An advocacy group of health-care providers says “widespread outbreaks” in Toronto’s shelter system are inevitable without more action.

In a survey of 22 of Toronto’s shelters, respites and drop-ins operated by the city and outside agencies, Health Providers Against Poverty (HPAP) found a lack of personal protective equipment and distancing of clients at most locations.

HPAP, an advocacy group of physicians, nurses and other health-care workers who support greater access to housing and safer shelter conditions, conducted the survey between March 30 and April 4 and shared the results with the Star Thursday.

The survey found only two agencies reported having “sufficient” personal protective equipment (PPE) and that “several sites have been working without masks for over two weeks,” according to HPAP, and some were conducting mandatory screenings of clients without masks, gloves or gowns.

“They are on the frontline, I would say almost to the extent that nurses and doctors are,” said Dr. Samantha Green, a family physician and HPAP representative. “People who are living in shelters are just by definition coming into contact with so many other people. They’re not able to socially distance or self-isolate and they’re at risk at contracting (COVID-19) or spreading it.”

She said everyone working in the shelter system should be wearing a surgical mask at all times.

The city has been creating space in the system by opening hundreds of hotel rooms and other locations like community centres. In collaboration with Inner City Health Associates, it has also created medical sites where shelter clients can be isolated while awaiting testing or after having been confirmed positive for COVID-19.

Mary-Anne Bédard, the head of the city division responsible for shelters, said in a statement that the city is following all provincial public health recommendations for PPE when it comes to frontline shelter workers, adding that PPE is not currently recommended or required for that work.

“The city continues to advocate to the federal and provincial governments to prioritize access to PPE for frontline shelter workers so that they can continue to provide critical services to vulnerable members of our community during the pandemic,” she said.

After conducting its own survey several weeks ago about PPE stock, the city provided $1.2 million in funding for shelters, respites and drop-ins to purchase equipment, as well as distributing from its own “limited” supply where needed.

Frontline advocates have said there needs to be a mass movement of shelter clients into empty hotels. There have been eight confirmed COVID-19 cases to-date.

The HPAP survey found only two agencies reported adequate space between residents for sleeping — at least six feet apart. Multiple shelters were found to have beds within two feet of each other.

The press release said “multiple” shelters told them clients sleep “head to toe” in cots as a “stop-gap solution” and that there is no space to physically isolate residents who present COVID-19 symptoms.

“I’m worried that so many people are going to die,” Green said.

She was working at Seaton House on Wednesday, a mens’ shelter where a case of COVID-19 was confirmed earlier this week.

Green described the screening there as “chaotic” and said there’s a need for Toronto Public Health staff to train and assist with screening at all locations, as well as mass testing in shelters for workers and clients.

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In its release, HPAP demanded that the city open as many hotels, housing units and student residences as needed to immediately to get people out of shelters, as well as provide appropriate PPE.

“HPAP found that widespread outbreaks of COVID-19 across the shelter system are inevitable without immediate action.”