Here’s Why Communities Become COVID Hotspots

Long before her area in Surrey was announced as a virus hotspot, Gurleen Kaur caught COVID-19. She was 21 last summer, working two full-time jobs as a security guard, up to 70 hours a week, with shifts ending as late as 2 a.m.

“I was happy to be making more money,” she said, “but I’d only go to work and straight to home — nothing else.”

In late August, she developed a cough and her legs began to ache. But her employer didn’t offer her sick days to get tested. The temperature check at one workplace was faulty. And when she had an appointment with her doctor, he didn’t mention the possibility that she could have COVID-19.

The symptoms got worse, but she couldn’t get days off. One morning, she couldn’t help but sleep in and miss her shift. “You really don’t sound well,” said a colleague when he called to check in on her. “That’s why I was asking for days off,” she said.

By the time Kaur got tested for the coronavirus, her symptoms included vomiting, sneezing and aches that wouldn’t let her stand for longer than two minutes. The testing site said they would contact her in 24 to 48 hours if she had a positive result, but didn’t.

After five days, she called to check. The operator who picked up said that she was indeed positive.

“Are you kidding me?” Kaur remembers yelling into the phone. “I could’ve literally been roaming around everywhere thinking I was negative!”

She began her quarantine, which would last 68 days as she slowly recovered.

Kaur was part of B.C.’s second wave of the virus, during which Health Minister Adrian Dix called Surrey “ground zero” for COVID-19.

Scholars who study the socioeconomic determinants of health would say that’s not a result of bad luck or poor decisions. Data show that Kaur lives in an area where risks of infection are predictably higher.

Areas that may be home to people with less privilege or freedom to protect themselves — perhaps not having enough space to distance from housemates, or not having a job that allows one to work at home, like Kaur — are the hardest hit.

We crunched the data on high-transmission areas to see why places like West Newton, where Kaur lives, might be harder hit because of constraints that deny residents the options to avoid risk.

Until April, the province had not previously provided this level of detailed geographic information, though recent leaks of internal data to news media have resulted in some improvements in its public reporting.

But the limited public data we have still poses the question of who is more at risk of the virus. Toronto, for example, provides case breakdowns that show that richer, whiter residents have a lower share of COVID-19 cases.

Pairing the latest hotspot announcements (from May 6) with 2016 census data, The Tyee was able to determine who lives in hard-hit areas of the Lower Mainland. This encompasses the Fraser Health region, which has 19 hotspot areas, and the majority of the Vancouver Coastal health region, which has eight.

Andy Yan, the director of Simon Fraser University’s City Program, says the data is in line with the types of communities harder hit in other jurisdictions.

“Instead of being some kind of unlucky biomedical lottery, COVID-19 seems to be more of a predator that stalks along trails of social difference and economic inequality,” he says.

Yan ran a high-level correlation analysis using 95 census variables against the list of Lower Mainland hotspots. He found that hotspots were correlated with high percentages of workers in manufacturing; households with three or more breadwinners; and households of five or more.

The negative correlations Yan uncovered are also telling. Managerial workers, people who work in real estate, and two-person households are underrepresented in hotspots.

Looking at “visible minority” groups, South Asian and Southeast Asian residents make up large percentages of the population in the hotspots.

This doesn’t mean that people are more likely to catch the virus simply because they identify as part of a certain ethnic group.

Racialized communities have often been blamed for being unhealthy due to “cultural factors,” experts interviewed by The Tyee said.

To reduce stigma and offer help, it’s important to focus on the social determinants that might be common within a cultural group or immigrant cohort — such as poverty, discrimination, household makeup, poor housing conditions, working on the frontline and having a first language other than English — and compound risk.

Yan says it is still early days for COVID-19 data, and more work is needed to determine the socioeconomic determinants of virus spread. But what we have now is a start.

Lower Mainland hotspots by the top 10s

The Ministry of Health told The Tyee that its high-transmission hotspots are identified based on a mix of factors, including cases per capita and hospitalization and vaccination rates. Hotspots are announced based on Community Health Service Areas, geographic areas which range from urban neighbourhoods to small cities.

To provide a snapshot of what kinds of areas are overrepresented among Lower Mainland hotspots, here are a few “top 10s” of various measures.

Top 10 areas with highest percentages of blue-collar jobs

Seven of these 10 areas are hotspots.

“Blue collar” is defined as jobs in sales and services, trades and transport, resources and production and manufacturing and utilities.

Yan mapped the Lower Mainland’s hotspots together with these blue-collar areas and revealed a stark divide in both Vancouver and Surrey: the places home to the immigrant working-class are hard hit.

Top 10 areas with highest percentages of households with three or more breadwinners

Nine of these 10 areas are hotspots.

