Three Toronto shelters are being investigated by Toronto Public Health as the number of COVID-19 cases rose to 30 in seven locations across the system that serves the city’s homeless and refugee populations.

Willowdale Welcome Centre, a refugee shelter at Yonge Street near Drewry Avenue, has 14 confirmed cases; Dixon Hall on Lakeshore Boulevard East has nine cases, and Seaton House at 339 George St. has three cases, according to TPH.

Toronto’s medical officer of health, Dr. Eileen de Villa, said TPH is ensuring infection prevention and control measures are in place at the facilities and the cases are being followed up to determine how clients were exposed to the coronavirus and who they subsequently came into contact with.

“We were prepared for this unfortunate situation of having cases in the shelter system and I am relieved to report that there have not been any COVID-19 deaths amongst clients in our shelter settings,” said de Villa.

De Villa said that people experiencing homelessness are already at increased risk of dying prematurely and suffer a higher incidence of health problems, including infectious diseases.

She said that early studies from the United States suggest that there may be a higher incidence of COVID-19 in the homeless population, compared to people with secure housing.

She also expects that people experiencing homelessness will be sicker, as they are more likely to have pre-existing hypertension, diabetes, cardio-vascular disease and respiratory disease, which have been associated with poorer outcomes among those who get COVID-19.

“This deeply concerns me,” said de Villa.

Seven facilities have reported cases, but only the three being investigated were identified.

Patricia Mueller, chief executive officer of Homes First, which runs Willowdale, said Tuesday that 16 staff across eight shelters and 13 rental housing sites operated by Homes First also have the illness.

Homes First staff have reached out to the Star to say they don’t believe they were properly supplied with personal protective equipment (PPE), but Mueller said Homes First followed all the recommendations made by public health when it came to distributing PPE, adding that it has been a rapidly moving target.

Speaking at a press conference on Tuesday, Mary-Anne Bédard, general manager of the city’s shelter, support and housing administration, pointed out that Toronto has the largest shelter system in Canada, with 72 separate respite and shelter sites accommodating more than 7,000 people each night.

She said the city has provided community agencies with more than $1 million for their own PPE and cleaning supplies and increased wages for frontline workers.

Hours have been extended at some shelters; portable toilets and hand-washing stations have been set up in the downtown; social distancing cues, similar to the arrows in grocery stores directing which direction people should walk and where they should stand, have been added to facilities. Meal times have been staggered and so has use of common areas.

Given that there are more than 70 separate shelter locations in the city with varying layouts, maintaining adequate physical distancing has been one of the biggest challenges, said Bédard.

Capacity has been reduced at some shelters — more than 1,000 clients have been moved to spaces in community centres, hotel rooms and permanent housing, and another 1,000 will be moved into new spaces by April 30 to improve social distancing, among other things.

A moratorium has been placed on clearing homeless encampments and the focus has shifted instead to safety in the encampments, including increased cleaning and garbage removal, said Bédard. Street outreach teams are continuing to work with those living outdoors.

“Given the scale of this pandemic, we knew that despite our best efforts it would unfortunately only be a matter of time before we saw cases of COVID-19 within the shelter system,” said Bédard.

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A 400-bed site for the homeless recovering from COVID-19 is in the works. In the meantime, an interim location was opened on Tuesday.

“These steps will require tens of millions of dollars in partnership with other levels of government to get us through the next 90 days,” said Bédard.

She said that the final figure will be reported at the conclusion of the pandemic.