What went wrong in Vaughan? City became York Region's COVID-19 hot spot

ANALYSIS: Is travel to blame or demographics or the high number of manufacturing jobs?

Yorkregion.com
June 10, 2020
Kim Zarzour and Dina Al-Shibeeb

This could be a tale of two cities.

In one, residents met the pandemic forewarned and forearmed; in the other, they seemed caught off-guard -- and now are struggling.

Markham and Vaughan share a lot in common: Neighbours at the southernmost end of York Region, they have similar-sized populations and are both multicultural booming hubs nestled up to the border of Canada’s largest city.

But when it comes to COVID-19, the similarities end.

Markham has a slightly larger population, but the number of coronavirus cases in Vaughan has consistently been nearly double that of its closest neighbour. It remains highest across York Region and, on a per-capita basis, Vaughan is at the top of the heap. Or the bottom.

Vaughan Mayor Maurizio Bevilacqua said he takes pride in his municipality's performance during the pandemic. The City of Vaughan was well aware of the dangerous virus six weeks prior to the World Health Organization declaring it a global pandemic, he said, and was the first in the region to declare a state of emergency.

COVID-19 appeared to have arrived in Vaughan through travellers and those close to travellers, Bevilacqua said. Then cases transitioned to institutional outbreaks.

But a closer look at the graphs on the region’s website paint a slightly different picture.

More than any other municipality in York Region, Vaughan is grappling with the spread of COVID-19 through local transmission, close contacts and workplaces, with some communities -- like Woodbridge -- hit especially hard.

So what’s going on here?

Like many things COVID-related, it’s complicated, but we took a deep dive and came up with five factors that could account for Vaughan’s bad luck: mid-March travel, different approaches to testing, attitudinal differences, workplaces and age demographics.

MORE MONEY, MORE TRAVEL?

In the early days of the pandemic, international travel was a big source of transmission.

While there are communities in York Region with roots in different parts of the world -- in Markham, the Chinese community, in Richmond Hill, Iranian, and in Vaughan, Italian -- there was no large-scale transmission of the virus from those related countries to this region, Dr. Karim Kurji, York Region’s Medical Officer of Health, said.

Instead, travel-related cases arrived primarily from the U.S., Mexico and cruises, he said.

“At that time, we didn’t have the rigorous rules around quarantine,” he said. “The message was if you’ve travelled anywhere in the last 14 days, be mindful of signs and symptoms.

“The borders, remember, were quite porous at one point. We had about 400,000 people crossing the Canada-U. S. border a day.”

York University professor Aaida A. Mamuji suggests a community’s affluence might be indicative of such travel.

That’s backed up by a new website, HowsMyFlattening.ca, that analyzes COVID-19 cases based on socioeconomic factors. It found a higher rate of travel-related cases in the least deprived neighbourhoods versus the most deprived.

In other words, the infection was sparked by a population skewed toward higher wealth and, possibly, more travel.

Unlike Toronto, where a public health map of all COVID-19 cases shows low-income areas disproportionately affected by the virus, Vaughan is at the opposite end of the spectrum.

Vaughan's median income ($105,351) is among the highest in a region that is already higher than most in Canada, the 2016 census shows, and it surpasses that of Markham ($89,028).

But both cities remain above the provincial household income of $74,287, and residents of other communities besides Vaughan spent March break travelling south -- so there must be other factors, beyond travel, that caused these two cities to experience the virus so differently.

TESTING TROUBLES

There was a period of time when testing wasn't readily accessible because of a backlog of tests to be done by the province, Kurji said. “Many people did go for testing, but they were turned away, unfortunately.”

As soon as the provincial backlog cleared, local hospitals began to relax their criteria to test more, focusing on hot spots -- including Vaughan.

But the damage was done. Local hospitals reported seeing families with more than two individuals seriously ill with the virus -- none of whom had been tested, Kurji said.

“My speculation is that this would arise with folks who have been isolating themselves in the home, but not having availed themselves of the testing facilities, maybe because they heard that testing is difficult.”

But that backlog would have been the case across York Region. Vaughan residents may have faced another hurdle: proximity of testing.

Thornhill MPP Gila Martow notes communities like Woodbridge and other areas west of Highway 400 -- where COVID-19 numbers have soared -- are farther from their local hospital, Mackenzie Health in Richmond Hill.

If you were sick, that long drive may have felt daunting, especially if you weren’t sure you would even be tested, she said.

Those most westerly communities are also on the border of Brampton, which was identified by Premier Doug Ford May 25 as a   provincial hot spot.

