Citing Omicron’s Airborne ‘Potential’, Ontario Hospitals, LTC Homes Will Now Use N95 Ventilators With COVID Patients

Ontario health officials are changing a key recommendation on the use of personal protective equipment (PPE) in hospitals in response to the “potential” that the highly transmissible variant of Omicron can spread remotely through the air.

Healthcare workers providing care to a “suspected or confirmed” COVID-19 patient in hospitals, long-term care homes, or in a home care situation will now also need to wear an N95 Respirator, ”according to interim guidance issued by Public Health Ontario on Wednesday.

The use of loose-fitting procedural masks in Ontario hospitals instead of N95 respirators has been the subject of controversy long before Omicron, with critics saying the province’s rules did not conform to an increasingly certain reality that the COVID virus is transmitted through the air and is capable of infecting at a distance. through tiny floating “aerosol” particles.

Ontario Medical Director of Health Dr. Kieran Moore acknowledged the risk at a press conference Wednesday, saying the Omicron variant “is much more infectious and there is a possibility that it could spread through the air.”

He added: “We are very concerned that there may be much more spread of aerosols than other strains.”

On Thursday, featuring the Ontario COVID-19 Scientific Advisory Board latest Omicron wave modelingCo-Chair Dr. Steini Brown was more direct: “It is an airborne disease. I think it’s clear, ”he said.

He added that the province’s specific guidance on masking is up to Moore.

Ontario Hospital Association President Anthony Dale welcomed the change in a statement Wednesday, saying that given the uncertainty surrounding Omicron, OHA “fully supports today’s interim recommendations from Public Health Ontario regarding to the use of N95 respirators for some activities as a precautionary measure “.

According to the latest September data, at least 860 people have died of COVID-19 in outbreaks related to Ontario hospitals, making them the second-deadliest location in the province for outbreaks, after long-care homes. term.

Throughout the pandemic, public health officials have argued that close contact and droplet precautions, which do not require N95 except for specific procedures, were enough to keep patients safe, even as new research supported the idea that COVID spreads through the air in a way that could pass looser masks.

On the issue of the risk of airborne transmission of the virus, provincial guidelines had taken substantially the same approach in all previous COVID waves, recommending that the use of surgical masks, face shields, and general physical distancing was sufficient to protect individuals. patients and staff.

As the Star reported last summer, this position was controversial, with the Ontario Nurses Association even taking the provincial government to court in an effort to force air protocols, including the use of N95.

The nurses argued that “Directive 5,” the document that guides the use of PPE for hospital and long-term care homeworkers, did not apply the precautionary principle to the risk that COVID could overcome precautions against drops and long-term care. Contact. While Directive 5 gave workers the option to wear N95 masks or not, it does not make their use mandatory.

The Ontario Divisional Court dismissed the nurses’ action in May, saying that by allowing healthcare professionals to take individual precautions, including the option of wearing an N95, the precautionary principle was being respected.

Recognizing the virus’s capacity in the air is critical and long-standing, said Dr. Abdu Sharkawy, an infectious disease consultant at the University Health Network and an assistant professor of medicine at the University of Toronto. Still, he said, action is far more important than any academic debate.

“It doesn’t matter if we call it airborne or not. What matters most is the recognition that a stronger framework for the level of protection of PPE and the importance of optimal ventilation is essential to control the continued transmission of this virus ”. He added: “Omicron has set the degree of urgency for this in a really big way.”

On Wednesday, OHA’s Dale said he expects Directive 5 to be revised to replace the new interim measures.

As in the long-term care sector, which has been hard hit, the deadliest outbreaks in Ontario hospitals occurred before most patients and healthcare workers were vaccinated. There have been relatively few outbreaks in any environment since this spring.

However, experts are increasingly concerned that Omicron’s ability to infect people who have been vaccinated sets the stage for new waves of outbreaks in vulnerable settings such as hospitals and long-term care.

According to the Ontario Science Table, the variant is now dominant in the province, with cases growing at a rate that doubles every 2.2 days.

For some experts, Moore’s recognition of the possibility of the virus spreading through the air was too little, too late.

“I was livid that he’s standing there with a blue rectangle on his face saying maybe there is spray. It seemed really untrue to me, ”said Colin Furness, an infection control epidemiologist at the University of Toronto, noting that Moore was wearing a loose mask at Wednesday’s press conference, not an N95.

He said public health officials have long resisted updating the guidelines.

“We are slaves to these guidelines and this is hurting people.”

Ed Tubb is an Assignment Editor and Crime and Justice Focused Contributor for Star. He is based in Toronto. Follow him on Twitter: @edtubb

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