Ontario health guidelines downplay COVID-19 aerosol spread — critics say it puts lives at risk

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Almost a year after she died from COVID-19, registered nurse Rubina Khan is still not sure how she contracted the infection, but she suspects it may be linked to airborne transmission – a risk that Ontario health officials only recently acknowledged, Albeit quietly.

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

At the time, personal protective equipment was restricted to employees working in a section of the home where residents were quarantined as a precaution after hospital visits. “We didn’t have access to the masks,” she said elsewhere in the house.

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 mounting evidence that COVID-19 is spread primarily through the air in tiny particles called aerosols, which are expelled when a person speaks, coughs or sneezes. However, a lot of Broad public health guidelines in Ontario He has been focusing on precautions, such as staying away and washing hands, with the goal of limiting transmission of the virus that spreads through heavy droplets at close range.

Critics say the guidelines are outdated, and dangerous for many frontline workers in the country’s hardest-hit province.

More than 540,000 Ontarians have contracted COVID-19. Nearly 33,000 of these cases were among health care workers, including those in long-term care settings.

While Ontario has not been alone in its approach to containing the virus, Mario Busamay says the province is putting people at risk because it has failed to heed the warnings of its past.

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

“SARS was called a rehearsal for COVID-19,” Busamayi said.

Criminal investigator Mario Busamae played a key role on the Ontario SARS Commission, as it looked at Ontario’s response to the SARS outbreak in 2003. “It called SARS a COVID-19 dress rehearsal,” he said. (Osama Farag/CBC)

He points out that the main takeaway from the SARS Commission Ontario report, Released in 2007, that in the event of an outbreak of a new infectious disease, the chief medical officer of health must follow the so-called “precautionary principle”, which means to play it safe.

In the face of COVID-19, he says, that should have meant enforcing airborne precautions for frontline workers, including improved ventilation and higher-level respiratory protection, such as N95 masks, which are designed to close airways and block most airborne particles.

“The precautionary principle for COVID-19 has been established,” Busamay said. “When science gets mixed up, you err on the side of caution; you protect people. You wait until the science is more solid to decide if you can reduce precautions. But we haven’t.”

Since March 2020, Public Health Ontario guidelines have stated that droplet precautions are sufficient to protect against transmission of COVID-19. By countyAirborne precautions, such as N95 masks, are only required by those performing aerosol generation procedures, such as intubating a patient.

Provincial health authorities declined to comment on this story, or respond to any questions via email, citing a recent legal challenge against them filed by the Ontario Nurses Association (ONA) that is still in court. ONA has asked the Ontario Supreme Court to consider Ontario’s obligation to explicitly recognize airborne hazards in its health guidance. The court has not yet issued a full ruling.

Vicki McKenna, the regional president of the Ontario Nurses Association, has called for better access to high-level personal protective equipment since the start of the pandemic. Early on, she said, health care facilities were rationing supplies in an effort to preserve equipment. After filing a number of grievances, the ONA took the province to court last April, asking it to order health care employers to provide broader access to personal protective equipment.

McKenna says precautions on the front lines should have reflected emerging evidence of airborne transmission. She said, the nurses were told, “Don’t worry, you’re fine. Your surgical mask is good enough. It’s a connection [transmission]. “

Ontario Nurses Association regional president Vicki McKenna called for respiratory precautions, such as N95 masks, to be within reach of health care workers in order to protect against airborne COVID-19. (Osama Farag/CBC)

As Canadians bang on pots and pans in support of health workers across the country, infectious disease experts have repeatedly declared that COVID-19 was not airborne.

Among them was David Fisman. At the time, the idea that the coronavirus wasn’t airborne fit with the traditional understanding of how the virus spreads, says an epidemiologist and infectious disease expert at the University of Toronto’s Dalla Lana School of Public Health. By that measure, he said, it appears that COVID-19 is “a disease that spreads mostly on a short scale, spread through large respiratory droplets that don’t travel far,” and that high-quality masks, like N95s, weren’t around. Not necessary in most cases to limit the spread.

But when Fisman studied the events of the early superspreader, he said he saw things that didn’t add up. He said the virus has proven not to be highly contagious in some cases. “And on the other hand, in certain circumstances, it can explode.”

Fisman has found that cases on cruise ships are particularly puzzling when trying to explain the transition through close contact.

“People who were kept in their rooms became infected even though they were not in contact with anyone else known to be actually infected. Therefore, they were connected to each other by a ventilation system,” he said. “He should have told us it was an aerosol.”

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

Knowing what he knows now, Fisman said Ontario should have started by being “extremely vigilant” about the risks posed by aerosols. “I’m actually ashamed, 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 of that.”

These effects go beyond health care workers. The overwhelming third wave in Ontario in the winter of 2021 was largely driven by essential workers. Busamay said the outbreaks “could have been prevented and avoided”.

Had the danger been publicly recognized, he said, there would have been an increased focus on ventilation and indoor air purification, and high-risk workers would have had immediate access to N95 respirators.

Busamay points out that there could have been costs associated with rethinking how transmission occurs at home, and that would have meant, “admitting that your medical beliefs are wrong.”

Eventually, Public Health Canada, and later Ontario, Acknowledge the airborne risks of COVID-19 on their websites. However, there were no visible changes in the overall guidance.

Rubina Khan is a registered nurse in a long-term care home in Southern Ontario, still recovering after contracting COVID-19 in March 2020. (Osama Farag/CBC)

As coronavirus recedes as vaccinations increase, McKenna says it’s time to solidify lessons learned so that in the future we don’t suffer from the same type of infections and deaths in many of the cases we’ve seen in this county.

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

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

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

She said there is a lot of high-quality PPE now. And while she said she is grateful for her second chance, she is also sad and angry. “If only preventive measures had been taken at first,” she said, sighing heavily,[this] It will be a different story.”


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