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December 3, 2020

Governments must update their guidance for health care workers to recognize - and respond - to the science on COVID-19 transmission


On December 2, the following letter was sent to individual provincial ministers of health by the leaders of the Canadian Federation of Nurses Unions and the nurses unions of Newfoundland and Labrador, Nova Scotia, Prince Edward Island, New Brunswick, Ontario, Manitoba, Saskatchewan, and Alberta.

Dear Minister of Health,

Your Urgent Intervention is Required – Governments must update their guidance for health care workers to recognize – and respond – to the science on COVID-19 transmission

Since March 2020, when the COVID-19 was declared a pandemic, we have learned a great deal about the virus. Recently, scientists at the Public Health Agency of Canada (PHAC) have confirmed that one of the main routes of transmission of COVID-19 is through close-range aerosol transmission (within 6 feet) when an infected person “coughs, sneezes, sings, shouts, or talks”. This is a particular risk in the absence of adequate ventilation measures in enclosed spaces with infected individuals because potentially infectious aerosol particles can be “suspended in the air” and build in concentration over time.

The PHAC’s updated position states: “The droplets vary in size from large droplets that fall to the ground rapidly (within seconds or minutes) near the infected person, to smaller droplets, sometimes called aerosols, which linger in the air under some circumstances. Infectious droplets or aerosols …may be inhaled into their nose, mouth, airways and lungs.”

Within health care settings current guidance indicates where there is the potential for the inhalation of aerosols that contain the COVID-19 virus (SARS CoV-2) respiratory protection (N95s) is required. The PHAC has now confirmed that aerosol transmission of COVID-19 may be occurring in health care settings in the absence of complex medical procedures (aerosol-generating medical procedures (AGMPs)).

Given the updates to the scientific evidence, there is a very real risk of health care workers inhaling the virus since their work requires them to come into regular, close, repeated, and prolonged contact with patients/residents/clients presumed or confirmed as having COVID-19. The facilities they work in contain enclosed rooms that may also lack adequate ventilation.

With the risk of non-AGMP aerosol transmission established, health care workers must be provided with respiratory protection (fit-tested N95s) when caring for presumed or confirmed cases of COVID-19. Federal and provincial guidance must be immediately updated to reflect this change. However, despite the evidence, federal and provincial guidance for infection prevention and control for health professionals have yet to be updated, more than a month after the PHAC updated the evidence.

Safeguarding the occupational health and safety of our health care workers – and by extension their patients, must be a priority for this government if we are to prevent further outbreaks among workers and their patients/residents at facilities across Canada.

Minister, you have the power to make a difference. We ask for your urgent intervention to ensure the update of the health care worker guidance to protect workers and reflect the latest science.

Unless we act now, governments will be remembered for their moral and ethical failure during COVID-19 for which they will be held accountable.

Yours sincerely,

Linda Silas
President, Canadian Federation of Nurses Unions

Debbie Forward, President
Registered Nurses’ Union Newfoundland and Labrador

Janet Hazelton, President
Nova Scotia Nurses’ Union

Paula Doucet, President
New Brunswick Nurses Union

Barbara Brookins, President
Prince Edward Island Nurses’ Union

Vicki McKenna, President
Ontario Nurses’ Association

Darlene Jackson, President
Manitoba Nurses Union

Tracy Zambory, President
Saskatchewan Union of Nurses

Heather Smith, President
United Nurses of Alberta