Use of Face-Masks by Health Care Providers Where Social-distancing is Not Possible.

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April 1, 2020

To the Minister of health, Premier and leaders of the Government of Alberta, CEO of the Alberta Health Services, Chief Medical Officer of Health of Alberta,


We, the undersigned, feel the current AHS approach to worker safety during the Corona Virus Pandemic is unnecessarily compromising AHS staff health and safety. As the numbers of COVID cases continue to rise exponentially in Alberta and across Canada, we, the AHS staff, urge the AHS organization to take the necessary measures to ensure that our frontline workers are properly protected.


According to the Joint Statement released on March 26, 2020, “All healthcare workers who are within two meters of suspected, presumed or confirmed COVID-19 patients shall have access to appropriate PPE.” The two meter recommendation is in line with the CDC definition of “close contact” for the purposes of social distancing (CDC. 2020). 


As updated research continues to show, the virus can be contracted through infected respiratory droplets - putting those within a two meter range of an infected person at risk. The virus can also be transmitted through contact with asymptomatic “carriers”, or with patients who have yet to show symptoms. 


While there has been mixed messaging about necessary mask usage, there has been a rise in health professional recommendations for donning masks when in close proximity to those outside an individual's nuclear family. The risk frontline workers who battle with COVID-19 return home where social distancing is almost impossible may pose is also great therefore the need of additional measures such as physical isolation is also starting to be recognized as several hotel and business owners have started to offer accommodations to health care workers to support this critical need in Windsor, ON. (CTV.2020)

Many of the AHS staff are therefore extremely concerned with the current policies that are being enforced by the AHS organization. As even the most basic tasks such as taking vital signs or performing the necessary Point of Care Risk Assessments involve close contact with patients that may or may not have contracted COVID, it is irresponsible to place workers in such close proximity without allowing them access to PPE such as surgical masks, especially with asymptomatic community transmission cases on the rise. 

Furthermore, as workers go from patient to patient, the risk of transmitting to multiple patients increases. Particularly for those working with vulnerable populations such as the elderly, and the immunocompromised, this presents an unacceptable level of risk.


As long as workers are unable to maintain a two meter distance from patients while carrying out necessary duties, they MUST be required to use appropriate PPE such as masks in order to protect their well-being and that of those they care for. 


A lack of adequate PPE supplies (masks, eye protection and gowns) prevent medical staff from protecting themselves from COVID exposure while at work. Current AHS policies restrict certain medical workers from using PPE even when it is available. Many AHS workers feel that these policies are at odds with government sanctioned social distancing requirements, and the latest COVID transmission research. 


As long as we cannot ensure that patients ARE NOT infected by COVID, the denial of PPE to AHS workers that are working in close proximity to unknown patients is a violation of their safety. In the long run, there may be a risk of mental health issues as many AHS staff are experiencing high stress levels, possibly developing PTSD. This is particularly relevant to nurses with close connections abroad, in Wuhan, Italy, and other epicenters of the pandemic. The first-hand accounts of the tragedies from their families and friends, combined with the denial of PPE on the frontline, are causing high levels of stress and anxiety in these individuals. 

Our objective is to encourage AHS step up protection for all medical workers so that everyone has access to necessary PPE and support of their team and management to use proper PPE at all times. At a minimum, we strongly request all patient contact at less than two meter separation will require mandatory use of surgical masks by all AHS staff.

Citations:

American Journal of Infection Control. (44 /2016 S95-S101). Indoor Air as a Vehicle for Human Pathogens: Introduction, Objectives, and Expectation of Outcome. https://vidashield.com/files/ajic-2016-supplement.pdf 

CDC. (Last Updated March 22, 2020)Interim US Guidance for Risk Assessment and Public Health Management of Persons with Potential Coronavirus Disease 2019 (COVID-19) Exposures: Geographic Risk and Contacts of Laboratory-confirmed Cases. https://www.cdc.gov/coronavirus/2019-ncov/php/risk-assessment.html

CTV. (2020, March 29). When should I wear a face mask? Mixed messaging abounds. https://www.ctvnews.ca/health/coronavirus/when-should-i-wear-a-face-mask-mixed-messaging-abounds-1.4873421 

CNN. (2020, April 1). Asia may have been right about coronavirus and face masks, and the rest of the world is coming around. https://www.cnn.com/2020/04/01/asia/coronavirus-mask-messaging-intl-hnk/index.html