerabilities of street-involved people are compounded and the potential consequences of those vulnerabilities are made apparent.

Denial of access to PPE will also contribute to the social exclusion of street-involved people. Street-involved people already exist on the margins of society, are disconnected from positive support networks, and are often excluded from public spaces.^[9]Supra note 6 at 145. A lack of access to masks would further contribute to barriers accessing necessities such as transportation, food and healthcare.

The City of Ottawa has received $11.4 million from the provincial and federal governments to support the homeless population during the COVID-19 pandemic, with the majority of funding dedicated to “boosting Ottawa’s existing shelter system.”^[10]Craig Lord “City of Ottawa to spend $11.4M to support homeless population during coronavirus pandemic”, Global News, (20 April 2020) electronic source. This shows that the government recognizes the significant effect COVID-19 could have on homeless shelters and the homeless population. This funding is a step in the right direction, however there are broader issues that are not addressed by this emergency funding.

Broader impacts of COVID-19 on street-involved populations

The ways in which people are affected during emergency/pandemic times are “directly rooted in the pre-existing social patterns that are established in non-emergency times.”^[11]Supra note 6 at 144. The COVID-19 pandemic and the recommendations of social isolation shine a light on the need for housing support for street-involved people. Health officials and other public officials deliberate how to handle an outbreak in a shelter or how street-involved people can social distance and quarantine, when the broader issue is the lack of housing support and homelessness which existed before the pandemic began.

The solutions that governments provide to manage the pandemic in the context of homelessness (such as emergency funding, working with community partners to help people access PPE, and using community centres to quarantine street-involved people) are temporary solutions which do not address the root issue. The government would not have to come up with creative solutions, specific to street-involved people, if housing support and greater access to social services for street-involved people was available in the first place.

It is also worth noting that the Canada Pandemic Influenza Preparedness plan, the Ottawa Interagency Pandemic Plan, and the Ottawa Public Health Emergency Plan all contain little to no measures in regards to people experiencing homelessness.^[12]Canada, Public Health Agency of Canada, Canada Pandemic Influenza Preparedness: Guidance for the Health Sector, (guidance document); Ottawa, Ottawa Public Health, Ottawa’s Interagency Influenza … Continue reading  The Canada Pandemic Influenza Preparedness plan acknowledges that street-involved people are a vulnerable group which could be differently affected from the general population, but does not describe any measures to protect street-involved people. The fact that pandemic plans in place to protect the Canadian population do not include measures to protect people experiencing homelessness is concerning.

The social stigma surrounding homelessness is partly to blame for the lack of emergency planning specific to street-involved people. People experiencing homelessness are often perceived as the underclass by larger society.^[13]John R. Belcher & Bruce R. Deforge, “Social Stigma and Homelessness: The Limits of Social Change” (2012) 22:8 J Human Behaviour in Soc Env 929 at 930. The stigma and negative perceptions towards street-involved people cause them to be perceived as undeserving of equal rights and access to societal resources.^[14]Ibid at 931. These views allow society and political leaders to justify control over street-involved people, through criminalization of poverty and over-policing, while also denying them access to resources, such as housing support or adequate welfare.

After the 2002-2004 SARS outbreaks, and again after the 2009 H1N1 pandemic, activists and community support workers expressed concerns with how street-involved people would be severely impacted by an outbreak and how the conditions of homeless shelters promote the spread of illnesses. However, Canada’s Pandemic Influenza Preparednessplan still does not include measures to protect homeless people from a pandemic, despite the plan having been reviewed and updated three times since its first publication in 2004, with its most recent update coming in 2018. Also, homeless shelters in Ottawa continue to be overcrowded.^[15]Laurie Fagan “Overcrowded shelter want city to better serve homeless”, CBC (8 October 2018) electronic source. This demonstrates that although emergency funding may be provided to support street-involved people in shelters to some extent during the pandemic, once the pandemic is over, our governments failed to design strategies to address the effects of homelessness on a future pandemic, and fail to address the broader issues which caused homelessness.

Conclusion

The Temporary Mandatory Mask By-Law requiring that masks be worn in public enclosed spaces is an important measure to protect the health and safety of residents. However, ensuring universal access to PPE is as important as passing the by-law itself, and it ought to be the responsibility of local, provincial, and federal governments to ensure all residents, including street-involved people, have access to face masks. Because of the overcrowding of emergency shelters and the pre-existing medical conditions prevalent among street-involved people, COVID-19 could spread quickly in a shelter and have severe effects on its residents. Failure to provide universal access to face masks could result in the further detriment of the health of street-involved people, and reinforce their social exclusion.

 Furthermore, the broader issues discussed above which existed pre-pandemic, such as a lack of housing support, the lack of pandemic planning specific to street-involved people, and the social stigma of homelessness, negatively impact how street-involved people experience the current pandemic. Some issues may be addressed through emergency funding. But, it is more important that governments address and resolve these broader issues causing homelessness to ensure all residents are protected during and after pandemic, rather than being forced to come up with solutions to the unique challenges of homelessness during a pandemic.

References

Cheryl S Leung et al, “Homelessness and the Response to Emerging Infectious Disease Outbreaks: Lessons from SARS” (2008) 85:3 J Urban Health 402.

Canada, Public Health Agency of Canada, Canada Pandemic Influenza Preparedness: Guidance for the Health Sector, (guidance document).

City of Ottawa, by-law No 2020 – 186, Temporary Mandatory Mask By-law (15 July 2020).

Craig Lord “City of Ottawa to spend $11.4M to support homeless population during coronavirus pandemic”, Global News, (20 April 2020) electronic source.

Email from Katy Prusakowski, Human Needs Task Force, City of Ottawa, to Jade Roberts (15 July 2020).

Homeless Hub, Community Profiles: Ottawa, https://www.homelesshub.ca/community-profile/ottawa.

John R. Belcher & Bruce R. Deforge, “Social Stigma and Homelessness: The Limits of Social Change” (2012) 22:8 J Human Behaviour in Soc Env 929.

Kristy Buccieri & Rebecca Schiff, Pandemic Preparedness and Homelessness: Lessons from H1N1 in Canada, (Toronto: Canadian Observatory on Homelessness Press, 2016).

Melissa Perri, Naheed Dosani & Stephen W. Hwang, “COVID-19 and people experiencing homelessness: challenges and mitigation strategies” (2020) 192: 26 CMAJ 716.

Laurie Fagan “Overcrowded shelter want city to better serve homeless”, CBC (8 October 2018) electronic source.

Ottawa, Ottawa Public Health, Ottawa’s Interagency Influenza Pandemic Plan, (emergency health plan).

Ottawa, Ottawa Public Health, Ottawa Public Health Emergency Plan, (emergency health plan).

“People with certain Medical Conditions” (30 July 2020), online: Center for Disease Control and Prevention<https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html>.

World Health Organization. (‎2020)‎. Advice on the use of masks in the context of COVID-19: interim guidance, 5 June 2020. World Health Organization <https://apps.who.int/iris/handle/‌10665/332293>.