Inside Ontario’s hospitals, health-care workers are asking: Will we be protected from COVID-19?
The pandemic caused by the SARS-CoV-2 virus created a global shortage of personal protective equipment that has left hospitals scrambling, governments arguing, and front-line workers anxious. While gowns and face shields are essential components of PPE, masks have generated the bulk of the controversy. Unions and public-health experts have sparred publicly over the necessary levels of protection; the United States blocked a shipment of three million masks from crossing the border only to release it later; and hospitals have asked staff to “conserve” PPE while they develop processes to reuse typically disposable supplies.
Public confusion was created when the United States’ Centers for Disease Control and Prevention reversed course and recommended that Americans wear masks in public — a suggestion Donald Trump questioned just moments after announcing it. Canadian experts have also shifted their messaging. Theresa Tam, the country’s chief public-health officer, now suggests that people wear homemade “non-medical” face masks (basically, bandanas or old T-shirt material that can protect others around you) in public situations where social distancing is difficult, such as on public transit or at the grocery store.
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The confusion around mask use is unfortunate, because it’s a critical public-health issue. Each virus has its own profile for “trophism” — where it likes to hang out. Some, like rabies, prefer the brain, while others, like echovirus, prefer the heart. The new coronavirus that causes COVID-19 loves to live in lungs. When you cough, sneeze, or even talk, particles of water from your lungs exit your mouth and enter the atmosphere.
In the atmosphere, particles can either fall by gravity and land on surfaces, or evaporate, leaving only the virus. We call the virus the “nuclei” and the water the “droplet.” Droplets have infectious nuclei that are very light and float around after the droplet evaporates. That’s what makes a virus airborne.
Temperature, humidity, and airflow all affect whether a droplet becomes airborne. We know that the coronavirus is usually in a big enough droplet that it falls to the floor. But, when there is coughing or airway manipulation going on (in an intensive-care unit, for example, or in the back of an ambulance), these droplets get small enough to be considered airborne, or aerosols.
Airborne viruses can infect through inhalation more easily than droplet viruses. That’s why health-care workers need more expensive masks, called respirators, to protect themselves. Droplet viruses — the kind most of us are likely to encounter — are stopped by surgical masks, which are cheaper, easier to acquire, and more comfortable to wear.
This is where shortages come in. The SARS Commission — formed by the province after the 2003 SARS outbreak — recommended that we take a precautionary approach in pandemics: that is, wear the most protective mask possible. Shortages have made that approach untenable.
Watching the news, it’s clear that each country is taking its own approach. Local and government leaders have done a poor job of communicating decisions and instilling confidence in the public. The CDC, the World Health Organization, and the Public Health Agency of Canada have changed their guidance many times, and a lack of transparency about the supply chain has created distrust among front-line workers.
During preparations for Ebola, hospitals across Ontario acquired PAPRs, powered air-purifying respirators that look like something out of Hollywood. The full-head garment resembles a motorcycle helmet with a vacuum hose that’s attached to a battery pack and fan worn at the hip. It is very effective and would be ideal for use in pandemics marked by transmission mechanics and risks that are not well understood. Sadly, these reusable devices weren’t maintained at most hospitals and now sit idle with expired components or dead batteries.
We find ourselves now making do with what we have: imperfect, evolving science and dwindling supplies. Most Ontario hospitals recommend respirators only for high-risk activities more likely to involve aerosolization; droplet masks are suggested for everything else. This isn’t unreasonable, given the situation we find ourselves in. The highest-quality masks, which aren’t of benefit to the public, must be reserved for front-line health-care workers to keep them safe. Governments are now working around the clock with industry partners to produce the masks locally. As these efforts continue, clear, transparent information will help us all breathe easier.