In March, staff at Willowdale Welcome Centre, which would become the site of the largest COVID-19 outbreak in the city’s shelter system, grew concerned about infection control at the facility.
The refugee centre had opened in the fall. It housed about 200 men and women on separate floors, many of them professionals from Uganda and Nigeria seeking a better life in Canada.
It was soon operating seamlessly and clients quickly found housing and jobs.
“Once the shelter had its roots in place, it was pretty well-run. I was impressed,” said an employee who is not being named because he is worried about his future employment.
As March progressed, concerns about COVID-19 transmission grew — concerns which the employee and others at Homes First Society, the registered charity that operates Willowdale, felt were not being heard by management.
This account is based on interviews with staff at Willowdale and other shelters at Homes First; on e-mails between employees and management and official complaints made to the Ministry of Labour, Training and Skills Development.
Staff at the shelter were being told not to wear masks — not unusual in the early days of the pandemic, when the focus was on preserving supply for front-line workers and as research suggested masks provided limited defence against the virus outside of health-care settings.
Staff were told to focus on proper handwashing and increased cleaning with disinfectants. But Lysol wipes, used to clean tables in the cafeteria between services, quickly went missing and were not replaced.
Responding to questions from the Star, Patricia Mueller, Homes First’s chief executive officer, said the charity followed public health guidelines at all times when it came to infection control measures, including personal protective equipment for employees.
Meanwhile, the outbreak is now over at the shelter, Mueller said, as no active cases remain.
In the beginning, the Willowdale employee said, it was difficult to get the shelter’s clientele — most of them 40 or younger — to consistently abide by the rules of social distancing and to follow the detailed recommendations related to handwashing and other measures.
“Younger ones said, ‘I’m not going to die,’” said the employee.
Many clients were diligent. Others were not.
The employee had heard, for example, that even after the city banned gatherings of more than five people, some refugees at the centre continued to attend church services — meeting in private residences.
“We have a friend’s house that is running it,” one of them told the employee.
It was while he was watching a newscast from New York City, fast becoming an international hot spot for the virus, that the employee made his decision.
“It made me realize we were on the same trajectory and I didn’t want to be a part of it,” said the employee. He quit soon thereafter and hasn’t been back.
He remains healthy. Meanwhile, more than two dozen of his former co-workers and more than 180 clients at Willowdale have been diagnosed with COVID-19.
“I have really close friends who got it. My heart breaks for them,” he said.
The Willowdale outbreak highlights the challenges of fighting COVID-19 in a congregate setting — anywhere people are grouped together indoors — and how a top-down, one-size-fits-all approach can go awry.
The refugee centre became the location with the highest number of infections in the city’s shelter system, which includes 72 locations. As of Wednesday, 185 clients had tested positive for COVID-19, and more than a dozen staff. No one has died.
At one point, the large number of clients at Willowdale being moved into COVID-19 recovery sites set up by the city raised concerns that there would be no room for clients from other shelters at the recovery centres.
So Willowdale was itself turned into a recovery centre, and medical personnel were brought to the shelter to attend to clients there, Mueller said.
Four Homes First workers who were interviewed for this story, including two who worked at Willowdale, say things would not have gotten so bad if their early concerns had been addressed in a timely fashion.
They are not being identified because they are fearful of being fired or not being rehired.
“Homes First dropped the ball on guarding against the disease,” according to a statement from Warren (Smokey) Thomas, president of the Ontario Public Service Employees Union representing workers there.
Homes First Society lists 18 properties on its website, offering shelter ranging from single rooms for single men to townhouses for families.
According to an email exchange provided to the Star, union representatives at Homes First shelters began discussing the need to talk to management about safer working conditions on March 15. They spoke to human resources on March 19 and Mueller on March 23.
Their fears proved prescient: After scanning the news and medical literature for what was going on in other parts of the world, they asked for measures that would soon come to be regarded as routine, including maintaining a two-metre distance in shelters, ending the practice of allowing staff to work at more than one location, and face masks.
They tried to escalate their concerns in some cases, taking their complaints to the Ministry of Labour, Training and Skills Development.