Breadwinners, called household maintainers in the census, are people who pay for housing costs. While having multiple breadwinners in a household sounds like it could increase risk of exposure to COVID-19, Yan says that the benefits shouldn’t be ignored.

For example, an immigrant family with three or more adults living together would be able to offer one another social, economic and everyday household support, especially in a pandemic.

Top 10 areas with highest percentages of households of five or more

Nine of these 10 areas are hotspots.

Rural areas in B.C. with equally high percentages of large households, such as Peace River North Rural and Telegraph Creek, are not hotspots. This is likely due to homes simply having more room, says Yan.

Top 10 areas with highest percentages of commuters by transit (pre-pandemic)

Seven of these 10 areas are hotspots.

Top 10 areas with highest percentages of residents who live in ‘unsuitable housing’

Unsuitable housing is defined as too few rooms for the number of people living in a home, according to the census. Eight out of 10 of them are hotspots.

Top 10 areas with highest percentages of South Asian residents

These 10 Lower Mainland areas also happen to be most South Asian areas in all of B.C. All 10 of them are hotspots.

In B.C., South Asian residents have been overrepresented among COVID-19 cases, something that Dr. Henry was careful to contextualize last November.

“It’s not in any way to blame the community,” she said in a press conference with South Asian media at the time. “Many people in the South Asian community live in Surrey and areas around there, and also own and work in many of the essential businesses that have kept our province going, whether it’s food production or trucking or working in health care.”

The census definition of “South Asian” includes Indian, Pakistani and Sri Lankan Canadians, among others.

Top 10 areas with highest percentages of Southeast Asian residents

Eight out of 10 are hotspots.

Renfrew-Collingwood, at the top of the list, is known for its large Filipino presence and the “Little Manila” cluster of businesses by St. Mary’s Parish. Many people who live here are essential workers who rely on the Joyce-Collingwood SkyTrain.

The Tyee also looked at the Lower Mainland areas with the lowest median household incomes to see if they were at greater risk of becoming COVID hotspots.

But they weren’t. It’s mostly middle-income, working-class areas that are hotspots, as opposed to those that are very poor or very rich.

Privilege in a pandemic

Valorie Crooks of Simon Fraser University is a health geographer, studying how place affects health. This includes big questions like “Why are people over here healthier or less healthy than people over there?”

“One of the strongest determinants of health is freedom over the choices in your life,” said Crooks.

Not everyone has the freedom and resources to take action to protect themselves or improve their health. In the pandemic, not everyone can choose to work from home, choose to avoid riskier spaces or choose where to go grocery shopping.

“Even things like changing routines, going grocery shopping at 9 p.m. For some people, their lives accommodate that, and it’s a reflection of their privilege. Not everyone can change their working hours or change jobs.”

In December, Crooks and her colleagues published maps of Metro Vancouver that show which areas are more vulnerable to COVID-19. The model takes into account personal factors such as work, language and household composition, but also place-based factors, such as the prevalence of crowded spaces like restaurants or food-processing facilities.

Crooks says it’s challenging to determine exactly what variables are behind COVID-19 spread in the recent government-flagged hotspots.

But generally, people most affected are those “with so many constraints on what it is they can and cannot do to limit their exposure to risk.”

For Gurleen Kaur in Surrey, the lack of choice played a big role on her health.

She couldn’t choose to take a sick day, because her employers didn’t allow it. She doesn’t own a car, and in sprawling, suburban Surrey, the only other option was the bus. It was the one place she was around people in close proximity, and she suspects that’s where she caught the virus.

Her long quarantine was a depressing time, but she also took the time to draw, play the guitar and record a video greeting for her sister, whose wedding in India she had to miss.

Her advice for anyone experiencing symptoms: “Don’t ignore it.”

“All of my injuries hurt more than before,” said Kaur, who was hit by a car not long after arriving in Canada as an international student. “This isn’t a sickness that’s leaving my body.”

Kaur tried to work two jobs again, but with her condition, eventually settled on a single job.

For scholars who work with data like Yan and Crooks, there is, of course, worry about stigma: blaming the groups harder hit by COVID-19.

Crooks says maps like hers aren’t meant to tell people, “Don’t walk your dog over here.”

Instead, exposing the factors that might make certain residents more vulnerable to the virus can show where public health action is needed. For example, the province has acted on the hotspots, speeding up the vaccine rollout in those areas.

But there are other vulnerabilities that could have done with more action earlier on.

Are there a lot of people in an area who need support in a language other than English? Are there a lot of essential workers in an area who don’t have enough sick days? Are there a lot of multigenerational households whose risks are not being addressed by public health recommendations that assume a narrow definition of household?

“The danger in data research is that it chops up society into segments and doesn’t bring them back together again,” said Yan. “We also need solidarity in who we should be helping.”