WEDNESDAY,MARCH11,2020 | THEGLOBEANDMAILO NEWS | A
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 risk-
ed wasting precious resources.
Health-care workers in Ontario will now use
what’s known as “droplet precautions” to pro-
tect 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 re-
view of the scientific evidence. The province has
to ensure health-care workers are protected
while also preventing the misuse of limited re-
sources, which is why the new policy makes
sense, they said. The officials were granted ano-
nymity because they were not authorized to
speak on the matter.
The updated Ontario policy is in line with rec-
ommendations from the Public Health Agency
of Canada and health officials from other prov-
inces.
According to the policy, airborne precautions
should only be used when health workers are
performing what’s known as “aerosol-generat-
ing procedures,” such as bronchoscopies, which
require them to be close to a patient’s airway
and typically cause individuals to cough vigor-
ously.
Until this week, health-care workers in Onta-
rio were using airborne precautions to guard
against COVID-19. Airborne precautions in-
clude the use of special respirator masks,
known as N95s, as well as negative-pressure iso-
lation rooms, which prevent air from escaping
into adjacent halls.
Airborne precautions are typically reserved
for infectious diseases that spread via small par-
ticles 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 precau-
tions, as more evidence demonstrated they
aren’t necessary and could even put patients
and health workers at risk by depleting re-
sources. For instance, requiring health workers
to use N95 masks when treating anyone sus-
pected of carrying the coronavirus increases the
likelihood of running out.
With a looming worldwide N95 shortage, in-
fectious disease experts say health officials
need to conserve those masks for situations
where they are warranted. Airborne precau-
tions 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 pre-
cautions for health-care workers across the
country.
But the evidence shows that droplet precau-
tions 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 phy-
sician 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 con-
serve resources, she said.AnursewearsfullpersonalprotectiveequipmentataTorontohospitalonMar.2.Ontariohospitals
nowrequirethatworkersusesurgicalmasks,gowns,glovesandeyeguardstoprotectagainst
coronavirus.TIJANAMARTIN/THEGLOBEANDMAIL
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CARLYWEEKS
HEALTHREPORTER
By encouraging many of Italy’s
62 million people to stay home
and further drying up what was
left of the country’s already bat-
tered tourism industry, the lock-
down could increase the likeli-
hood of a recession, dealing an-
other blow to reeling global mar-
kets.
Italy’s economy, the third-
largest of the 19 countries that
use the euro currency, relies
heavily on industries requiring
the physical presence and prox-
imity of workers: tourism, man-
ufacturing and retail.
Shops, cafés and restaurants
were ordered to close at 6 p.m., a
seismic restriction in a country
that prizes its gastronomy, luxu-
ries and café culture. Giorgio Ar-
mani announced the closing of
his hotel, restaurant and bou-
tiques in Milan, citing “preventa-
tive measures adopted so far to
safeguard the health of the em-
ployees and customers.”
“I’ll do whatever they tell me
to do,” Rome florist Stefano Fulvi
said. “If I have to close, I’ll close.”
Italy also found itself increas-
ingly sealed off as other coun-
tries sought to keep infections
contained.
Malta and Spain announced a
ban on air traffic from Italy. Brit-
ish Airways and Air Canada sus-
pended all Italy flights. Austria
barred travellers from crossing
the border without a medical
certificate, Slovenia closed its
border with Italy and Albania
banned Italy air and ferry traffic.
But in China, the diminishing
threat prompted President Xi
Jinping to visit the central city of
Wuhan, the epicentre of its out-
break, on Tuesday and declare:
“We will certainly defeat this epi-
demic.”
It was the latest sign that Chi-
na is edging back toward normal
after weeks of extreme quaran-
tine measures. China reported
just 19 new infections Tuesday,
down from thousands each day
last month.
“Things are slowly returning
to normal,” said Yang Tianxiao, a
finance worker in Beijing, where
the city government is gradually
easing restrictions.
But in growing swaths of the
globe outside China, virus-relat-
ed disruptions were increasingly
the new normal. More than 100
countries – more than half of the
United Nations’ membership –
now have confirmed cases. Pana-
ma and Mongolia, which borders
China, were among the latest.
Congo and Burkina Faso also
confirmed their first cases, in-
creasing the number of infec-
tions in Africa to 105 in 11 coun-
tries.The virus reached into the cor-
ridors of power. In the United
States, several senior politicians
were self-quarantined and, in
Spain, a leading member of a far-
right party tested positive for the
virus.
A British health minister was
also diagnosed with the disease.
Nadine Dorries, a junior minister
in the Department of Health,
said she is self-isolating as she
recovers. Dorries met hundreds
of people in Parliament in the
past week and attended a recep-
tion with Prime Minster Boris
Johnson, the Times of Londonreported.
At least two top European mil-
itary commanders also tested
positive after a conference on an
U.S. military base in Germany,
and the commander of U.S. Ar-
my Europe isolated himself in
case he also was exposed. New
York Governor Andrew Cuomo
announced that the city of New
Rochelle, a New York suburb and
the biggest known cluster of U.S.
coronavirus cases, would have a
“containment centre” where
houses of worships and large
gathering places would be closed
for two weeks.
National Guard troops will
help clean surfaces and deliver
food in the area, a 1.6-km radius
around a point near a syn-
agogue, Mr. Cuomo said.
In Washington State, where 19
of its 24 deaths have been con-
nected to a Seattle-area nursing
home, Governor Jay Inslee an-
nounced new rules for screening
health care workers and limiting
visitors at nursing homes.
