Group items tagged

Then the province began methodically destroying the goods. They’d reached their best-before date, which for most N95s – it varies among manufacturers – was five to 10 years.

By 2013, according to the annual auditor’s report, Ontario had disposed of 80 per cent of the stockpile because they were deemed not up to 100 per cent par. Elastic bands had degraded and were susceptible to snapping. The crucial filtering material had deteriorated.

Now the Centers for Disease Control has changed its protocols, its National Institute for Occupational Safety and Health branch concluding from controlled testing that expired N95s remain effective beyond the manufacturer’s expiry date if they’ve been stored properly. Indeed, in a crunch – and this is a crunch – health care workers should try bandanas and scarves.

Whether the health ministry ever replenished that cache or to what extent is unclear. But obviously not to the level of acute preparedness or front-line workers wouldn’t be issued two ordinary surgical masks a day, as one nurse told the Star, and the government wouldn’t be scrambling to outbid for massive replacement delivery – at least five million masks on order, Premier Doug Ford said Wednesday.

But they’ll take weeks to get here, even with production cranked up by manufacturers globally. By which time, who knows what havoc will have unfolded in Ontario hospitals, as the peak of the coronavirus pandemic rolls across the province.

Possamai, a forensic investigator by profession, was senior advisor to the SARS Commission

“The ministry was in the process of destroying expired stock prior to the start of COVID-19,’’ said Travis Kann, in an email. “Once the situation in China was known, the ministry paused all destruction activities. They remain paused.’’

Kann added that the ministry is consulting with experts to evaluate how or if the remaining expired stock may be used, in training or in lieu of surgical masks, with the un-expired N95s reserved for patients.

Another former health official during the previous Liberal regime told the Star, on background, that the N95s were deliberately not got rid of, so they could be used for training and testing purposes as part of emergency planning and preparedness activities.

“The government, federally and provincially, has not been transparent about how many of these N95 masks are still around. They didn’t move in an expeditious fashion. They’ve been flatfooted. We should be on a war footing, to see how many of these expired respirators can still be used and get them out the door.

“Weeks ago, as soon as they realized something pretty awful was coming, they should have confiscated all the supplies of N95s that were in the marketplace. Why could an ordinary person walk into a hardware store and buy an N95 when we needed those for health-care workers. Now they’re begging for them. Did nobody realize, hey, we might need these.’’

He adds: “Both at the provincial and federal level, there was huge funding of pandemic planning, workshops and committees. They took on the knowledge of the SARS commission and other best practices. But the fact that there’s such a shortage of N95s and lab testing and respirators tells me nobody really thought about the practicalities of what we’re going to do during a pandemic.

“The central message of the SARS commission was the precautionary principle. Which is that you err on the side of precaution when there’s no scientific certainty.’’

The increase in hospital-onset infections associated with the Omicron variant belies the fact that nosocomial transmission of SARS-CoV-2 has been part of the COVID-19 pandemic from the beginning.

The frequency of hospital-based transmission, however, is likely unappreciated. This is because few hospitals systematically test patients throughout and following their hospital stays. Most hospitals only test patients for SARS-CoV-2 at the time of admission and therefore may miss some infections acquired after admission, especially because approximately 40% of SARS-CoV-2 infections are mild or asymptomatic and thus do not trigger repeat testing. Furthermore, hospital stays for many non–COVID-19–related conditions are short, so some infections will only develop after discharge and will be missed or misattributed to posthospital exposures.

In a study from the University of Oxford that evaluated 803 inpatients and 329 staff members from 4 hospitals who were diagnosed with SARS-CoV-2 during a 7-week period in late 2020, an estimated 188 of 803 (23.4%) patient infections were deemed to potentially be nosocomial.2

Most hospitals have already implemented multifaceted infection control programs to prevent nosocomial SARS-CoV-2 transmission. These typically include universal mask wearing, strong encouragement or mandates for staff vaccination, requiring symptomatic staff members to stay home, contact tracing, and testing of all inpatients at admission. These measures have markedly reduced hospital-based transmissions, but the increase in nosocomial infections associated with the Omicron variant raises the urgent question of what more can be done to protect patients and staff.

