A plea to my conservative Catholic friends in Ontario: hear the cry of the poor!

In Ontario, half of all SARS-CoV-2 infections are in 20% of neighbourhoods.* Overwhelmingly, these hotspots are poor neighbourhoods; disproportionately, members of racial minorities are getting sick and dying. One of the neighbourhoods now thankfully designated for accelerated vaccination on the basis of high incidence, M6K, was Theresa’s and my own home for five years. We ourselves had a lot more options than did many of our neighbours there in Parkdale, which has the highest concentration of psychiatric survivors in Canada.

Take two minutes, please, to hear how a patient hospitalized at Toronto Western was desperate about his three family members sick with COVID at home. “The people who are getting sick with COVID-19,” his critical care physician explains, “are the people who have no choice but to leave their house and expose themselves to the virus at work. And they may or may not have been vaccinated. And they may or may not have the agency and the social capital while they go to work to speak up if they’re in an unsafe environment…. And if they do get sick, the likelihood that they’re going to infect everyone that they live with is very high.”

One thought leader with whom I have been on friendly terms may well be referring to interviews such as this when he derides “fear porn.” I should enquire to clarify, but in any case, this physician’s fundamental point isn’t fear, it’s empathy for those who are suffering — and consequently a healthy respect for the threat the virus poses to the persons with whom we share this nation and this planet.

Unfortunately, it’s been all too common for persons ostensibly committed to the sanctity of human life from conception to natural death to discount the pandemic’s toll of illness and death and grief.

And this is what most incenses me.

In the face of grievous human suffering, many conservative thought leaders I once held in esteem have reacted not with compassion but instead with complacency, scandalous performative complacency. Some act with unshakable certainty that they know better than anyone else what’s really going on and how to deal with it. And though certain persons would robustly encourage a can-do attitude when faced by a challenge in any domain other than COVID, little can budge their conviction that public health measures are doomed to futility.

My mind is boggled by efforts to explain away Australia’s success in pursuing a #COVIDzero strategy. By actually wrestling COVID to the ground, Australia has achieved the enviable status of being able to safely return to pretty normal social life. But seemingly any alternative explanation, no matter how far-fetched, will satisfy some commentators so long it spares them from conceding any merit at all to l‑o‑c‑k‑d‑o‑w‑n-s. Viruses gonna virus, so why even try to stop ’em?

COVID strikes down the poor

The six harder-hit provinces, though, have been regrettably slow to learn from Atlantic Canada’s example. As a result, our own governments have seesawed for many months as half measures bring case rates down — enough to stimulate quite understandable pressure to reopen, but not enough to extinguish the embers — and then because the roots of the problem haven’t been addressed, another wave eventually begins. This cycle is exhausting and frustrating for everyone, whether we’ve believed the half measures we’ve been given ought to have been tighter or looser. And then the abundance of often moralistic talk about personal responsibility diverts attention from more fundamental institutional factors.

Crucially, the actual burden of illness and death has fallen in shocking disproportion upon the poor and the marginalized. (This disparity overlaps with how the burden has fallen disproportionately upon disabled persons, but the havoc in Canada’s nursing homes, far worse than that in many comparable nations, merits a separate essay.)

Incidence of SARS-CoV-2 Infections in 516 Ontario Neighbourhoods, January 23, 2020 to January 16, 2021. Source: Brown KA, Stall NM, Joh E, et al. A strategy for the mass distribution of COVID-19 vaccines in Ontario based on age and neighbourhood. Science Briefs of the Ontario COVID-19 Science Advisory Table. 2021;2(10). https://doi.org/10.47326/ocsat.2021.

This map powerfully illustrates the fact of regional disparity between Brampton or Windsor-Essex, where red shading for the highest incidence is concentrated, and other parts of the province, shaded mostly green or blue. It’s not set up, though, to show how much worse the pandemic is in the former. In itself the map would be equally consistent with a fairly mild gradient between the higher-risk and lower-risk neighbourhoods.

The gradient is anything but mild.

On Sunday night I stared just dumbfounded at this “heat map” of deaths or hospitalizations due to COVID in Ontario.

Incidence of COVID-19 Deaths or Hospitalizations by Age and Neighbourhood of Residence in Ontario, from January 23, 2020 to January 16, 2021. For those not familiar with this chart type: as on a topographical map, cells shaded in the same colour are at the same “elevation.” Here that means a region’s incidence of events per 100,000 inhabitants (other than those living in long-term care or retirement homes). Source: Brown KA, Stall NM, Joh E, et al. A strategy for the mass distribution of COVID-19 vaccines in Ontario based on age and neighbourhood. Science Briefs of the Ontario COVID-19 Science Advisory Table. 2021;2(10). https://doi.org/10.47326/ocsat.2021.

