Dr. Kieran Moore
393 University Ave., 21st Floor
Toronto, ON M5G 2M2
Dear Dr. Moore
Re: Directive #5 Issued under Section 77.7 of the Health Protection and Promotion Act
We write to you on behalf of the Ontario Council of Hospital Unions (OCHU)/CUPE and the Service Employees International Union- Healthcare (SEIU). Together we represent over 100,000 staff working in hospitals, long term care and homecare in Ontario.
We are requesting that you urgently revise the current version of Directive #5, dated April 7, 2021, respecting the use of personal protective equipment (PPE) in hospitals and long-term care homes to mandate the use of N95 respirators for all workers who share space with known or suspected COVID-19 patients.
OCHU-CUPE and SEIU Healthcare members – which includes RPNs, clerical staff, porters, personal support workers and cleaners – are working tirelessly on the front line of the COVID-19 pandemic. Throughout the pandemic, these individuals have been exposed to unnecessary and unjustifiable risks daily due to inadequate access to PPE.
We wrote to your predecessor Dr. Williams on several occasions in the past, pleading with him to mandate enhanced protections for front line workers in hospitals and long-term care homes (see our letters dated July 21, 2020, August 4, 2020, and November 10, 2020, copies attached).
These letters were written at a time when Ontario was still facing the original SARS-CoV-2 virus. Since then, Ontario has seen the emergence of three variants – Alpha, Delta, and now Omicron – each with greater transmissibility than the last.
Indeed, according to Public Health Ontario, the omicron variant carries with it the highest number of novel mutations documented in any variant of concern, many of which have been associated with transmissibility and immune escape.
There can be little question that the risks that workers in hospital and long-term care homes face is far greater today than at any previous point in the pandemic. Even with available vaccines, these workers require high quality PPE to safely serve on the front lines of the pandemic.
We have been trying for nearly two years to have your office and Public Health Ontario recognize that COVID is an aerosol-spread disease. As a disease spread by aerosols, the simple reality is that contact and droplet precautions in healthcare settings are manifestly inadequate. A surgical/procedure mask is simply not designed to protect the wearer from aerosols. What is required are airborne precautions.
Sadly, the public health guidance issued by your Office has failed to reflect the reality of aerosol transmission. Both your Directives and the PHO IPAC guidance that underpin them senselessly deny the existence of airborne transmission as a significant factor in the COVID-19 pandemic.
However, the rest of the world has moved on, and accepts the realities of how COVID is spread.
Since the early days of the pandemic, both the Centres for Disease Control and Prevention and the European Centre for Disease Prevention and Control have recommended N95-type respirators for any person in contact with known or suspected COVID-19 cases in healthcare settings. Since July of last year, the World Health Organization has also recognized airborne transmission of SARS-CoV-2.
Even the Federal Government has recognized the role of airborne transmission of COVID-19. Today, Health Canada urges consideration for the use of N95 respirators for any individuals who care for someone who is known or suspected to have COVID-19, even outside of the healthcare setting.
The new guidance from PHAC, which supports the use of respirators in community settings, is based on the latest scientific evidence on SARS-CoV-2 variants of concern, emergent data on mask types of their respective effectiveness, and the impact of vaccination and immunity in the population. These are exactly the types of sources that you ought to have regard to in engaging in evidence-based and precautionary decision making.
Dr. Theresa Tam, the Chief Public Health Officer of Canada, has publicly stated that “the virus can linger in fine aerosols and remain suspended in the air we breathe, much as expelled smoke lingers in poorly ventilated spaces” and that “that fit to provide a good snug seal on your face and are constructed with layers of materials that can filter fine virus particles are best for preventing or reducing the amount of infectious respiratory particles you may inhale.”
What Dr. Tam was describing was an N95 respirator.
As you are well aware, your duty under the Health Protection and Promotion Act is to apply the precautionary principle, particularly in the exercise of your powers under s. 77.7. Recall that s. 77.7 was created in response to the original SARS crisis, in which healthcare workers died while IPAC practitioners debated and denied the need for high-quality masks.
As a society we promised ourselves that we would not make those mistakes again.
Yet here we are.
Directive 5 should have mandated airborne precautions from the day it was issued. Today, when N95 respirators are broadly available, and variants of concern have increased the transmissibility of COVID-19 far beyond anything we imagined in 2020, there is simply no room for reasonable people to disagree: Directive 5 must be amended to provide that any health care worker who has patient or resident contact must wear a fit-tested N95 respirator.
We cannot change the mistakes of the past, but you can take the necessary steps to ensure that those same mistaken are not made in the future.
We look forward to your prompt action in this respect.
The Ontario Council of Hospital Unions/CUPE
 Public Health Ontario, COVID-19 Variant of Concern Omicron (B.1.1.529): Risk Assessment, December 1, 2021, at 1.
 Centres for Disease Control and Prevention, Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic(updated September 10, 2021).
 European Centre for Disease Prevention and Control, _Infection Prevention and Control and Preparedness for COVID-10 in Healthcare Settings – Sixth Update _(9 February 2021) at 6.
 World Health Organization, Transmission of SARS-CoV-2: Implications for Infection Prevention Precautions (9 July 2020).
 Nicole Ireland, “Canada’s mask guidance has changed. Here’s why you might need an upgrade”. CBC News, November 25, 2021 (quoting PHAC explanation for updated guidance).
 Public Health Agency of Canada, Remarks from the Chief Public Health Officer on November 12, 2021.