In an open letter addressed to municipal and provincial officials, including Toronto Mayor John Tory and Ontario Premier Doug Ford, 313 physicians and nurse practitioners are calling for immediate action to help people experiencing homelessness and precarious housing during the COVID-19 pandemic.

“We are seeing first hand the extreme toll that COVID-19 is taking on people who are the most marginalized … Conditions in Toronto’s shelters, boarding homes, 24-hour drop-ins and respite centres do not allow for physical distancing, putting both clients and staff at high risk for COVID-19,” the letter said.

“Unless there is ongoing rapid action, we will see preventable deaths and outbreaks with broad public health implications during this pandemic.”

The letter called for COVID-19 outreach testing and sentinel surveillance for all shelters, respites, drop-ins and boarding homes.

READ MORE: Toronto’s homeless COVID-19 patients sent to hospital due to lack of recovery site

It also urged local public health to issue an order under the Health Protection and Promotion Act requiring that all shelters, 24-hour drop-ins and respites to ensure there is physical distancing of at least six feet between clients, including no bunk beds.

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Finally, it called for the rapid opening of 7,000 hotel rooms, housing units and student residences.

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According to Toronto Public Health, there were 25 confirmed cases of COVID-19 across seven homeless service settings, such as shelters, in the city as of Monday.

“These are individuals who have been neglected, that have had shorter life outcomes and now with COVID-19 … this is life and death,” said Dr. Andrew Boozary, executive director of health and social policy at University Health Network.

The order given by health experts on a daily basis to practice physical distancing is exposing long-standing inequalities, he added.

READ MORE: Advocates for Toronto’s homeless plead for major increase in accommodations, testing

“There are thousands of people that do not have those privileges and do not have what I would argue are those rights to self-isolate, to physically distance,” said Boozary.

The most damning part, he added, is that this should come as no surprise because the disease burden in society has never been equal.

“Individuals who are experiencing and living in poverty, precarious housing, have more chronic diseases, have shorter life expectancy to begin with before COVID-19 and you can imagine when these individuals get infected their chance of survival is so much less,” he said.

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Street nurse Cathy Crowe, an advocate for those who are homeless in Toronto, urged immediate action and mobile testing.

She said the number of cases of COVID-19 is likely much higher in shelters but there is insufficient testing.

READ MORE: Toronto’s homeless face dire situation as support collapses, advocates say

“It’s like pulling teeth to get action — three weeks to get toilets up, over two weeks to get 300 people in hotels, and they should be operating this as a military-style operation with urgency, with emergency, or we’re going to see who knows how many deaths,” she said.

Boozary said he has been working with municipal governments, public health and community agencies to find solutions to what he called “chronic neglect … something that’s been happening for decades.”

“There is harm happening every single minute that we are not allowing people to physically isolate, we’re not allowing people to be tested, we’re not allowing shelter staff and workers to have [personal protective equipment],” he said.

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“And we’re not having testing in sites of vulnerability or vulnerable spots or hot spots for COVID-19.”