Ontario health guidelines minimize the aerosol spread of COVID-19. Critics say it puts lives at risk


More than a year after nearly dying from COVID-19, RN Rubina Khan still doesn’t know how she got infected, but she suspects it could be linked to airborne transmission – a risk officials say Ontario health officials have only recently recognized, albeit quietly. .

Khan does not recall anyone coughing in her presence while caring for residents at a long-term care home in southern Ontario last March. But by the time the 61-year-old found out she had contracted COVID-19, a coronavirus outbreak had set in that saw more than 60 of her colleagues and dozens of residents fall ill as well.

At the time, personal protective equipment (PPE) was reserved for staff working in a section of the house where residents were quarantined as a precaution after hospital visits. Elsewhere in the house, she said: “We had no access to masks.”

In hindsight, she said, airborne particles carrying the virus could have played a role. “You breathe the same air.

Since that first wave, there has been growing evidence that COVID-19 mainly spreads through the air in tiny particles, called aerosols, which are expelled when a person speaks, coughs or sneezes. However, much of Ontario’s public health policy has remained focused on precautions, such as distancing and handwashing, intended to curb the transmission of a virus that spreads through heavy droplets at short notice. distance.

Critics say these guidelines are outdated and dangerous for many working on the front lines in the country’s hardest-hit province.

More than 540,000 Ontarians have been infected with COVID-19. About 33,000 of these cases involved healthcare workers, including long-term care facilities.

While Ontario was not alone in its approach to contain the virus, Mario Possamai says the province has put people at risk because it has ignored warnings from its own past.

Possamai is a forensic investigator who played a key role in the Ontario SARS Commission, which reviewed Ontario’s response to the SARS outbreak in 2003. Recently, he wrote reports for unions in nurses on COVID-19.

“SARS has been called a dress rehearsal for COVID-19,” Possamai said.

Forensic investigator Mario Possamai played a key role on the Ontario SARS Commission, reviewing Ontario’s response to the SARS outbreak in 2003. He said: “SARS has been called a dress rehearsal for COVID-19 “. (Ousama Farag / CBC)

He points out that a key element of the Ontario SARS Commission report, released in 2007, was that in the event of an outbreak of a new communicable disease, the Chief Medical Officer of Health should follow what is called the “Precautionary principle”, which means Play it safe.

Faced with COVID-19, he says, that should have meant the application of airborne precautions for frontline workers, including improved ventilation and next-level respiratory protection, such as N95 masks, designed for seal the airways and block most airborne particles.

“The precautionary principle was made for COVID-19,” Possamai said. “When the science is mixed, you err on the side of caution; you protect people. You wait until the science is stronger to decide if you can lower the precautions. But we didn’t.”

As of March 2020, Ontario public health guidelines indicate droplet precautions are adequate to guard against transmission of COVID-19. According to the province, precautions against airborne transmission, such as N95 masks, are only necessary for those performing aerosol-generating procedures, such as intubating a patient.

Provincial health officials declined to comment for this story or answer questions via email, citing a recent legal challenge filed by the Ontario Nurses Association (ONA) which is still in court. The ONA has asked the Ontario Superior Court to rule on Ontario’s obligation to explicitly recognize airborne risk in its health guidelines. The court has yet to render a full judgment.

Vicki McKenna, provincial president of the Nurses Association of Ontario, has been advocating for better access to high-level PPE since the start of the pandemic. At first, she said, health facilities rationed supplies in an attempt to conserve equipment. After filing a number of grievances, ONA took the province to court last April, asking it to order healthcare employers to give wider access to PPE.

McKenna says the frontline precautions should have reflected the new evidence of airborne transmission. The nurses were told, she said, “Don’t worry, you’re fine. Your surgical mask is good enough. It’s contact. [transmission]. “

Nurses Association of Ontario provincial president Vicki McKenna has advocated that respiratory precautions, such as N95 masks, be made more accessible to healthcare workers to guard against COVID-19 by suspension in the air. (Ousama Farag / CBC)

As Canadians tapped pots and pans to support healthcare workers across the country, leading infectious disease experts have repeatedly stated that COVID-19 is not airborne.

David Fisman was among them. An epidemiologist and infectious disease expert at the University of Toronto’s Dalla Lana School of Public Health, he says at the time, the idea that the coronavirus was not airborne matched a conventional understanding of how a virus is spreading. By this measure, he said, COVID-19 appeared to be “a disease that spreads mainly at short distances, spreading via large respiratory droplets that do not travel very far,” and that higher quality masks, such as N95s, were not needed in most cases to curb the spread.

But when Fisman studied the early events of the super-spreaders, he said he saw things that didn’t match. The virus has been shown to be mildly infectious in some cases, he said. “And then on the other hand, under certain circumstances, it might just explode.”

Fisman found the cases on cruise ships to be particularly confusing when it came to explaining close contact transmission.

“People confined to their cabins were infected even though they were not in contact with anyone else who was in fact infected. They were therefore connected to each other by a ventilation system,” he said. . “That should have told us it was an aerosol.”

David Fisman is an epidemiologist and infectious disease expert at the Dalla Lana School of Public Health at the University of Toronto. He said he had “learned a lot” about the aerosol transmission of COVID-19 during the pandemic. (Ousama Farag / CBC)

Knowing what he knows now, Fisman said Ontario should have started by being “very careful” about the risk posed by aerosols. “I actually feel sheepish, because I feel like a lot of this information was already in front of us last year. And I didn’t necessarily understand the implications.”

These implications go beyond healthcare workers. Ontario’s third crushing wave in the winter of 2021 was fueled in large part by essential workers. The epidemics, Possamai said, were “therefore preventable and preventable”.

Had the risk been openly recognized, he said, more emphasis would have been placed on indoor ventilation and air purification, and high-risk workers would have had immediate access to respirators. N95.

Possamai points out that there would have been costs associated with rethinking how transmission occurs internally, and that would have meant “admitting your medical orthodoxy is wrong.”

Eventually, the Public Health Agency of Canada, and later Ontario, acknowledged the airborne risk of COVID-19 on their respective websites. However, there have been no clear changes in public guidelines.

Rubina Khan is a registered nurse at a long-term care home in southern Ontario, who is still recovering after being infected with COVID-19 in March 2020. (Ousama Farag / CBC)

As the coronavirus recedes with increasing vaccinations, McKenna says it’s time to consolidate lessons learned so that in the future, “we don’t suffer from the same type of infections and deaths in many cases. that we have seen in this province “.

Fisman has since worked with ONA on hospital grievances to ensure better access to full PPE, including N95 masks, for healthcare workers in the future. He says he wonders how many infections and in particular deaths so far could have been prevented “with good science”.

“You know, I think you’re talking about thousands of people who are still here and not here now.”

As for Khan, she almost died. Now fully vaccinated, she is back in the same nursing home she worked in for 21 years, but doing clerical work because she still can’t stand for more than a few minutes at a time.

There is a lot of higher level PPE now, she said. And although she said she was grateful for her second chance, she is also sad and angry. Sighing heavily, she said, “If preventive measures were taken early on, [this] would be another story. “

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