Kleinburg resident Tracey Kent points out there's no testing centre in this part of the region. The closest is William Osler in Etobicoke, a 30-minute drive, or a two-transfer public transit ride away.

Because of that geographical anomaly, some Vaughan residents may have been part of a mixup involving hundreds of positive COVID-19 cases that weren’t reported to local public health units.

The majority of the missing cases came from Etobicoke General Hospital’s drive-thru assessment centre (which is just south of Vaughan), according to Toronto.com.

York Region spokesperson Patrick Casey said 31 cases were relevant to York Region.

As of June 1, all 31 cases were entered into the integrated public health data system, he said.

Public health is now completing the case investigation and contact tracing for all newly reported cases as a result of the lab error. This will provide a better sense if further spread might have occurred, he added.

“Individuals who seek assessment and testing are advised of the importance of self-isolating while awaiting their results. These instructions will help reduce the likelihood of further unknown transmission.”

There may also have been issues with the province’s online assessment tool. Mackenzie Health, Markham Stouffville Hospital and Southlake Regional Health Centre all advise people to take the online assessment if they want to be tested, but Kurji said the tool may have screened out anyone with mild symptoms who doesn’t have links to travel or pre-existing conditions. Instead, it advised them to self-isolate and contact their own doctor or Telehealth, (which may be using the same strict algorithm).

“If they are just being asked to self-isolate, as opposed to go to assessment centres, we might have missed some important people.”

As well, each York Region hospital takes a unique approach to assessment.

At Mackenzie Health, unlike Southlake and Markham Stouffville, you need an appointment to be assessed and, until recently, you were required to contact a primary care provider or Telehealth first. (That step is no longer required.)

“There are mixed messages,” Martow said. “My constituents want to know why they have to make an appointment with Mackenzie Health. People are hearing about other areas where they have drive-thrus and tents where you don’t have to make an appointment, not even have to get out of their car.”

Spokesperson Christina Cindric said Mackenzie Health requires appointments to maintain physical distancing and to ensure anyone seeking assessment could be seen by a nurse or a physician in a timely manner.

“By scheduling appointments, we are limiting the number of people gathered in a waiting area and minimizing the potential risk of exposure to other patients and staff,” she said in an email. “We’ve found our approach to be an efficient way to maximize our ability to test.”

Kurji said health officials have been urging hospitals to ramp up testing and an increasing number of tests conducted recently show it's having an effect.

Cindric said Mackenzie Health expanded its criteria for testing and extended the assessment centre hours of operation to 11 a.m. to 11 p.m. weekdays, 10 a.m. to 8 p.m. weekends.

These changes are helping, Kurji said.

“We are making progress with respect to the public's assistance in terms of staying home and the physical distancing part, and also making sure that they're going for testing.”

But Woodbridge remains a concern, he added.

ATTITUDINAL DIFFERENCES

Social media has been bristling for weeks with reports of Vaughan residents not physical distancing.

Many voiced concern on Twitter:

“Went to a garden centre. Almost no elderly (quite a few) were wearing masks. Seeing almost no masks as I drive around Woodbridge. Only 2 people w/masks in LCBO. This is bad,” tweeted Tracey Kent.

Supplied photo showing people aren't social distancing.

“Woodbridge is quite the hot spot because NO ONE respects social distancing! Just take a drive down my neighbourhood. Parents/family over for Sunday dinner,” Ingrid de Cosecha tweeted.

Some took to Facebook, like Tony Bisceglia, who posted a video of what he believes were high-level soccer players in private training at a local soccer centre -- something the soccer facility denied (saying the crowded parking lot was due to a sports rehab facility on site).

Others, like Cynthia Logan, sent emails, asking YorkRegion.com, “Why are the numbers so much higher in Vaughan than other areas? I live in Maple and am 65, and am, frankly, scared of this.”

Logan said she has been avoiding people, but is saddened and confused to see others not following guidelines.

"Extended families are getting together and they're in the same house, so touching the same things. We just don't know if people have it and aren't showing symptoms."

“I’m beyond disheartened and frustrated with everything going on, especially in my own backyard,” Adrienne Shulman, said. “I live right by Westmount and City Playhouse and the park behind my house is packed with people. Teens congregate in the backs of their parent's SUVs, all huddled together, different families gather with their strollers, people bring blankets ... It's beyond ridiculous."

Vaughan Coun. Marilyn Iafrate voiced frustration, too.

“People are only social distancing when it’s convenient to do so,” she said.