Seattle’s King County, the ep-
icentre of the Washington out-
break, reported an additional 74
cases and two deaths on Tues-
day, with statewide numbers ris-
ing to 267 cases and 24 deaths.
Experts believe the number of
actual cases is much higher.ASSOCIATED PRESSVirus:XivisitsWuhaninsignChinaisedgingbacktonormalafteroutbreak
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MilanonTuesday.Shops,
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wereorderedtocloseat
6p.m.inItalyaspartofa
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MIGUELMEDINA/
AFPVIAGETTYIMAGESTravis Kann, a spokesman for On-
tario Health Minister Christine El-
liott, said the in-home testing
plan, which is in its early stages, is
designed to complement out-of-
hospital coronavirus assessment
centres to “ease the pressure on
hospitals and emergency rooms.”
In parts of Alberta where call
volumes are lower, paramedics or
public-health nurses conduct
tests in people’s homes so they
don’t have to visit hospitals or
clinics, potentially putting other
patients or health-care workers at
risk, Alberta’s Chief Medical
Health Officer Deena Hinshaw
said Tuesday.
Edmonton and Calgary, which
have higher call volumes, have
set up assessment centres where
people can go for testing.
Some B.C. health authorities
have also dispatched public-
health teams to test the close con-
tacts of confirmed cases in their
homes.
Governments and public-
health officials have grown in-
creasingly concerned that hospi-
tals won’t have the staff, beds or
equipment to care for thousands
of patients if the virus sweeps
across Canada the way it has
across Italy, site of the deadliest
outbreak outside of China.
Air Canada announced Tues-
day that it was suspending flights
between Canada and Italy.
Canada’s 15 new cases reported
Tuesday comprise seven each in
B.C. and Alberta and one in Onta-
rio, bringing the total recorded
since January to 94.
In B.C., that included two men
in the Fraser Health region – one
in his 90s, and one in his 40s –
who contracted the disease de-
spite having no recent travel his-
tory and no clear links to other
cases.
“It is these community cases
that give us some degree of con-
cern,” Provincial Health Officer
Bonnie Henry said Tuesday. “But
being able to detect them is really
important, because as soon as we
detect them, we can start that de-
tailed investigation to find out
where they might have come in
contact. This helps us uncover
where other chains of transmis-
sion are in our community.”
The new B.C. cases also include
a man in his 90s who had been a
passenger on the Grand Princess
cruise ship, and two more health-
care workers at the Lynn Valley
Care Centre in North Vancouver,
where an outbreak was declared
last weekend and the country’s
only COVID-19 death was record-
ed.
B.C. Health Minister Adrian Dix
said the province has opened a
new call centre to accommodate
calls to the 811 health information
line, which have recently tripled
to about 3,800 calls a week.
Testing for the new coronavi-
rus has ramped up significantly
in the past week, especially in On-
tario, B.C. and Alberta, where
most of Canada’s cases have been
discovered.
The provinces have moved be-
yond testing only patients who
have travelled to conducting
what’s known as sentinel surveil-
lance, largely by adding COVID-testing to existing influenza
screening programs.
Ontario had tested 2,747 pa-
tients as of Tuesday, while Alberta
had conducted tests in 1,452 cases
as of Monday. B.C. had tested
2,008 people as of Friday.
“I definitely think there could
be a role for home testing,” said
Jerome Leis, medical director of
infection prevention and control
at Sunnybrook Health Sciences
Centre in Toronto.
Dr. Leis also said that virtual
screening and off-site coronavi-
rus assessment centres would be
necessary to preserve hospital
space for the seriously ill, and to
help prevent sick patients from
spreading the virus to others.
Dr. Leis was one of the co-au-
thors of a study published in the
Canadian Medical Association
Journal on Friday that found the
vast majority of 135 patients test-
ed for the new coronavirus in the
emergency departments of eight
hospitals in the Greater Toronto
Area between Jan. 20 and Feb. 19
were well enough to be sent
home right away.
Only one tested positive for
COVID-19.
“If [the emergency depart-
ment] was our only system for
caring for these patients, we
could rapidly be in a very non-
sustainable and frankly, unsafe,
situation,” Dr. Leis said.
Toronto Public Health has al-
ready performed a limited num-
ber of at-home tests for patients
who have tested positive for the
new virus.
Public-health officials do not
consider patients to have reco-
vered from COVID-19 until they
have tested negative twice;
trained tuberculosis nurses have
visited patients at home to collect
nasal and throat swabs for clear-
ance testing. Tuberculosis nurses
are trained to safely put on and
take off protective equipment as
they care for patients with highly
contagious diseases.
Adrian Sebastian, a registered
nurse and manager at Toronto
Public Health, said the priorities
during home testing are protect-
ing the nurses performing the
swabs – all of whom are outfitted
in full protective equipment –
and safeguarding the privacy of
patients.
“The worst thing would be ...
someone sees you donning and
doffing in the hallway and thinks,
‘Oh my gosh, what’s going on
here?’ They hear the news that
there’s coronavirus. It’s just going
to cause a panic in that building,”
Mr. Sebastian said.
Mr. Sebastian was on-site su-
pervising another nurse during
the at-home testing of Canada’s
second confirmed coronavirus
patient, a woman who flew home
from China with her husband in
January. He was the first patient
to be diagnosed with the virus in
Canada.
Fortunately, Mr. Sebastian said,
the couple had a garage they
hadn’t entered since returning
home.
“We got them to open their ga-
rage, we went into their garage,
prepped in the garage and we did
our business,” he said.WithareportfromEricAtkinsTesting:EdmontonandCalgary,
whichhavehighercallvolumes,
setupvirusassessmentcentres
FROMA