Raise the Hammer
In a week of increasingly bleak news on the health care front, it is good to be able to celebrate a victory that was designed and delivered right here in Hamilton.
By Jason Allen
Published December 21, 2020
The past year has been a difficult one for our health care system. As the pandemic has spread, various pieces of our health care system in Hamilton have come under tremendous pressure. Long Term Care homes were the worst story, but there were plenty of other impacts of COVID-19, whether on hospital staff, or with decreased health care access for people with conditions other than the coronavirus.
However, one part of Hamilton stands out from the rest in terms of success in fighting the virus - our homeless shelters.
While Toronto's shelter system groaned under the weight of hundreds of cases, shelters in Hamilton have remained remarkably COVID-19 free. This success was the direct result of an innovative program of testing led by Dr Tim O'Shea, Associate Professor of Medicine at McMaster University.
As a doctor with the Shelter Health Network, HamSmart, and with Keeping Six, it was O'Shea's involvement with many points in the health care system that enabled him take quick action in the spring.
O'Shea pulled together a diverse set of resources to prevent the spread of COVID among the homeless population living in shelters, including testing capability, health care workers and volunteers.
The program began during the beginning of the COVID outbreak with extensive testing of anyone within the shelters who had symptoms that could have been COVID. With St Joseph's Health Care donating lab services, the Shelter Health Network team was able to process the swabs right there rather than through public health. That significantly reduced the time it took to get results and made it possible for the shelters to minimize spread from any positive test results found.
Another key difference with Hamilton's swabbing program was that nurses came to the shelter and swabbed potential COVID cases in place, rather than asking them to go to an offsite testing location. According to Dr O'Shea, other jurisdictions had found that these centralized testing locations "could be hard to get to for people without access to transportation, so they often just wouldn't go."
"Bringing the swabbing into the shelters ensured that cases could be identified early, and those with the coronavirus could be quickly isolated, preventing further spread."
Perhaps the most innovative part of the program, however, was a research project initiated by O'Shea to swab anyone who was willing to take a test, once a week, in the shelters. "We didn't use the normal nasal-pharyngeal swab," explains O'Shea. "We found that if someone had that test one week, they would never volunteer for it again. Instead we used a cheek swab and a less invasive nasal swab that residents would administer themselves."
Over the summer, the tests were administered by nurses from Public Health. As the second wave intensified, those staff were required for contact tracing and other work. However, the project continued with the tests currently being done by lab staff volunteering from St. Joseph's, which also continues to donate their lab services to the project. Thanks to funding from the Hamilton Academic Health Sciences Organization (HAHSO), 8,000 tests have now been performed.
The result? Several people who were pre- or asymptomatic were identified and quarantined before they could spread the infection to others in the shelter.
There was also an unexpected result. "There was a lot of fear among shelter staff when COVID first appeared," explained O'Shea. "Staff in shelters have a very challenging job, and as a result of concerns around getting infected, there was some absenteeism early on. This research project has greatly reduced that."
Part of this program has been driven by necessity. Hamilton has been less successful than other cities at getting people off the streets and into hotels, in part due to the unwillingness of some hotel operators to offer use of their facilities. The isolation provided by hotel rooms has helped to curb the spread of COVID among homeless populations in places like Guelph and London. In Hamilton, however, O'Shea and the various organizations he works with were required to be proactive and creative.
As a result, O'Shea says "There has not been a single case of spread between residents in congregant care in the shelter system in Hamilton."
In a week of increasingly bleak news on the health care front, it is good to be able to celebrate a victory that was designed and delivered right here in Hamilton.
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