Hospitals could invoke 3 additional measures to further reduce the risk of nosocomial SARS-CoV-2 transmission as the Omicron variant continues to surge

Mandate Booster Doses

2 doses of messenger RNA vaccine only lowered the odds of symptomatic disease by 6%

Booster doses, however, increased protection to 68% against symptomatic disease

Booster effectiveness does decrease over time, declining to approximately 50% after 10 weeks from boosting, but this is still substantially more than the protection afforded by 2 shots alone.

booster doses will likely decrease transmission of Omicron in addition to preventing infections. In an analysis of 2225 people infected with the Omicron variant in Denmark, household members who had received a booster were less likely to become infected compared with vaccinated household members who had not received the booster after adjusting for age, sex, and the vaccination status of the source (25% vs 32%, respectively

Test More Frequently

Some hospitals not only test patients at admission but continue testing patients every few days thereafter to detect cases that were incubating prior to admission (and thus missed by the initial admission test) as well as cases acquired in the hospital.

The Omicron variant’s short incubation period (median of 3 days) and high contagiousness makes this more critical than ever. Detecting newly positive patients is essential because patients are most contagious within the first few days of infection. Rapidly detecting newly infected patients allows facilities to quickly isolate these patients to prevent transmission to staff and other patients.

This is especially important for patients in shared hospital rooms. The estimated risk of infection for a patient admitted to a shared room with an occult positive SARS-CoV-2 carrier is 30% to 40%. Serial testing of patients in shared rooms could help decrease this risk. Placing portable high-efficiency particulate air filters between patients in shared rooms may also decrease transmission risk. There may also be a role for more frequent testing of asymptomatic staff; however, the discovery of additional positive staff members may further exacerbate hospitals’ current staffing crises.

Implement Universal Use of N95 Respirators

Surgical and procedural masks reduce viral exposure by an estimated 40% to 60% depending on mask fit.

Outbreaks have also been documented in many hospitals despite universal mask wearing policies.8

The greater contagiousness of the Omicron variant magnifies the risk of mask failure.

it does mean that smaller amounts of exposure are likely able to lead to infections. The solution is more effective respiratory protection. N95 respirators decrease aerosol exposures by 95% or greater, far exceeding the protection provided even with mutual mask wearing by patients and clinicians.5 N95 respirators have the further advantage of providing more effective source control compared with surgical masks.9 This means N95 respirators can also protect patients from occult positive clinicians and other hospital personnel and therein further reduce nosocomial transmission.10 Some object that universal use of N95 respirators is not practical because they are too uncomfortable to wear for long periods. This likely reflects many hospitals’ preferential use of older, hard-shell N95 models. Newer soft-shell models are considerably more comfortable and breathable.

These measures all work in conjunction in the hierarchy of infection control.

This is of particular urgency because Omicron outbreaks in hospitals further exacerbate critical staff shortages and threaten hospitals’ capacity to accommodate the unprecedented surge in inpatient admissions.

Ontario, which includes Canada's largest city Toronto, said in 2007 it would buy 55 million N95 masks and other medical supplies to prepare for future epidemics. A report by the province's auditor general, completed in December 2017, found that more than 80 percent of that stockpile had expired.

Officials did not say how many masks remained in the stockpile.

"You are correct in your understanding that the N95 masks purchased 13 years ago have expired," Ontario's health ministry said in a statement to Reuters.

Asked whether provincial officials have any masks on hand, the ministry did not answer directly. It said health organizations are getting their usual supply shipments, adding: "We are working with them and our supply chain partners to ensure they continue to have adequate access to supplies as they continue to effectively respond to COVID-19," the disease caused by the coronavirus.Ontario Nurses' Association president Vicki McKenna said in an email, "We believe that there is a supply problem but government officials will not confirm supply. ... This question is asked at every meeting with ministry officials."The spread of the coronavirus has triggered a global shortage of N95 respirator masks. The United States, for example, has said it has about 12 million, but needs roughly 300 million.

