This is just the proverbial tip of the iceberg. At least shelter uses are
not fat.

The proportion of tenants spending >30% of total income in 2001on rent is
very high in Canadian cities (43% in Vancouver, 42% in Toronto, and 36% in
Montreal.) The proportion spending >50% is also strikingly high as well
(22% in Vancouver, 20% in Toronto, and 18% in Montreal).
---------------------------------------------------------------------------------------------------------------------------------------------------------
Nov. 26, 2004

TB claims life of homeless man
Illness undiagnosed despite checkups

Two workers from same hostel infected

MOIRA WELSH
STAFF REPORTER

A homeless man died of late-stage tuberculosis in Toronto this week, his
illness undiagnosed despite numerous visits to doctors.

The disease went undetected despite a public-health blitz aimed at
containing the infectious disease, which has already hit vulnerable
residents of downtown shelters.

The man was a long-time resident of the same Salvation Army hostel, Maxwell
Meighen Centre, where two employees recently contracted active TB — a
discovery that led the public-health department to test 4,000 people for
the deadly disease.

"We didn't catch him. He didn't come forward" for the tests, said Barbara
Yaffe, Toronto's associate medical officer of health.

"We are doing our best with shelter staff to get everyone, but it is a
voluntary program," she said. "You really have to have some legal grounds
to force people to get tested."

Cathy Crowe, a street nurse, said shelter users are afraid the disease will
continue its spread now that the cold weather is sending more people into
overflowing shelters, whose crowded rooms and poor ventilation act as
incubators for disease.

"We're bracing for the worst," Crowe said.

Toronto public-health officials found another active TB case last week. A
homeless man from Seaton House is now being treated in the hospital.

It will take several weeks before tests in both new cases will determine
whether the TB strain carried by the men is the same as the one that
infected the shelter workers. Both of those workers are infected with the
strain that caused an outbreak in 2001.

As a result of the man's death, Toronto public health issued a notice on
Wednesday to hospitals, health centres and infectious-disease experts to
"think TB" when diagnosing patients.

Public-health officials said yesterday that the dead man, whose identity is
not being released but is in his 50s, would have suffered from active
tuberculosis for several months.

Symptoms of tuberculosis include coughing, night sweats and weight loss.
Despite many visits to doctors in downtown hospitals and health centres,
his disease went undiagnosed, Yaffe said.

On Saturday morning, shelter workers found him in a sickened state, she
said. They sent him to the emergency ward at Mount Sinai Hospital, which
followed infectious control measures and later diagnosed him with the lung
disease, officials said.

By late Monday, the hospital reported the TB case to public health, but by
early Tuesday the man was dead.

"People should not be dying of TB these days," Yaffe said. "Tuberculosis is
preventable, treatable and curable."

This is the sixth case so far in 2004 in which TB either caused a death or
contributed to death, said public-health spokesperson Gene Long.

It is unclear, however, whether the five other cases were contracted in
Toronto. There are up to 400 active cases diagnosed every year in the city,
with up to 15 of those among the homeless population.

The majority are latent cases picked up in the victim's country of origin
that can become active years later.

Outside the Maxwell Meighen Centre on Sherbourne St. last night, several
homeless men said they had not heard that a fellow resident had died of TB.

"It's kind of scary, but we've known it's been going around for some time,"
said one resident, who did not want to be identified.

In a report to the city last February, then medical officer of health
Sheela Basrur asked for increased funding to counter the spread of TB among
the homeless.

"There is a strong link between TB, poverty and homelessness," Basrur
wrote. "In crowded shelters, where poor nutrition, stress and underlying
health problems abound, a person with infectious TB can touch off an
outbreak that can go on for years."

With files from Kerry Gillespie and Henry Stancu

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