After the Easter weekend, Iafrate said she observed people visiting with friends or family members. Her constituents complained the same thing was happening in their neighbourhoods.

Local grocery stores are packed with shoppers and some people were still using parks even though they were closed, she said.

Far too many people seem to think, “I’m OK, nothing is going to happen,” she said.

Some wonder if it’s a cultural issue or an attitudinal one.

Vaughan’s largest ethnic group is Italian, which makes up one-third of the population. In Woodbridge, it’s even larger at 53.5 per cent -- the highest concentration in Canada, according to the 2016 census.

“While there was great awareness among the Chinese communities and precautions taken, there may have not been as much awareness among the Italian community until we started hearing about cases overloading the local health-care system in northern Italy,” Steven Hoffman, professor of global health, law and political science at York University, told The Toronto Star.

“While there was great awareness among the Chinese communities and precautions taken, there may have not been as much awareness among the Italian community.”

Mary Joe, a Vaughan resident of Chinese descent, agrees.

“As an Asian, we are more concerned about social distancing and being very thorough, sometimes a little too extreme. Asians have WeChat and they are very aware of what measurements China went through.”

Prina Val, from Vaughan, rejects the comparison, describing Italian Canadians as “very cautious.”

She doesn't visit with her “healthy” parents, for example, and only goes out to grocery shop. That’s when she sees differences in customers’ behaviour.

Multiple stores and businesses in Vaughan have reported COVID-19 outbreaks.

In contrast, Markham businesses, especially Asian grocery stores, appear to have come through -- thus far -- relatively unscathed, having launched early no-mask-no-service policies and other pandemic prevention measures as early as February.

Chinese community groups cautioned against crowded places and Chinese New Year celebrations. Anyone returning from China was asked to voluntarily isolate, whether showing symptoms or not. The community teamed up to help facilitate that isolation and safely carpool from the airport.

It’s complicated, said Jennifer Dean, assistant professor at University of Waterloo’s School of Planning, referring to "neighbourhood culture" and “ethno culture.”

It's quite possible, she added, that two neighbours, of similar ethnic background may behave differently.

Martow suggests some communities didn't adapt as quickly.

The pandemic requires a new approach to everyday tasks -- more planning ahead, for example, whether it’s for virus testing or just ordering groceries online.

“This is not the time to worry about ingredients for your recipe,” she said.

She believes community leaders play a key role.

In Thornhill, Martow said, she and local councillors Alan Shefman and Sandra Racco worked together to spread the message, working with local rabbis who’d seen what happened in New York.

“They took it seriously early on. It has to be continuous and escalating.”

“Sometimes it just takes one person who is highly infectious -- in SARS we called them super spreaders. They can go to a busy spot and you see an incredible spike,” she said, pointing to the mid-March outbreaks at two Vaughan gyms.

“It’s not necessarily a failure of the system. It could just be bad luck.”

WORKPLACES

Unlike Markham, dubbed by Mayor Frank Scarpitti as the “Tech Capital of Canada,” Vaughan has the lion’s share of York Region’s manufacturing jobs -- in 2019 there were 48,100 jobs in this sector, or 58 per cent of the 82,500 manufacturing job regionwide.

Given its proximity to the Toronto Pearson Airport and other major highways, Vaughan is also home to several large distribution centres and warehouses.

Although York Region public health officials are just starting to look at how these types of workplaces may be contributing to the spread of the virus, there are early indications from other communities.

In neighbouring Peel, where public health has investigated more than 450 workplace exposures since March 21, chief medical officer Dr. Lawrence Loh said he is seeing “dozens more” workplace-related exposures compared to two weeks ago.

Investigators are focusing on warehouses, the transportation and logistics sector, and food-processing plants to see if there are risk factors in sectors that “may need a little more attention from us.”

“I think it really reflects the hypothesis we’re working on, which is that it reflects the employment profile in our region. We have a lot of very large workplaces where people cannot work from home,” he said. “While we don’t necessarily have the results from our own investigations right now, we have read the hypotheses and findings of other jurisdictions that suggest many of these people are precariously employed (or) don’t necessarily have the option to not work.”

A similar picture appears to be emerging in Vaughan.

In early May, a 57-year-old man from Newmarket -- a worker at Saputo distribution centre in Vaughan -- died of COVID-19. At the time, York Public Health said 23 other employees at the Saputo Dairy Products facility, near Highway 7 and Highway 427, also tested positive. Five of those workers were from York Region.

