It was just going to be another routine day for a geriatric specialist. Dr. C (who prefers to remain anonymous) woke up, got her three children ready for school, kissed her wife on the way out the door. First stop was the local Long-Term Care (LTC) facility, where she was in charge of checking on the elderly patients one-half day per week.
There was a bit of a twist to this morning, however. COVID had been making the rounds of the seniors’ homes in the region and this facility was no exception. She wasn’t going in unprotected, as surgical masks were provided to protect her from the patients and vice versa. These masks, sometimes known as medical or procedural masks, were common with both health-care workers (HCWs) and the public, their sky blue vivid on many faces. This, along with a plastic gown and a pair of gloves, were what she was given to protect herself from the COVID virus.
She decided to leave the sickest patient, Benny, for last. His roommate had been diagnosed with COVID, but Benny had not, though he was feeling unwell. Despite public health assurances that COVID was not airborne transmitted, someone had done some protections: they had placed a HEPA filter in the room and opened the window. On Benny’s bedside table was his breakfast, still uneaten three hours after being left there. Dr. C sat down and held the juice to his lips, which he sucked back greedily. “He’s too weak to eat or drink,” she thought to herself, spending the next 10 minutes spoon-feeding him and providing hydration. Although he wasn’t sneezing or coughing, and she was wearing all the right gear she had been told would protect her, she remembers thinking, “this feels dangerous.”
Four days later, she started to feel off.
__________________________________________
Obligations of employers 3(1) Every employer shall ensure, as far as it is reasonably practicable for the employer to do so, (a) the health, safety and welfare of (i) workers engaged in the work of that employer … and (iii) other persons at or in the vicinity of the work site whose health and safety may be materially affected by identifiable and controllable hazards originating from the work site (all bold text in this article comes from Alberta Occupational Health and Safety Legislation).
__________________________________________
Laws that should have prevented COVID infections in the workplace already exist. Known as Occupational Health and Safety (OHS) regulations, they exist across the Western world, built piecemeal over time as various illnesses and injuries were unveiled as related to the workplace. Each law, requiring employers to protect their employees from harm, exists because advocates such as labour leaders, unions, public health officials, politicians, lawyers and bereaved families fought for protections after harm had become obvious to all.
Initially, the primary focus was on factories, industrial sites and mines, with heavy duty machinery and high-risk activities. Later, they turned to unusual illnesses such as black lung in coal workers and lung cancer in uranium mine workers. Requirements for Personal Protective Equipment (PPE) and other safety rules dramatically improved the health of workers in these industries.
The rules are comprehensive, stipulating every aspect of an employer’s obligation to workers, such as how to safely store explosives, how many toilets must be on a remote work site and, yes, how to protect workers from inhaled hazards, including asbestos, spray paint and respiratory viruses. And they have been effective – U.S. records show a 60 per cent drop in workplace fatalities, and a 40 per cent drop in injury and illness, in the 30 years since its Occupational Health and Safety Act was enacted, despite a doubling of workers.
In Canada, health-care worker (HCW) safety was thrust into the limelight during the 2003 SARS coronavirus epidemic. An illness transmitted almost uniquely through hospital patients, HCWs and their families, the epidemic petered out through the use of airborne precautions in the hospitals, in particular universal N95 respirator masks.
To learn from this horrifying experience (438 cases, 44 deaths), the Ontario government created the Campbell Commission. It noted the strong resistance among many medical practitioners to acknowledge that SARS spread predominantly through airborne transmission. In its 1,200-page report, the commission highlighted that “The point is not who is right and who is wrong about airborne transmission. The point is not science, but safety. Scientific knowledge changes constantly … When it comes to worker safety in hospitals, we should not be driven by the scientific dogma of yesterday or even the scientific dogma of today. We should be driven by the precautionary principle that reasonable steps to reduce risk should not await scientific certainty. Until this precautionary principle is fully recognized, mandated and enforced in Ontario’s hospitals, workers will continue to be at risk.
It is painfully apparent that we didn’t learn the lesson in time for Dr. C’s visit to the nursing home. Although based in the Eastern U.S., her experience is echoed by HCWs across North America. With rare exception, almost no jurisdiction used the lessons of the past to inform its response to the new virus. Indeed, six years later, we still haven’t learnt it.
__________________________________________
Four days after her visit, Dr. C went out for her usual run, prepping for her next marathon. She felt increasingly unwell and tired during her normal route, so much so that mid-run she had to call her eldest son to come pick her up. Over the next 36 hours, she continued to worsen, with sore throat, cough, diarrhea and extreme fatigue but unlike many, she never became severely unwell. And she infected her wife, too.
