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Alberta and Ontario have reached agreements with unions to allow some health-care workers to use N95 respirator masks if they feel it is necessary.Nicholas Pfosi/Reuters

At least two provinces have bowed to union pressure to let some health professionals use specialized respirator face masks when treating COVID-19 patients, sparking concern among infection-control experts this will undermine health workers’ trust in their advice.

Alberta and Ontario have reached agreements with unions to allow some health-care workers to use N95 respirator masks if they feel it is necessary. Nova Scotia’s largest nursing union is now calling on provincial officials to do the same.

But the Canadian Union of Public Employees criticized Ontario for not going far enough, as the new policy on N95 masks applies only to registered nurses working in hospitals.

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Michael Hurley, CUPE’s Ontario Council of Hospital Unions president, said on Thursday that all health-care workers should have the choice to wear N95 masks. He said the union is set to have more discussions with Ontario about expanding its directive.

Every province, as well as the Public Health Agency of Canada, recommends that health-care workers take “droplet precautions” when treating suspected or confirmed COVID-19 patients. Droplet precautions include the use of regular surgical masks, as well as gowns, gloves and face shields. According to mounting evidence, this provides sufficient protection from infection.

But many unions and other associations representing health-care workers have been pushing provinces to move to “airborne precautions," claiming it is not entirely clear whether droplet precautions are enough. One important distinction with airborne precautions is that they require the use of N95 masks, which are specially designed to block tiny viral particles that can remain in the air for longer periods. Airborne precautions are typically used when treating patients with measles, where small particles remain suspended in the air for hours.

For COVID-19, provincial and federal governments recommend using airborne precautions only when workers are doing what is known as “aerosol-generating procedures,” such as an intubation. Such procedures can generate small viral particles that can remain in the air longer than they would under other conditions, such as when a person coughs or sneezes.

The new agreements in Alberta and Ontario give some health-care workers discretion to decide when to use airborne precautions and don N95 masks. In Ontario, the directive specifically applies to registered nurses working in hospitals.

Janine McCready, an infectious-diseases physician at Toronto’s Michael Garron Hospital, said Ontario made the new decision without consulting infection-control experts. The directive risks sending the false impression to health-care workers that droplet precautions are insufficient.

“It’s been very challenging and kind of undermines a lot of work we’re doing at the hospital level to work with our staff,” Dr. McCready said.

She has been interacting with COVID-19 patients for weeks wearing a surgical mask, she added, and is confident about that level of protection.

Michael Gardam, chief of staff at Toronto’s Humber River Hospital and an infection-control expert, said the overwhelming evidence shows droplet precautions provide enough protection, but that conflicting warnings from some medical groups is creating confusion among health professionals.

“It’s really created big problems in health care,” Dr. Gardam said. "You get people saying, well am I protected or am I not protected?"

He added that advocating for use of N95s when they are not necessary means Canada’s supply of the masks could run out. This is particularly troubling, as Canada is expected to see a surge in COVID-19 cases in the coming weeks and many health professionals will have to perform aerosol-generating procedures.

“If you want to take an extra level of precautions, I’m not going to fight you,” Dr. Gardam said. “But that’s different when you have limited supply.”

Sandy Buchman, president of the Canadian Medical Association, said there is a legitimate concern Canada will not have enough N95 masks to protect workers in the coming days. A new survey of nearly 5,000 CMA members found more than one-third of community-based physicians said they would run out of N95 masks and other protective equipment within two days, while others said they had already run out.

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