On May 21, York Region reported two more Vaughan workplaces -- UPS and a window manufacturer -- saw COVID-19 outbreaks.

At the UPS plant, there were 21 confirmed cases. Aluminum Window Designs (AWD) had 26 cases.

While two of the confirmed cases at UPS are York Region residents, none of the cases at AWD are York Region residents.

So far, the total number of confirmed workplace cluster cases is 255; 68 are York Region residents and the whopping majority, 173, aren't, as per York Region data last updated on June 1.

As of June 3, Markham's workplace outbreak is about 3 per cent of its total cases, while Vaughan's is 4 per cent.

Patrick Casey, York Region's director of communications, said, on May 27, public health is investigating 45 workplaces with more than two cases related to possible exposure or transmission of COVID-19.

With reports of manufacturing plants, grocery stores and delivery companies having COVID-19 cases in the GTA, which Vaughan has aplenty, Dr. Kurji said May 28 the majority of workplace outbreaks -- about 70 per cent -- are in Vaughan versus about 11 per cent in Markham. The remainder are distributed relatively evenly between the other municipalities.

But Casey said “not all investigations will be considered outbreaks” and that “there are many unknowns and other factors that make drawing these conclusions difficult.”

Dean, from the University of Waterloo, also emphasized that, “We don't know the answer until this blows over. And there can be some deeper investigation into who those people are, where exactly they're living in the cities, the nature of their work.”

“Until we know where employees in Vaughan’s manufacturing sector live, we can’t make the connection,” Dean said.

“Broadly though, those who can work from home have less likelihood of exposure than those who need to travel to work in the manufacturing sector.”

While the questions around the virus and warehouse workers are still being looked at, the story of how it's impacting health-care workers has been a lot clearer for quite some time.

And Vaughan has a high number of health-care workers -- 8,315, though it ranks behind Markham at 9,030.

Of those working in Vaughan, 101 have had or still have COVID-19, with 71 cases resolved as of May 25. Comparatively, Markham saw 79 health-care workers test positive for COVID-19, with 55 cases being resolved and one death.

Also, there is ongoing construction in Vaughan in a city known for being ambitious. That has led some people to speculate that this may be driving up Vaughan's numbers.

“Vaughan has so many in construction, they are still working. If you drive through Woodbridge at 3:30 to 6 you still have traffic,” said Kent. “It’s probably why our numbers are high.”

But as of June 2, there were no reported COVID-19 cases in construction.

LONG TERM CARE HOMES, AGE DEMOGRAPHICS

Another factor that could be driving up Vaughan’s coronavirus cases is the high number of long-term-care homes. The city has 22 long-term-care homes and retirement residences of the total 77 across York Region, while Markham has 13.

As of June 3, York Region reported that there are 462 confirmed institutional outbreaks in Vaughan, with 64 deaths, while Markham has 225 with 31 deaths. Out of all of the York Region facilities, it’s Woodbridge Vista Care Community that has the highest active outbreaks at 139 -- 102 patients have COVID-19 and 37 health-care workers are positive, as of June 3.

When combining the presence of long-term-care homes and retirement residences with the two cities’ age demographics, it’s Markham's that is slightly younger. This could possibly strengthen Markham's position against COVID-19.

Vaughan is closely situated to York Region’s median of 14.5, where 14.2 per cent of its population are 65 and older, as per the 2016 Census, while Markham has the least older adults at 12.9 per cent.

As York Region Public Health gains more data, the scenario of why Vaughan won the title of being the region's COVID-19’s hot spot becomes clearer.

York Region now is able to give data on how COVID-19 has been acquired.

For the total 2,567 cases of COVID-19 in York Region as of June 3, about 36 per cent of these cases were acquired through institutional outbreaks, close contact accounted for 30 per cent and 19 per cent were from local transmission.

In Vaughan, the scenario changes. For Vaughan, close contact is the main driver for COVID-19 infection at 33 per cent, institutional outbreak second at 30 per cent, local transmission at 21 per cent. As for Markham, close contact is even higher at 36 per cent, institutional outbreak at 33 per cent and local transmission is 20 per cent.

These figures show how each municipality has its own factors. Even districts within each municipality have their own imprints. When looking at data, Woodbridge in Vaughan, has the highest rate of COVID-19 at 44 per cent, Maple at 20 per cent and Thornhill at 15 per cent. However, there is no data pertaining to Markham’s districts for micro comparison.

Like Dean said, the full story will come out after Canada closes its chapter on COVID-19 and wins the final battle.