A colleague attending the same LTC facility, also wearing a medical mask, was infected and spent 11 days in the ICU, retiring from medicine shortly after. Many nursing colleagues were also infected, including some who were ill for much longer, months to years. A symptom complex now called Long COVID.
_________________________________________
228(1) If the hazard assessment indicates the need for personal protective equipment, an employer must ensure that (a) workers wear personal protective equipment that is correct for the hazard and protects workers, (b) workers properly use and wear the personal protective equipment, (c) the personal protective equipment is in a condition to perform the function for which it is designed, and (d) workers are trained in the correct use, care, limitations and assigned maintenance of the personal protective equipment.
247 An employer must ensure that respiratory protective equipment used at a work site is selected in accordance with CSA Standard Z94.4-02, Selection, Use, and Care of Respirators.
_________________________________________
In reading the OHS legislation, it is clear that the employer has a responsibility to protect HCWs like Dr. C from bioaerosol hazards. There is no mention in any OHS legislation, including the quoted Alberta version, that medical masks constitute protection from an airborne-transmitted hazard like the SARS-CoV2 virus.
Medical masks were never designed as respiratory PPE and, until recently, were never purported to be such. They were designed as splash guards: to keep the wearer’s respiratory droplets from flying through the air, and to keep blood and other body fluids from spraying into the wearer’s nose and mouth (that is why they are fluid resistant).
Respirator masks, which are explicitly referred to in OHS legislation as the appropriate PPE for airborne hazards, on the other hand are designed explicitly to prevent inhalation of threats like asbestos or COVID-19. They have a much better filter than medical masks but, more importantly, they fit tight to the face, so that all air inhaled into the lungs must first pass through the filter. Loose-fitting medical masks allow air to enter through the sides, making them inherently much less safe. Ironically, it is why they are sometimes preferred by wearers: the loose fit means less breathing resistance, and less pressure on the face. But that also makes them inadequate for the purpose.
_________________________________________
Dr. C continued to work remotely a few hours a day through her illness. Her sore throat and cough quickly cleared, but the malaise and the fatigue persisted beyond the expected two weeks of recovery. She began working one day a week, but that would wipe her out for the next six days… until she tried one more time to push through.
One month into this cycle, she started reading in earnest about possibilities. It reminded her a lot of her teenage self’s recovery from Mono, which took about 18 months. Going through medical school, she had had a single lecture on myalgic encephalomyelitis (ME, formerly known as chronic fatigue syndrome), and had never even heard of Postural Orthostatic Tachycardia Syndrome (POTS). But going through her symptoms, these two syndromes correlated with her symptoms pretty well. And the new entity of long COVID.
_________________________________________
244(2) … the employer must consider (a) the nature and exposure circumstances of any contaminants or biohazardous material, (b) the concentration or likely concentration of any airborne contaminants, (c) the duration or likely duration of the worker’s exposure, and (d) the toxicity of the contaminants
_________________________________________
How is it possible for hospitals, nursing homes and other health-care employers to allow respiratory PPE that doesn’t fit the legal standard previously set for protecting workers against an airborne hazard?
Simple. They just stated (and continue to state) it isn’t airborne.
Despite the evidence of the 2003 SARS virus being airborne, and the 2007 Campbell Commission’s recommendation to treat future pandemics as airborne, the World Health Organization (WHO) explicitly asserted, over and over again, that COVID-19 was not airborne, but instead spread through contact/droplets. (Remember wiping down your groceries in March 2020? For the public, that lasted about two months, until we realized it was not useful to prevent infection.)
Except, on top of the evidence generated by 2003 SARS epidemic, there was soon a substantial increase in the evidence that SARS-CoV2 was similarly spread by airborne means. And there was also a clear lack of evidence of spread by contact/droplet: the U.S. Centres for Disease Control (CDC) famously came out with a statement that the risk of contracting COVID-19 from contact was one in 10,000.
By April 2021, the CDC and the WHO were forced to acknowledge the significant role airborne transmission played. It took until November 2021 for the Public Health Agency of Canada (PHAC) to follow suit. So, how is it still possible that the Canadian OHS laws requiring the appropriate PPE for airborne spread don’t apply?
PHAC, to this day, has never used the word airborne.
It’s implied. The “announcement” by PHAC that COVID was airborne came in a statement (notably, not in a press conference) in November 2021, describing how “how the virus can linger in fine aerosols and remain suspended in the air we breathe, much as expelled smoke lingers in poorly ventilated spaces.”
