In an emergency measure to address the third wave of the COVID-19 pandemic, Ontario, Canada went into “shutdown” on April 3. As a practical matter, this did not have a particularly big impact on Toronto, Ontario’s capital, which has been in one form or another of strict lockdown—by North American standards—since last fall. But it did cast doubt on whether the government’s approach to stopping the virus’s spread has been working; after all, pandemic preparedness was generally woeful in countries around the globe. All indoor, and many outdoor, non-essential activities have been shuttered or severely curtailed for months, yet people in the Toronto area keep getting sick and dying from the coronavirus at alarming rates. Is this a case that simply shows the challenge of a pandemic virus in a country without enough vaccines for what it is, or could it show what public policy might look like in the future?

For Zain Chagla, public health strategy in the Toronto area, effective in some respects, has ignored the dire situation in the low-income communities where many essential workers come from. The idea that the virus would go away if everyone would just stay home ignores those whose jobs don’t allow them to stay home. And evidence bears this out: Chagla, an infectious diseases physician at St. Joseph’s in Hamilton, and an associate professor at McMaster University, is one of the authors of a new paper showing that the more dangerous new variants of COVID-19 are more prevalent in these communities—building on earlier findings that showed the “disproportionate” impact of the virus on essential workers.

Phoebe Maltz Bovy: Here in Toronto, where we’re speaking, COVID-19 cases continue to rise despite the city having been in lockdown since November. But there’s not much general understanding of why this is happening. Public conversations seem stuck where they were a year ago, with photos of people socializing in parks still generating controversies on social media, and so on. How are the realities of the pandemic different from popular assumptions?

Zain Chagla: One thing we realized quickly [working in the hospital] was that the patients weren’t the big source of transmission. Staff were. All of us have anecdotal stories of the guys that had the barbecue together, or watched the game together, and all of them got COVID. But in all of this, there was a current of people put in places where they got COVID: workplaces, crowded shelters, jails—places, again, when they had no choice; where when they came in, it was going to hit them.

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