Within the KFL&A public health unit, the impact of COVID-19 has affected communities and neighbourhoods differently, with widely differing rates of COVID-19 positivity and vaccination. Newly-compiled data from the non-profit think-tank ICES (formerly the Institute for Clinical Evaluative Sciences) can provide insight into what these neighbourhood-specific realities look like for residents, giving clues regarding how the pandemic can be addressed more effectively and equitably. To learn more about this, Kingstonist spoke with Dr. Gerald Evans, the Chair of the Division of Infectious Diseases and a Professor in the Departments of Medicine, Biomedical & Molecular Sciences, and Pathology & Molecular Medicine at Queen’s University and an attending physician in Infectious Diseases and Internal Medicine at Kingston General Hospital and Hotel Dieu Hospital.
Dr. Evans noted that his colleagues at ICES, an organization that collects and studies health administrative data in Ontario, have been doing a lot of work in this area. Their analysis focuses particularly in large urban areas such as Toronto where the higher population density makes patterns easier to see, but the principles apply to communities and cities of all sizes.
ICES analysts use Forward Sortation Areas (FSAs) a system based on first three characters in postal codes, as a way to designate regions into smaller geographical units. All postal codes that start with the same three characters are together considered an FSA. The KFL&A health unit contains six FSAs.
“What [ICES analysts] have done is looked at the pattern of what sort of workers are in those areas,” Dr. Evans said, “and saying okay, we know that that young age group of between sort of 20 and 40 is driving most of the cases… we would likely get a biggest ‘bang for our buck’… if we vaccinate those younger individuals in those particular neighborhoods or FSAs so that the reduction in total number of cases will be substantial. And that has a spillover effect into reducing overall cases everywhere including cases that we would see in older people.”
Dr. Evans pointed out that this strategy is a complement to initial vaccination strategies, where the driver has been to immunize older individuals who are at risk, particularly those in long term care. “Early on, everybody was appropriately concerned to protect older individuals in our society, and especially those long term care, so that became the dominant strategy. And now that that has been fairly successfully rolled out, we’re pivoting to the other strategy, which is just to get cases down, and that’s where this sort of pitch at younger people, [focusing on] FSAs where there’s high levels of cases, is going to have the maximum effect.”
Looking specifically at the data compiled from the KFL&A Public Health Unit, Dr. Evans turned his attention first to the numbers in the downtown Kingston area. “Right now of course the [infection numbers] as you know are being driven by young people in their 20s, primarily, and that’s a large 20-ish population group. And these large numbers associated with the student outbreaks are why you’re seeing high positivity.”
This area, under the K7L FSA, is both the highest in terms of local positivity rates and also in terms of vaccination rates – in fact, according to ICES records, it is the second highest for vaccinations, among all ages, in all of Ontario. “The fact that they’re second highest in vaccination, I think is a probably a reflection that mixed in with that [student] population is quite an older population that live in an area that is sort of northwest of the university,” said Dr. Evans. “It’s a mixed bag that the [high rate] of cases exists within a demographic in that area that’s in the young age group, principally 20 to 30, but there’s a high rate of vaccination in that particular area because there’s a lot of older people and there’s a lot of healthcare workers who work there, because it’s also of course close to the hospital. So I think that reflects those funny numbers like such a high number of cases, 1.08% per 100. But the second highest rate of vaccination is because of that mixed population that you see there.”
Evans also noted that FSAs can reveal areas of inequity and problems of accessibility. “We also know that it pans out that if you live in an FSA which is well off socioeconomically, we actually know vaccination rates in those places are much higher than they are in these other parts. Other FSAs… suffer from all the problems that maybe have been seen by a marginalized population, maybe a lack of access to facilities that would allow for vaccination.”
Looking at the K7K postal code FSA, particularly north central Kingston, Dr. Evans noted that “there’s socioeconomic barriers that are probably in place that are creating some issues, and I know that public health is particularly interested in running some mobile and pop-up clinics in that particular area of the city to try and increase those vaccination rates because they’re really low; 94th (in the province) amongst all ages.”
Dr. Evans continued that issues of mobility, being able to physically get to a vaccination clinic, can be a barrier in many cases. “One of the things that we’ve been talking about is instead of bringing people to the vaccine, you need to take the vaccine and bring it to the people. [Areas like K7K] are a classic example of why you have to do mobile pop-up clinics. If you live in that part of town and they pop up a clinic that’s a block away from you, yeah, you’ll walk over there; that’s not a big risk. But you know if you have to hop on a bus, try and get over to the Invista Centre or even going to a pharmacy that that might be a little bit further distance, it’s those challenges that really create the problem.”
Dr. Evans noted that Napanee’s low vaccination rate and population demographic indicates that it would benefit from that second vaccination strategy. “There is a hospital in Napanee, and… a long term care home that’s actually attached to Lennox & Addington County General Hospital, so there would be a lot of vaccinations amongst that group. But it looks like the rest of Napanee seems to not be getting vaccines and that is probably a reflection [that] the people who live there are either younger and so haven’t qualified on an age basis, or they’re not in specific types of jobs where there’s considered to be an issue. There is a very big Goodyear Tire plant north of Napanee. And that’s exactly the kind of place where the current strategy would apply, because it’s a large manufacturing facility, and people are in close contact. And so vaccinating them would be really important.”
KFL&A Public Health acknowledged this issue, providing some additional context about the data Dr. Evans was responding to, and noting that data is always evolving. “The data that was pulled for the vaccinations released only represented data up to March 29th. Between March 20th and April 6th, we administered almost 10,000 doses,” noted KFL&A Public Health.
“The time frame has significant impact on the vaccination rate in Napanee,” KFL&A Public Health pointed out. “The Strathcona Paper Centre [mass vaccination site] opened in mid-March, later than those in Kingston. To account for this, more allocations have been given to this site through April. KFL&A Public Health are constantly working to ensure an equity lens is applied to our vaccination efforts and to ensure equitable access across all of KFL&A.”
The fact that data changes and situations develop is crucial to understanding and interpretation, Dr. Evans agreed. When considering the logic of vaccine roll-out strategies overall, Dr. Evans encouraged the public to keep in mind that strategies must be flexible as health leadership responds to changing data. “As we’ve learned things about the pandemic, we’ve shifted our focus on different things. We’re also recognizing there’s such a huge benefit from vaccinating essential workers, which could include teachers, as well as people work in grocery stores, for example. Everybody has to remember variants are picking on younger people.” He explained that this second prong of the vaccination strategy is a good example of being able to change and pivot based on evidence.
Dr. Evans is convinced that wise analysis of data like this is valuable, and can have a direct impact on success against COVID-19 within communities both large and small. “It’s all part of a strategy where if the models are right, we’re going to be able to really kick this third wave right in the gut and try and knock it out.”