Not all seniors are the same

In the 80-and-over group, the incidence of hospitalization or death has been more than 22 times greater in the highest-incidence neighbourhoods than in the lowest-incidence neighbourhoods. Another figure reveals that for this same age group the death rate was 27 times higher in the highest-incidence neighbourhoods than in the lowest-incidence neighbourhoods. And those ratios of incidence in the recent past have been shown to be predictive of risk going forward.

Which means a young adult resident of a highest-incidence neighbourhood has, on average, a substantially greater chance of being hospitalized than does even an 80-and-over resident of a lowest-incidence neighbourhood. The value in the yellow-shaded top left cell is 380 times that in the bottom right cell. Three hundred eighty times higher.

In one of its few sensible COVID initiatives lately, the Ford government has prioritized vaccination of residents of these hotspots. (Along with these high-incidence neighbourhoods, it has given vaccine priority to a few other zones in the absence of a convincing public health rationale.)

The fantasy underlying the Great Barrington Declaration was that the most vulnerable could by some never-specified magic be selectively protected while the rest of us got on with our lives, unencumbered by lockdowns. Well, guess what? It’s well nigh impossible to protect vulnerable seniors without protecting the people that vulnerable seniors live with. Which in hotspot postal codes means the working-class — I was about to say “stiffs” — the working poor who are currently being crushed by workplace exposures to COVID-19. Many of the residents of hotspots don’t have the option of working from home; instead, they are out doing the jobs that enable the middle class to shelter in place in relative comfort and safety.

How have we used our power?

I know many of you are personally generous, directly or through charitable giving. I’ve seen you rally round when the need for hospitalization has struck within a social network we share. But there’s more to the problem. Consider the support needed in white-collar families of our acquaintance and then multiply it by, say, a factor of five to imagine how much more support is needed in hotspot neighbourhoods, far more of whose residents have become seriously ill when their social networks were already stretched thin.

The Catholic principle of subsidiarity is not crude libertarianism: when a problem is too difficult to be resolved by resources at the personal and local level, subsidiarity calls for higher-level resources to be mobilized. Which means the State. Unfortunately the government of Ontario has been pretty unresponsive to the needs of those hotspot residents, aside from its welcome new advancement of their vaccination schedule.

So, friends, I have a question for you, which I dare not withhold. Consider, please, the relative effort you’ve put into (1) defending your right to worship as you consider proper and (2) defending the poor from being put in positions where their very lives are endangered. When you read from the Prophet Isaiah, how clear is your conscience? As for your own answer, that’s between you and God. I can tell you, though, that my own conscience is pricked, so I’m going to be making some changes to how I use the resources at my own disposal.

Hear, O heavens, and give ear, O earth;
for the Lord has spoken:
“Bring no more vain offerings;
incense is an abomination to me.
New moon and sabbath and the calling of assemblies —
I cannot endure iniquity and solemn assembly.
Seek justice,
correct oppression;
defend the fatherless,
plead for the widow.” (Isaiah 1:2a, 13, 17)

How many children have needlessly been deprived of their fathers! How many fewer men and women would have been widowed if those of us with cultural capital had pleaded for the province to protect the working poor!

Friends, you genuinely might not have known how bad the pandemic has really been. Sadly, some sources you have trusted because they’re congenial in other domains of social life might not ever tell you. But now you know.

Respect for public health advice

The men and women who have devoted their careers to protecting public health are not infallible. They have their biases and may lean a bit further towards paternalism than I myself would. On certain issues not closely related to COVID we might well part company altogether. But isn’t it in the nature of thinking for oneself — a value to which COVID contrarians unfailingly pay lip service — that affinity for the truth, or at least for some particular truth, will sometimes draw together persons whose natural alliances might otherwise place them in different company?

There’s something I find ironic and bewildering. Conservatism itself embraces tradition and gradual change. Yet when it comes to COVID, more than a few self-identified conservatives have joined the vanguard of those agitating for change that’s thoroughly revolutionary. Here, though I’m admittedly caricaturing some of the more extreme positions I’ve confronted over the past year, I’m not making up anything out of whole cloth:

None of the tools that have been developed over the past century to understand the natural world are of any intrinsic value, nor do they demand any respect for their conceptual integrity. Instead, where they can serve the overthrow of Big Pharma, they are to be appropriated; otherwise, any harvest they might yield can well be left to rot in the fields. The consciousness of the common citizen is superior to corrupt modelling by the pointy-headed bourgeoisie! Smash the elitist claims of the epidemiologists! Seize the means of cultural production! Parler, good; Twitter, bad!