Today, the PHAC website on COVID transmission mentions breathing in particles that can linger in the air, a euphemism for airborne transmission. The section on preventing infection includes improving ventilation in indoor spaces.
But in all cases the word airborne is strangely missing.
For years, the advice to the public is to wear the “best made, best fitting mask,” terminology that only describes a respirator-style N95 mask, essential for mitigating airborne transmission. Thankfully, PHAC is now explicitly recommending respirator masks (along with medical masks) for the public. Ironically, and tragically, the public is advised to take better precautions than HCWs, many of whom are still caring for COVID patients.
It isn’t possible to determine why the word “airborne” is avoided so consistently, but the impact is clear: without that word, OHS requirements can be evaded.
Even today, if you were to walk into a room in a hospital with a COVID patient, the warning on the door would say that PPE requirements are to prevent contact/droplet transmission. No mention of airborne. No need to use an N95 respirator mask.
It results in the very strange situation of walking through hospital wards under renovation and seeing construction workers in full PPE (including an N95 respirator to protect them from construction related aerosols) while HCWs wear no mask, or an inadequate (as per OHS regulations) medical mask.
_________________________________________
Dr. C stopped working as a physician three months after her illness onset and hasn’t yet resumed. She is only upright for one to two hours per day. Something as simple as attending an online medical conference, sweeping the floor or reading a book can cause her to “crash,”, a Long COVID term that means a setback causing severe fatigue, worsening symptoms such as headache, GI distress and sore throat, and increased disability for days to weeks. It took two years to find a physician replacement for her.
As a work-related illness, an investigation was done. As part of the interview, her boss told her it was likely that she had made a mistake putting on or removing her PPE, resulting in her infection. At no point has the facility acknowledged that inadequate PPE, insufficient to prevent the airborne transmission of COVID, might have been a factor in her occupational illness.
_________________________________________
(6) If an injury, illness or incident or worker exposure occurs at a work site, the employer shall (a) carry out an investigation into the circumstances surrounding the injury, illness, incident or worker exposure, (b) prepare a report outlining the circumstances of the injury, illness, incident or worker exposure and the corrective action, if any, undertaken to prevent a recurrence of the injury, illness, incident or worker exposure
_________________________________________
None of this would matter if HCWs weren’t being hurt. Data is extremely hard to come by, but when Alberta stopped reporting HCW deaths in March 2022, 12 had already died from COVID. A report from the Canadian Institute for Health Information stated that by March 2022, 150,000 HCWs had been infected and at least 46 had died.
Disability from Long COVID is also rampant among HCWs, a profession long recognized as one of the most affected. Again, data is sparse in Canada. However, a recent United Kingdom analysis of Long COVID in HCWs indicates a prevalence as high as 40 per cent. Because the infection prevention protocols were identical, it is likely our Canadian HCWs would have fared similarly. This likely has contributed to the significant, persistent post-COVID HCW shortage.
Embedded within all OHS legislation is a system for identifying improvements to an organization’s OHS plan. Each major injury, illness or incident is to have a full investigation, and “corrective actions undertaken to prevent a recurrence.”
In Alberta, in 2021 there were 25 workplace fatality investigations by the government. None of them were for the HCWs that died from workplace infections. It is unclear why dying from an occupational injury is deemed worthy of an investigation to prevent future occurrences while dying from an occupational disease is not.
_________________________________________
The purposes of this Act are (a) the promotion and maintenance of the highest degree of physical, psychological and social well-being of workers, (b) to prevent work site incidents, injuries, illnesses and diseases, and (c) the protection of workers from factors and conditions adverse to their health and safety
_________________________________________
People are tired of the COVID pandemic. There is a desire to move on. But even as I write this, there continue to be outbreaks in Alberta hospitals and LTC facilities. It really has become more like the original 2003 SARS-1, a predominantly nosocomial (health-care facility acquired) disease – except this has now lasted six years, not a few months.
Government data shows that in the week ending Jan. 11, 2026, 44 per cent of COVID patients in hospital acquired COVID while in hospital, even though studies have shown respirator masks to be better at source control (preventing an infected person from infecting someone else).
And along with the ongoing preventable HCW infections is the ever-present danger of a new, more severe COVID wave or, god forbid, another deadly pandemic pathogen accosting the world and our health-care system. We absolutely did not learn the OHS lessons from our 2003 SARS-1 (practice) epidemic. We must learn the lessons from the COVID-19 pandemic to prevent future Dr. Cs, and the thousands like her, from acquiring a preventable workplace-acquired illness.
Ed. Note: A version of this article was originally published in the Tyee on March 27.
