By Linda Silas
On November 3, 2020, the Public Health Agency of Canada (PHAC) updated its guidance on the routes of transmission of COVID-19 to recognize potential aerosol spread of the virus.
Although it elicited little fanfare, this critical move came in response to months of pressure from labour unions and health-care advocates who had urged PHAC to recognize recent scientific evidence that pointed to airborne transmission as one of the possible ways COVID-19 is spread.
While we welcome PHAC’s recent recognition of the airborne spread of the virus, Canada could have fared much better had it only heeded the lessons learned from its own experience with SARS in 2003. From the moment the virus was detected on Canadian soil, the precautionary principle should have guided our nation's course of action.
The precautionary principle holds that in the absence of scientific certainty about how an illness is spread, we must err on the side of caution and adopt preventive measures to protect health-care workers and their patients.
Canada’s failure to take a precautionary approach has had profound consequences for health-care workers. For months, they have followed the government’s advice in their workplaces, caring for presumed and infected COVID-19 patients, at close range and for long periods of time, and often in wards that lack proper ventilation.
We are now at a decisive moment. In light of the airborne spread of COVID-19, we remain deeply concerned by PHAC’s failure to update its guidance on personal protective equipment and other protective measures for health-care workers.
Following the release of Mario Possamai’s landmark report, A Time of Fear: How Canada Failed Our Health Care Workers and Mismanaged COVID-19, dozens of experts from around the globe—including the Canadian Federation of Nurses Unions—cosigned a consensus statement based on the report’s key recommendations. Among them is that safety guidelines for health-care workers should be developed with the precautionary principle acting as a core principle and with the active involvement of health-care-worker unions.
Other signatories to the statement include Dr. Lidia Morawska and Dr. Donald Milton, who coauthored an open letter in July, signed by 239 scientists from 32 countries, urging the World Health Organization to recognize the potential for the airborne transmission of COVID-19 and to adopt preventive measures to mitigate its spread.
In Canada, health-care workers represent almost one in five cases of COVID-19, approximately twice the global average.
As we battle a second wave, there is little to be gained from pointing fingers. Our collective focus should be on scaling up efforts to protect health-care workers now, as well as absorbing the lessons from the first wave and earlier disease outbreaks.
Going forward, all guidance impacting the safety of health-care workers must be made on a precautionary basis by workplace regulators, health-care-worker unions, and worker-safety experts—and those decisions should form the basis of health worker safety guidance issued by public-health agencies.
PHAC has yet to offer assurances that its guidance will be updated to recommend airborne protections for health-care workers. The federal agency’s continued lack of flexibility in responding to emerging science is troubling and poses serious questions about PHAC’s approach to worker safety.
The true cost of these decisions is measured in the infections and deaths of health-care workers and the Canadian public who have put their trust in our leaders and public-health experts to see us through this pandemic.
It's essential that workers are treated as partners when decisions impacting their safety are made. We mustn't forget: there is no patient safety without health-care-worker safety.
Throughout the first wave, we heard from health-care workers who felt that they had been treated like their lives were disposable. Without proper protection, they nonetheless ran toward the pandemic and risked their lives to treat the sick and stem the spread of the virus.
When Canada needed them most, health-care workers were there for us. Our decision makers can't let them down a second time. As a second wave grips the nation, immediate action is needed to prevent even more deaths and further trauma.
We are running out of time.
The Public Health Agency of Canada needs to immediately undertake a review of its guidance on infection prevention and control for health-care workers and require airborne precautions for all those caring for patients with suspected and confirmed COVID-19.