http://www.thestar.com/NASApp/cs/ContentServer?pagename=thestar/Layout/Article_Type1&c=Article&cid=1102027808471&call_pageid=968256290204&col=968350116795

Dec. 3, 2004. 01:00 AM
Toronto is tempting a pandemic
TB outbreak in shelter system is a warning to fix problem of the
homeless, By Kathy Hardill

The last century saw more medical advances than ever before in the
history of humankind: CT scanning, magnetic resonance imaging,
microvascular surgery — a dizzying list. Which makes it at all the more
ironic that, even as we claim more superiority over the human body, it
is the ancient plagues that now threaten to kill us off in droves.

The World Health Organization tells us to expect the currently mutating
avian flu to deliver a long overdue pandemic predicted to threaten
millions of us.

Drug-resistant bacteria thrive, as if to thumb their cellular noses at
what begins to look like puny medical advances not providing much
protection after all.

Predictably, it is our cities which act as gigantic petri dishes,
incubating viruses and bacteria old and new.

These tiny organisms seek out ideal growing environments, which they
find in poverty — among our shelters, rooming houses and squats. Like
hungry wolves, they wait for the opportunity to attack first those
animals at the edge of the herd weakened by illness, malnutrition, stress.

We have seen, recently, a virulent norovirus sweep through a Calgary
homeless shelter, and sky-high rates of HIV infection among Vancouver's
poorest citizens.

And now in Canada's largest city, more than three years after a
tuberculosis outbreak began in its shelter system, we have a beleaguered
public health department scrambling to locate the source person whose
undetected TB has infected two shelter workers with active TB. So
concerned are health officials that they have begun the laborious
process of testing as many as 4,000 homeless individuals across the city.

You know what they say: Every time you repeat history, it gets more
expensive. More than 100 years ago, New York City's commissioner of
public health, Hermann Biggs, said: "Public health is purchasable.
Within natural limits, any society can determine its own death rate."

Biggs would no doubt be dismayed to see how few lessons have been
learned a century later.

Public health officials knew more than a decade ago that almost half of
Toronto's homeless population was infected with latent TB.

City officials have known for at least as long the public health risks
associated with their policy of cramming homeless people into an
overcrowded shelter system and forcing them to constantly move from
place to place.

Toronto officials gambled on that risk, and now the pound of cure is
proving very expensive, indeed.

The 2001 shelter TB outbreak cost Toronto Public Health more than
$500,000. It cost three homeless men their lives. Last week, another
homeless man died of TB in Toronto. The current case-finding strategy
has pulled public health staff from many other departments and the
financial costs are as yet uncalculated.

And so now, if I am homeless in Canada's largest city, these are my
choices: Try to sleep outside, where I face rain, snow, disrupted sleep,
violence, frostbite, hypothermia and police harassment.

Or, try to get into a shelter where I face noise, crowding, disrupted
sleep, violence, influenza, tuberculosis, and bedbugs.

Or, try to get a mat on the floor of a church basement where I face
noise, poor air quality, even more crowding, disrupted sleep, influenza,
tuberculosis, the burden of carrying all my possessions with me wherever
I go, and the exhaustion that accompanies travelling from place to place
every night. A Hobson's choice if ever there was one.

Perhaps I will be among the 40 per cent of unlucky homeless people who
contract latent TB infection. If I am even unluckier and develop active
TB, how long before I am diagnosed? How will my movements or my contacts
be traced?

The lessons repeat, over and over, and always the price climbs. But
never, apparently, is it ever cheap enough, cost-efficient enough,
timely enough or anything enough, to just offer people housing they can
afford and let them live there — sleeping in their own beds, within
their own walls, breathing their own air, looking after their health.

Even with a record-setting financial surplus, the federal government
balks at spending money on a national housing program. Even after
signing an agreement to spend $366 million on affordable housing, and
promising 35,000 new rent supplements, the Ontario government drags its
feet.

What if SARS had entered Toronto's shelter system? Where would you
quarantine homeless people? Has anyone got a plan for that?

During the 1918 flu pandemic, Toronto city officials shut down theatres
and all congregate facilities, in order to try to stop the spread of the
virus. Now, we have about 5,000 weakened, stressed-out men, women and
children crowded into more than 60 shelters.

In an epidemic, where will these people go? In a pandemic, where will
they go? Does anyone have a plan?

Sadly, little has changed since Hermann Biggs' time, except that now we
have microbes that are drug-resistant, and a bigger population.

How ironic it will be if the refusal of governments to improve social
conditions ends up fuelling a cataclysmic pandemic that will change
society forever.

Kathy Hardill is a Toronto street nurse who has worked with the homeless
for 16 years.





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