In April 2020, a meat-packing plant in High River, Alberta, became Canada’s COVID-19 hot spot. In all, 1,560 cases were linked to the plant, including 936 employees, making it the site of the largest single facility outbreak in North America.
Aside from coping with their illness, many of the 1,700 people working at the plant were refugees, newly arrived immigrants and temporary foreign workers and faced the added challenge of language barriers and difficulty accessing health care.
“When cases suddenly increased to 1,000, it became apparent the situation was getting worse, and people were struggling to abide by public health interventions,” explained Dr. Annalee Coakley, a family physician and medical director of Calgary’s Mosaic Refugee Health Clinic.
The challenges in containing the virus existed both inside and outside the processing plant.
Dr. Coakley said that within the meat-packing plant, it was difficult for workers to physically distance. At the same time, personal protective equipment (PPE) quickly became damp in the environment, which compromised its effectiveness.
“Even if you are doing everything right, the virus can still be transmitted.” — Dr. Annalee Coakley
Outside the plant, workers with COVID-19 struggled to self-isolate because of their living conditions; many lived in multigenerational homes or homes with shared kitchens and bathrooms.
“Most workers don’t have the same social networks as someone who has lived in Calgary all their life,” explained Dr. Coakley. “You can’t tell people to stay in their house for 14 days and not provide them with food or income support.”
In addition, workers were facing stigma in the broader community, making it difficult for them to seek COVID-19 testing and care.
“I had patients evicted from their homes because of working at the plant,” said Dr. Coakley.
Addressing social determinants of health to prevent COVID-19 transmission
The outbreak became a stark example of how socioeconomic factors contribute to the spread of COVID-19, and it spurred Dr. Coakley to form a collaborative team made up of family physicians, allied health professionals and, most importantly, patient advisors with personal and cultural connections to the High River workers.
The CMA Foundation contributed $5 million to the Foundation for Advancing Family Medicine (FAFM) COVID-19 Pandemic Response and Impact Grant Program. This program is helping family physicians innovate to provide care during the pandemic.
Dr. Coakley’s project — COVID-19 Response and Impact Group for Quality Improvement — helped evaluate an enhanced clinical pathway to link plant workers with social agencies providing services such as COVID-19 testing, health care, housing and food. When workers were sick and isolated, family physicians checked on them every day to assess both their clinical and social well-being.
“If they didn’t have a family physician, they were connected to one,” said Dr. Coakley.
As part of the program, her team held numerous town halls to discuss how to prevent COVID-19 transmission, get tested and access social supports. Building trust with the community encouraged workers to seek care, eventually containing the outbreak. The team’s work also led to onsite vaccination clinics at meat-packing plants across Alberta.
“For a lot of our patients at meat-packing plants, they struggled to use the vaccine booking system tool as well because of the language barriers and digital literacy,” said Dr. Coakley. “That’s why we advocated for bringing the vaccine clinic to them.”
Over the course of two weeks in the spring, all the meat-packing plants in the Calgary Zone of Alberta Health Services hosted onsite vaccination clinics, in which 3,043 out of 3,740 workers received their first dose of vaccine, representing a vaccine uptake of 81% — a higher rate than in Alberta’s general population at the time.
Dr. Coakley explained it marked an important milestone in a community that had struggled to contain an outbreak only a year earlier.
“The grant has directly related to the immunization program we run,” she said.