Questions & Answers with Dr Etches on the COVID-19 Situation in Ottawa

The Ottawa Medical Officer of Health, Dr Vera Etches, joined the OLIP Health and Wellbeing Sector Table meeting on Friday, April 30, 2021 to provide updates on the COVID-19 & the status of vaccine rollout in Ottawa. Below is a summary of her presentation and the discussion that ensued.

What is the current COVID Situation in Ottawa Now?

People have been able to limit their contacts and that has led to a decrease of COVID-19 in the community but it is still really high. It is as high as last January and last fall, so we’re at a point where we cannot reopen schools again at this point, though we are hoping for a better situation by the end of the month. We’re not quite there yet. We may just be beginning to see a decline in hospitalizations  of people with COVID-19. It takes longer when people are admitted to hospital and unfortunately you see ICU visits and deaths may stay high longer.

There is a clear pattern of inequity in terms of who is testing positive.  This can be seen in neighbourhoods where there are challenges with adequate housing, and where there are disproportionately more people with employment that is outside of their home with greater risk of exposure. Employment and housing patterns have not changed, so the patterns of inequity are not changing in the short term, despite focused efforts to increase supports to people in less advantaged neighbourhoods.  Our collective interventions matter in pursuing equity in how we promote covid awareness and accessibility to COVID prevention measures, especially in communities with higher rates of COVID. For this, I am very thankful to our partnership with OLIP, the Human Needs Taskforce, and others. Thanks to our partnership, people can now isolate in a voluntary isolation centre, have access to food, and can get access to income supports etc.

I wish there was real progress on paid sick leave for essential workers.  The Ottawa Board of Health has advocated with the province to grant sick leave so people can stay at home when they are sick.  There is now news that there has been some progress, but more is needed.  This and other policies that enable equity are important because we still have covid in communities.

Ottawa Medical Officer of Health Dr Vera Etches.

We should also recognize that people are not dying at the rate they were; older adults are more protected by the vaccine. In Ottawa, there is now a high level of vaccine coverage for people in their 90s, 80s and 70s.  And now we have reached our target of 75 per cent of people in their 60s being protected. This is good, because even with the high levels of COVID cases we are not seeing the same level of deaths in these age groups.

There are people wondering whether covid variants cause more severe illness in younger people. It is possible.  This is possible, but the real issue is that we have a lot of COVID in the community so it’s reaching more younger people.  Still, COVID infection and hospitalization is dramatically less for people under 40 compared to older adults.

How is OPH getting to people at higher risk?

Now that we have protected the majority of older adults, the next sequenced group is people who cannot work from home, many of whom are newcomers and racialized. The province has announced a new approach to communities where the COVID rates are high. Provincially, they are going by age because that was needed to protect older adults and they are now down to 50+.

The Province is strongly considering “hotspots”.  These are neighborhoods with high COVID rates which have endured over time.  For Ottawa, some of the 21 neighbourhoods we had identified as priority for vaccine sequencing are now provincially designated as hotspots. For people in these neighborhoods, the eligibility has come down to 18+. This is really important and we need to spread the word for people in hotspot communities that overlap with the province’s neighbourhood approach.

There is also more access now for people with health conditions. And access to vaccination for the first group of people who cannot work from home (farm workers, educators, people responding to critical events, housing building, and more) has started. Next week, the second group of people who cannot work from home will be eligble, such as workers involved in transportation and retail. The age group will come down a little bit as well and by end of May, people are going to be able to book any adult in the provincial system.

Vaccine Equity and Confidence

Addressing vaccine confidence is one of the many aspects of our approach to build equity through the immunization process.  With this principle of equity in vaccination, we started to create platforms to address concerns in a targeted fashion.  And we know we need to put extra effort into providing access to vaccine information for communities with higher rates of COVID, when addressing vaccine concerns. However, I would also say that so far there has been a limited number of vaccines available so I don’t think we really tested the limitations that may exist to ensure high levels of vaccine uptake in the 21 priority neighborhoods.  As much as people talk about vaccine hesitancy or confidence, in practice we haven’t had enough volume of vaccine to really get to everyone who wants one. In fact, the polling we’ve done in Ottawa shows that pretty much everyone wants the vaccine.

Now more than ever, we are working to allocate vaccines and to set up vaccination clinics in Ottawa’s 21 priority neighbourhoods, while at the same time the general population access is growing.  Without this targeted push to vaccinate residents of neighborhoods that face barriers, we will continue to find inequities in who is vaccinated.

How will the vaccine allocation to pharmacies impact the supply to priority neighborhoods?

We are planning to protect the supply available for targeted neighborhoods.  And I can tell you, we are doubling even quadrupling what’s going to neighbourhoods this month and that will continue throughout the population immunization process.

 The Use of Data

We’re collecting data on vaccine coverage in neighbourhoods, which will allow us to compare 21 neighbourhoods with less advantage – that tend to have high concentration of immigrants and racialized population – to high and middle income neighborhoods. I want to congratulate OLIP and others working on COVID equity, because initially we saw very little inequity in vaccine coverage across the groups of neighbourhoods by income. We are starting to see some inequity as more of the general population has access to vaccination through the large community clinics.  This is important to keep measuring because as we see the evidence of inequity, we can change it.

The last week of April, we hit about 33% of Ottawa’s population over 18 that has had 1 dose of COVID-19 vaccine; but only six of 21 neighbourhoods had reached coverage rates over 30%. Most neighborhoods had coverage rates in the 20s and three had coverage rates in the teens. These three neighborhoods had over 50% of their residents identifying as from a racialized population.

That link between racialized populations and lower coverage rates is not universal across the 21 communities because there are other communities that have more than 50% identifying as from a racialized population where the coverage rate was more than 30%. This shows you there is work to be done. Our team is using data and partners’ inputs about what the barriers are to immunisation so we are able to create low-barrier approaches. For example, we are doing pop up clinics in these neighbourhoods.

Can workplaces be engaged as sites of vaccination to ensure we do not miss essential workers?

Workplace-based immunization is being discussed but it may become less relevant as other avenues of access to vaccination are created for workers.

There is tremendous collaborative work underway, and many of these efforts involves OLIP.  So I want to thank the OLIP Health & Wellbeing Sector Table for the major efforts mobilized that continue to bear fruits.