Posted on January 23, 2021 at 5:00 a.m.
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After recognizing in early January that aerosols play a role, but limited, in the transmission of COVID-19, the National Institute of Public Health of Quebec (INSPQ) is revising its recommendations regarding the protection of healthcare workers . A much awaited opinion, while several unions have been calling for months to extend the use of the N95 mask. And that an employee who chose to wear the N95 was asked not to wear it anymore, learned Press.
“It’s not going fast enough. We keep intervening with the Ministry of Health and the CNESST to say: “What are you waiting for to tighten up the protection rules? ”, Says Jeff Begley, president of the Federation of Health and Social Services (FSSS-CSN).
“We want to have access to respiratory protection for COVID patients. We are still waiting for them to change their policy, ”denounces Linda Lapointe, vice-president of the Fédération interprofessionnelle de la santé du Québec (FIQ). She says she wrote to the Minister of Health and Social Services, Christian Dubé, on January 12, to tell him to hurry on this issue.
At the beginning of January, the INSPQ certainly recommended the wearing of a more efficient surgical mask (level 2) for workers working with patients with COVID-19. But the unions are demanding more.
Worried workers
Since the start of the pandemic, 36,872 healthcare workers have contracted COVID-19 in Quebec. Dieu Huy Phan has been a home care assistant for 11 years in Montérégie. He loves his work. This is why he continues to exercise it in times of pandemic, even though he is 61 years old, has diabetes and is a caregiver to his sick mother.
For protection, however, Mr. Phan decided to wear an N95 mask at work during the second wave rather than the surgical masks provided by his employer. He pays for his masks out of his pocket. Without this protection, he fears contracting the disease.
Mr. Phan notes, for example, that he goes to private seniors’ residences, places at risk. He is close to patients when providing care. However, he was shocked a few weeks ago when a superior asked him not to wear these masks.
She told me it was going to scare others. That I was sending the wrong message.
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Dieu Huy Phan, home care assistant
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Mr. Phan does not consider himself to be a “bitch.” He recognizes that several measures put in place since the start of the pandemic by his CISSS and by the government are effective and valid. But for the masks, he just does not understand. “We are told that we are lucky to have us at the front. But me, if I am forbidden to wear the N95, I will leave. I’m at risk, ”he says.
For Mr. Phan, all patient attendants working closely with patients should have access to N95 masks.
PHOTO CHARLES KRUPA, ARCHIVES ASSOCIATED PRESS
At the Ministry of Health, it is stated that “wearing the N95 mask is only recommended when performing medical interventions generating aerosols”.
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At the CISSS de la Montérégie-Est, where Mr. Phan works, it is reported that “N95 masks must always be subjected to a ‘fit test'” and that “the personal protective equipment used in our facilities must be approved and provided by the facility ”. At the Ministry of Health, it is added that “to date, wearing the N95 mask is only recommended when performing medical procedures generating aerosols (IMGA)”, such as intubation.
A scientific debate
In a report published on January 8, the INSPQ concluded that COVID-19 “is transmitted mainly during close contact between people, less than two meters away, and prolonged for more than 15 minutes”. The data “also suggest that distant aerosol transmission could occur”, one reads, but “it is unlikely that it is beyond a few meters”.
COVID-19 is therefore not transmitted by aerosols as easily as diseases such as measles or tuberculosis. “With measles, you can infect someone who has been in the same shopping center as you, even if you have not been in close contact with him,” says Dr.r Jasmin Villeneuve, from the INSPQ.
If COVID-19 had been transmitted by aerosols so easily, protection recommendations would have had to be revised from top to bottom. But we are not in this register here, notes the Dr Villeneuve. Analyzes are still underway to check which situations involve risks and where protection recommendations could be adapted, he explains. “How will that be reflected in the field? Measures are under discussion, ”says Dr Villeneuve.
The latter underlines that scientific opinions diverge on the subject. No clear trend is emerging. “Since the start of the pandemic, when there is a clear trend, we do not wait for the end of the analyzes: we immediately change our recommendations”, underlines Dr Villeneuve.
The latter says that in growing environments, it is possible to “take control” even if not all workers wear the N95.
Some argue for wearing the N95 mask for everyone. But there are other solutions that work.
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The Dr Jasmin Villeneuve, from the National Institute of Public Health of Quebec
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The Dr Villeneuve adds that wearing the N95 or N100 mask, which is sometimes uncomfortable and limits communication, also has setbacks that must be analyzed.
Microbiologist, biochemist and researcher in the prevention of chemical, biological, mechanical and physical risks at the Robert-Sauvé Research Institute in Occupational Health and Safety (IRSST), Geneviève Marchand has been advocating since March for better protection of workers.
She explains that if the debate on aerosol transmission has lasted so long, it is because researchers do not agree on the definition of an aerosol. Some people talk about particles of 5 micrometers and less. Others are particles up to 100 micrometers in size. At the beginning of January, the INSPQ ruled: are considered as aerosols particles whose size can go up to 100 micrometers.
Mme Marchand welcomes this conclusion. “It’s nice to recognize a mode of transmission, but you should change your approach to protection and prevention,” she comments.
Mme Marchand admits it: the N95 mask “is not the only solution”.
This is one of the tools that should be put in place. But we must keep hand washing, washing surfaces, distance, ventilation …
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Geneviève Marchand, microbiologist at the Robert-Sauvé Research Institute in Occupational Health and Safety
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Even though aerosols play a role in the transmission of COVID-19, the N95 mask is not necessary to go to grocery shopping or to go to school, she adds. “But in places with a lot of cases, yes. I think the N95 should be the voice to take, ”she said.
In an article published Tuesday, the Union of Employees of the McGill University Health Center says more than 760 workers at the hospital have contracted COVID-19 so far. “With scientific institutes and specialists who, one by one, come to the conclusion that COVID is also transmitted in aerosol mode, the position of the Government of Quebec is untenable. You need N95 or better masks for anyone who works in a red or yellow area of a healthcare facility, “writes the union, which believes” current guidelines that seriously limit the wearing of N95 or higher masks are in part. responsible for the contamination that occurs within the health network ”.
Some numbers
Number of N95 masks used every day in Quebec: 20,000
Quebec reserve of N95 masks as of January 20: 5.7 million
Source: Quebec Ministry of Health and Social Services
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