So please be genuinely conservative, my conservative friends, in your thinking about science and public health and all that. Enough of listening only to self-selected authorities who tell you what you want to hear. I beg you, please think twice before circulating sciency claims on social media. Ten months ago I offered twelve tips for sifting through controversial scientific claims. That advice has aged pretty well, I’d say; the one thing I’d adjust, having seen the horrifying death toll since then, is that it now seems a lot more plausible that arguing with one’s friends over COVID might ultimately save some lives. So do argue, just argue well.

And from that piece I would really reiterate the caution that “to lean automatically towards the ‘alternative’ claim doesn’t show truly independent thinking. It’s more a sign of alienation from the institutions of civil society.” Ironically, while the contrarian thought leaders to whom many of you turn appeal to the value of thinking for oneself, they themselves march in all but perfect lockstep with one another. You, though, you can break ranks with your friends in your judgment about the prudence of various measures against the pandemic—while continuing to hold to other values that have drawn you together. When it comes to understanding what’s really happening around COVID, you can extend your trust beyond those sources that display the shibboleths of social conservative subculture. Not to deny that in some circles it could be socially costly to profess certain positions on the pandemic, but as a conservative Catholic living in our society you’ve already had practice navigating that general problem.

Anyway, God bless ’em, public health people know a lot more about how we can get out of this mess than do most of us, myself included. I’m not asking you to give them unquestioning deference; they’re big boys and girls who are capable of taking criticism. But more respect, albeit qualified, would be well in order within conservative circles.

What would actually help against the pandemic

On Friday my favourite Canadian epidemiologist, Dr David Fisman, lamented, “24 hours after we publish a paper that really shows why outdoor spaces are vastly safer than indoor spaces, our provincial response to a public health disaster is…to restrict access to outdoor spaces.” Fellow members of the Ontario COVID-19 Science Advisory Table shared his dismay over seeing the Ford government flatly ignore their recommendations. The Globe and Mail’s scathing interviews with members are a must-read: “Several say they considered resigning in protest, but feared the move would only worsen the government’s next steps.” During a call on Friday about the government’s new measures, the director of the advisory table, Dr Peter Juni, was in tears. Maclean’s too exposes the hollowness of Ford’s posturing.

Yesterday the science advisory table reiterated its key recommendations, summarized below. Please read the whole report, which is only about 800 words long.

  • Essential workplaces, only
  • Paying essential workers to stay home when they are sick, exposed or need time to get vaccinated
  • Accelerating the vaccination of essential workers and those who live in hot spots
  • Limiting mobility [i.e., between regions and coming into the province]
  • Focusing on public health guidance that works
  • Keeping people safely connected.

Very rightly it declares

There is no trade-off between economic, social and health priorities in the midst of a pandemic that is out of control. The fastest way back to work — and to all the other things that make life in Ontario great — is to get this disease under control as quickly as we can, together.

What now?

Provincial governments worry that making paid sick days for employees mandatory (eight of ten provinces do not require it) might result in business investment leakage. But a food processing company cannot relocate further away from the Ontario Food Terminal; Fed-Ex or Amazon cannot move away from Pearson International Airport; Walmart’s warehouses still have to be close to its stores. This fear of business investment leakage and the loss of tax revenues is unfounded. And if you compare one company paying an essential worker $100/day on sick leave versus all of us paying some $3100/day for one bed in an intensive care unit, the measure is fiscally responsible. Paid sick leave is good for families and for a functioning economy. It’s not socialism, not even close. It’s one step towards curtailing the pandemic; it won’t end it, but it will help.

You, as a non-cafeteria Catholic, accept the Catholic Church’s social teaching, yes? You believe in the Church’s preferential love (CCC 2448) for those who are oppressed by poverty, yes? You accept that injustice to the wage earner is one of the sins that cry out to heaven, along with oppression of the resident alien, the widow, the orphan (CCC 1867), yes?

If a brother or sister is ill-clad and in lack of daily food, and one of you says to them, “Go in peace, be warmed and filled,” without giving them the things needed for the body, what does it profit? (James 2:15–16)

We’re all tired of this pandemic, but 20% of Ontario has been burdened by it so much more heavily than the rest. It’s past time to insist that your government protect the people most at risk. This is not charity, it’s justice.

Christ is risen! May the good news stir us all to holy boldness.

*This version has corrected the proportion of cases in hotspots and aligns with how the science advisory table defines them. I regret any confusion.

Catholic practising in the Byzantine tradition. Medical editor, sometime historian of medicine. Widower. "Truth and love need each other."