Nurses and occupational health and safety experts across the country are indignant that guidance from the Public Health Agency of Canada (PHAC) asks health-care workers to wear surgical masks rather than N95 respirators. They say this leaves them less protected than the American Centre for Disease control and European counterparts.

Guidance from the PHAC says that workers should wear the more protective N95 respirator masks for certain close procedures only — partly because the public health agency wants to conserve supply of the masks.

Most of the time PHAC guidance tells workers to wear surgical masks when coming into contact with COVID-19 patients. The guidance has workers wearing the more protective N95 respirator masks for certain close procedures only. This is partly because the public health agency wants to conserve supply of the N95 masks.

The guidelines are based on science: Research that so far shows COVID-19 transmits from one person to another by contact with droplets containing the virus — like the product of a person’s sneeze from up close. The evidence says breathing in air containing small amounts of the virus is not nearly as likely to cause illness.

Hundreds of small companies have started making masks. A General Motors joint venture in southwestern China built 20 of its own mask-making machines and began bulk production.

This grant will support production and distribution of an Ontario-made medical respirator designed to keep healthcare workers safe, without compromising on comfort or breathability."

"After years of research and development, O2 Canada from Kitchener partnered with Jomi Technical Services in Barrie to produce a game-changing piece of protective equipment that allows a person wearing the device to breathe easily while offering excellent protection. I am grateful that Jomi could retool their space to hire more staff and make this comfortable piece of equipment that is also environmentally friendly."

Ontario is also investing $1,475,000 in Concord-based RONCO to help the company establish the production capacity to manufacture surgical masks and respirators at its Ontario plant, replacing production that is currently happening in China. With Ontario's support, the company will establish three surgical mask production lines to make more than three million masks monthly and will add one N95 respirator production line to make up to 260,000 respirators monthly.

O2 Canada’s respirator has an internal filter, plus an external filter that can be replaced without removing the base respirator, making it a reusable and sustainable piece of personal protective equipment (PPE).

Thornhill Medical (Toronto) Thornhill Medical is medical technology company located in Toronto that manufactures ventilators. It was created as a spin off from the University Health Network. It manufactures a portable integrated Intensive Care Unit product that includes a unique, oxygen-conserving ventilator and complete vital signs monitoring in a single, portable battery-operated system. Its products have applications in both hospitals and remote locations. It is working to supply Canada’s need for this equipment.

"This surplus in capacity means that we can now look at testing more people, particularly priority populations, including health care staff, residents and staff in long-term care and retirement homes and Indigenous communities," wrote Chazan.

"We expect to have more to say about a new testing strategy that makes full use of this capacity shortly."

Ontario has administered a total of 81,364 tests, more than any other province, Williams said.

Of the 614 total current cases that have required hospitalization: 233 are in intensive care units. 187 are on a ventilator. A shipment of badly needed medical masks is expected today.

Indoor workplaces where close contact is unavoidable – such as factories, warehouses, meat-packing plants, long-term care homes and hospitals – should shift to continuous respirator mask use.

Each workplace also needs to provide large “safe rooms” with upgraded ventilation and filtration, with enough space for distancing so that masks can be safely removed during breaks.

Upgrading ventilation and filtration should be done primarily in places where continuous masking is impossible (restaurants, bars, congregate living environments) or challenging (daycares, schools). Any indoor space where masks will be removed needs government-mandated ventilation standards, and government subsidies to help it meet those standards quickly.

Rapid testing should become standard immediately prior to entering any indoor space where masks will be removed, including restaurants, bars and in-home gatherings of different households.

This would require governments to make massive volumes of rapid tests easily available, free of charge. In addition, regular screening through rapid testing three times weekly would help keep the virus out of schools, which are the most challenging infection-control environment.

An aggressive approach to public education coupled with transmission reduction and a high vaccination rate is our best chance to combat Omicron. The point of these interventions is not to restrict personal freedoms. It’s to preserve them, and prevent lockdowns or heavier restrictions.