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New @ICESOntario report, led by Dr. Astrid Guttmann, coauthored by myself, numerous colleagues and scientists, looked at COVID-19 in immigrants in Ontario using pop-based admin data. With imp. contributions by members of the ICES public advisory council. A thread. 1/21 https://twitter.com/ICESOntario/status/1303680636616613888
1st, some facts about immigration to Ontario:
-30% of ON pop of 15 million were born outside of Canada, ~125,000 permanent residents arrive each year to ON 2/21
-30% of ON pop of 15 million were born outside of Canada, ~125,000 permanent residents arrive each year to ON 2/21
- All permanent residents (immigrants), newcomers, Canadian-born/long-term residents in report are eligible for publicly funded health care incl. COVID testing
- Since 1985, ~75% of immigrants to ON are non-White; w/ substantial representation from all world-regions
3/21
- Since 1985, ~75% of immigrants to ON are non-White; w/ substantial representation from all world-regions
3/21
Why should we be concerned about COVID-19 among immigrants:
1. High % of immigrants working in essential jobs during lockdown - >unable to WFH https://www150.statcan.gc.ca/n1/pub/71-606-x/71-606-x2018001-eng.htm
4/21
1. High % of immigrants working in essential jobs during lockdown - >unable to WFH https://www150.statcan.gc.ca/n1/pub/71-606-x/71-606-x2018001-eng.htm
4/21
2. Precarious employment is an imp. characteristic of many essential sectors – low-wage, unstable, no security/sick leave etc.
https://www.ontario.ca/document/changing-workplaces-review-final-report
Increases the chances of infection (e.g., multiple jobs increase exposure), affects ability to get tested and quarantine.
5/21
https://www.ontario.ca/document/changing-workplaces-review-final-report
Increases the chances of infection (e.g., multiple jobs increase exposure), affects ability to get tested and quarantine.
5/21
3. PPE is critical in preventing COVID-19 infection. Even community and hospital-based physicians were worried about PPE shortages in April.
https://www.cma.ca/sites/default/files/pdf/Survey/CMA-rapid-poll-Executive-summary-2_EN.pdf
Challenges to PPE access were likely worse in other sectors.
6/21
https://www.cma.ca/sites/default/files/pdf/Survey/CMA-rapid-poll-Executive-summary-2_EN.pdf
Challenges to PPE access were likely worse in other sectors.
6/21
4. Immigrants have lower access to high quality primary care in ON https://pubmed.ncbi.nlm.nih.gov/30219848/ ---> may affect knowledge of shifting testing strategy and public health measures, knowledge of testing centres etc
7/21
7/21
5. Most immigrants are racialized -> systemic racism contributes to COVID-19 risk – e.g., employment discrimination, racism in health care affect access to timely and appropriate care
8/21
8/21
Data sources
- 4 sources of provincial COVID data; COVID-19 testing b/w Jan 15-June 13, 2020
- Immigration data from the Immigration, Refugees and Citizenship Canada (IRCC) Permanent Resident Database - all PRs landing b/w Jan 1, 1985 to May 31, 2017.
-others
9/21
- 4 sources of provincial COVID data; COVID-19 testing b/w Jan 15-June 13, 2020
- Immigration data from the Immigration, Refugees and Citizenship Canada (IRCC) Permanent Resident Database - all PRs landing b/w Jan 1, 1985 to May 31, 2017.
-others
9/21
Results: immigrants in almost all categories had higher % positive than % tested -> suggesting imp. barriers to testing, partic. refugees and sponsored family. Caregivers appear to be the only group with lower barriers to testing but also had the highest COVID risk. 10/21
Refugees tend to have lower education upon arrival -> may be more likely to work in lower skilled jobs, be precariously employed and working in sectors that were deemed essential during the pandemic. 11/21
Even results for economic immigrants (non-caregivers), over half of whom have >=Bachelors education at arrival, suggest barriers to testing. Also had higher COVID risk than CDN/LTR. 12/21
Substantially elevated COVID risk among caregivers, with peaks correlating to testing of priority groups including those working in long-term care homes and other congregate settings. 13/21
Immigrant caregivers are mainly women, largely Filipino, w/ > half arriving with =>Bachelors education. Many train as PSWs and other health care workers in Canada – see http://p2pcanada.ca/files/2017/12/Assessing-the-Changes-to-Canadas-Live-In-Caregiver-Program.pdf for more info. 14/21
This piece from @tungohan provides critical details about migrant caregivers in the context of pandemic. https://www.broadbentinstitute.ca/filipino_healthcare_workers_during_covid19_and_the_importance_of_race_based_analysis
15/21
15/21
Improved testing needed for imms in low inc. areas. Surprisingly - even among imms in high inc. areas (Q5), greater testing needed; opposite for CDN/LTR living in Q5. 16/21
Immigrants born in Western Africa, the Caribbean, SE Asia, East and Central Africa have the highest COVID risk. East Asian immigrants were among those with the lowest COVID-19 risk. 17/21
Among those COVID+, there is a health care worker flag w/ ~40% of records missing/unknown. With these data limitations, regions of birth w/ the highest % of HCW reported (mostly women) is similar to the trend in COVID risk by region reported in earlier graph. 18/21
Concl: immigrants are disproportionately affected by COVID-19. Improved access to testing is needed for most immigrants, partic. refugees, living in low income areas. Need is evident even for immigrants w/ higher levels of education at arrival and living in high income areas.
Immediate term needs – improve access to testing, ensure access to PPE, improve safety measures for those at risk for workplace exposure, secure conditions for safe quarantine, improve job security and income supports for those recovering from COVID... 20/21
Long-term– Multi-faceted change needed to address systemic, structural inequities leading to income disparities, precarious employment, underemployment, experiences of discrimination/racism in health care etc, likely contributing to COVID risk affecting immigrants/refugees. /END