A spokesperson for the ministry said it investigated complaints regarding PPE at three Homes First locations in March and April, including Willowdale.
A ministry inspector investigated by phone and no orders or requirements were issued.
“It was determined that all appropriate guidelines were being followed and no orders were issued,” according to the ministry.
An employee at Willowdale who spoke to the Star was diagnosed with COVID-19 and became so ill she thought she would die.
In the early days of the pandemic, she said she was told by management that she could wear a mask if she liked, but she had to provide them herself — and at that time, masks were impossible to buy in stores.
Initially, there were Lysol wipes on the lunch tables to keep the surfaces clean between shifts, but they were removed because management said they were being stolen.
After that, the wipes were locked in offices, the employee said.
There were sinks with soap and paper towels, where people could wash their hands before sitting down to eat, but they’d sometimes run out of paper towels, she added.
Staying the recommended two metres away from clients was difficult because of the layout of the shelter, she added. The lobby is where the intake office is located and the security desk, and it’s where people would line up for the cafeteria. People were constantly criss-crossing paths.
“It’s a pretty small bottleneck,” she said.
Mueller agrees there were issues around supplies, including Lysol and paper towels — in some cases they were being stolen, in some cases overused, she said, and it took a while to figure out how to address that.
Another concern for staff at Homes First was the high rotation among staff between homes, according to a third employee, who asked to remain nameless.
Homes First employs about 300 people, including about 175 relief staff who used to move between facilities, Mueller said.
She said that after the meeting between staff and management on March 23, Homes First began taking steps to end the practice, but it took several weeks to accomplish.
“I’m with them, I would have wanted it done faster,” Mueller said. She added that it simply wasn’t possible to manage the change more quickly.
Before the pandemic began, there were more than 7,000 people in Toronto’s shelter system, including nearly 3,000 in hotels and family settings, according to the city’s Shelter, Support and Housing Administration.
The city operates 11 shelter and respite locations; 61 are operated by community non-profit agencies like Homes First.
In order to increase social distancing, SSHA began moving people within existing programs on March 18, according to SSHA general manager Mary-Anne Bedard.
By the end of April, 1,400 shelter clients had been moved. The figure now tops 2,000, Bedard said in an interview.
Activists have criticized the city for not moving enough clients quickly enough, and for moving some to community centres, which don’t provide enough opportunities for social distancing or isolating people who begin showing symptoms.
A group of activists sued the city, which, as part of an interim settlement, agreed to meet physical distancing targets at all homeless shelters.
Bedard said community centres were chosen because they were easy to convert quickly.
“I know there is criticism out there, but I am confident that we’ve done everything as quickly as we could,” Bedard said.
While masks were provided to shelter staff in March, there was significant concern about the availability of PPE, and the pressure was on not to use valuable stock if it didn’t have to be used, she added.
She said SSHA doesn’t yet understand why there were outbreaks at some shelters and not others.
She warned that the numbers of infected at shelters will continue to rise.
“There’s good reason for that — because we are doing more testing,” she said.
If all the recommendations put forth by Willowdale staff early in the pandemic had been put into place, would the outcome have been different?
Dr. Isaac Bogoch, an infectious disease specialist at the University of Toronto and Toronto General Hospital, who has also worked with Willowdale, said masks may have made a small difference.
“The masks aren’t perfect — it’s not like you’re sealing the secretions from leaving your face — these are porous masks and you can still contaminate surfaces around you. Masks are helpful in these settings, but they aren’t the saviour,” he said.
Listening to front-line workers is critical, according to Tiziana Casciaro, professor of organizational behaviour at the University of Toronto, Rotman School of Management.
While drafting policies at the top — like the public health policies that informed decisions at Willowdale and other institutions — is the most efficient way to meet challenges, it has drawbacks.
“It allows top-down directives to take over the life of an organization without any opportunity for the bottom-up loop to ever close. This is something that I think applied in this particular case,” Casciaro said.
Bedard and Mueller meanwhile, say they did the best they could with the information at hand.
“There is always going to be, in retrospect, things that you look back on and say I wish, I could have, and we will learn from that for sure, but I don’t think we can second-guess the things that we did,” Bedard said.
