Ontario has changed its policy for protecting health workers from the new coronavirus after infectious disease experts warned the previous rules didn’t reflect scientific evidence and risked wasting precious resources.
Health-care workers in Ontario will now use what’s known as “droplet precautions” to protect against COVID-19, the name of the disease caused by the coronavirus. Droplet precautions include the use of surgical masks, gowns, gloves and eye guards. Mounting evidence shows the coronavirus spreads through droplets, such as when someone coughs and sneezes.
Senior provincial health officials told The Globe and Mail the decision was made after a review of the scientific evidence. The province has to ensure health-care workers are protected while also preventing the misuse of limited resources, which is why the new policy makes sense, they said. The officials were granted anonymity because they were not authorized to speak on the matter.
The updated Ontario policy is in line with recommendations from the Public Health Agency of Canada and health officials from other provinces.
According to the policy, airborne precautions should only be used when health workers are performing what’s known as “aerosol-generating procedures,” such as bronchoscopies, which require them to be close to a patient’s airway and typically cause individuals to cough vigorously.
Until this week, health-care workers in Ontario were using airborne precautions to guard against COVID-19. Airborne precautions include the use of special respirator masks, known as N95s, as well as negative-pressure isolation rooms, which prevent air from escaping into adjacent halls. Airborne precautions are typically reserved for infectious diseases that spread via small particles that can travel far distances through the air, such as measles, but Ontario decided to use them for the new coronavirus to err on the side of caution.
For weeks, infectious disease experts urged the province to stop using airborne precautions, as more evidence demonstrated they aren’t necessary and could even put patients and health workers at risk by depleting resources. For instance, requiring health workers to use N95 masks when treating anyone suspected of carrying the coronavirus increases the likelihood of running out.
With a looming worldwide N95 shortage, infectious disease experts say health officials need to conserve those masks for situations where they are warranted. Airborne precautions also require patients with suspected cases of COVID-19 to be placed in negative-pressure rooms, which are scarce in hospitals.
Michael Gardam, chief of staff at Toronto’s Humber River Hospital and an infection control expert, said the onerous rules could dissuade health-care workers from even wanting to test individuals.
Some nursing groups, such as the Canadian Federation of Nurses Unions, oppose the switch to droplet precautions, saying it could put front-line health-care workers at risk. They’ve been urging other provinces, as well as the Public Health Agency of Canada, to use airborne precautions for health-care workers across the country.
But the evidence shows that droplet precautions are sufficient at protecting workers from infection. For instance, B.C. hospital workers who are treating COVID-19 patients have been using droplet precautions since the outbreak began and, so far, none has contracted the infection.
Janine McCready, an infectious diseases physician at Toronto’s Michael Garron Hospital, said it made sense to use airborne precautions at the outset of the outbreak, when little was known about COVID-19. But as more evidence emerged demonstrating the disease is spread by droplets, the best course of action is to use those precautions to protect workers and conserve resources, she said.