Canada is scrambling to secure and deliver protective equipment for health-care workers battling the COVID-19 crisis. But once those masks and gloves arrive on the front line, some are worried they won’t be entitled to them.
“Registered nurses come first. Then you start to walk down the list afterward; there are people down that list,” said Jerry Dias, president of Unifor, which represents nearly 30,000 health-care workers in hospitals, long-term care facilities and emergency medical services.
“There’s no question the priority is giving to nurses and doctors. The problem is, it doesn’t do anything to those workers at the hospital being exposed to the same thing.”
The workers “falling between the cracks” range from those who deliver food and do laundry at hospitals to cleaners and long-term care employees, Dias said.
Canada has sourced more than 230 million surgical masks amid the pandemic, and over 16 million have been delivered to date, according to government figures as of April 7. Prime Minister Justin Trudeau said the country is expecting a shipment of 500,000 surgical-grade masks from U.S.-based firm 3M as early as April 8, and 2.3 million will be in Canada’s possession by the end of the week.
There has been a growing outcry from hospital workers across the country that there isn’t enough personal protective equipment (PPE) to go around as hospitalizations for COVID-19 rise.
Workers at the bottom of the list are just are scared, Dias said, and deserve protection, too.
“Somehow, they’re categorized as ‘not as vulnerable,’ but if you look at the number of people in health care who contract COVID-19, it’s workers in all of these classifications,” Dias said.
Much of Canada’s health system operates at a provincial level, so the guidelines from public health authorities can differ.
Measures from the Ontario Health Ministry say: “All health-care workers who are within two metres of suspected, presumed or confirmed COVID-19 patients shall have access to appropriate PPE.” Specific job roles are not mentioned, just “front-line health care workers.”
The ministry says “the employer will not unreasonably deny access to the appropriate PPE” after a determination is made as to what’s needed to care for a patient.
By contrast, in British Columbia, government guidelines say cleaners and “other areas of patient transit” (i.e. those working in other wards and corridors) should be provided medical masks, gowns, heavy-duty gloves and eye protection.
In the U.S., which has become a global hot spot for the virus, direction on protection methods and equipment is similarly spotty. A union representing hospital workers in Chicago told Reuters that while there are protocols for keeping housekeepers and cleaners safe, there’s often a breakdown of communication, leaving workers with conflicting messages.
At some hospitals in New York, where the death toll has surged above 5,000, nurses are tasked with taking out the trash from COVID-19 patients’ rooms themselves to preserve PPE, according to Reuters.
Michael Hurley, president of the hospital division of the Canadian Union of Public Employees (CUPE), said there are inconsistencies about who is allowed the equipment and when.
“We had one case of a pregnant cleaner who asked for the N95 mask to clean a COVID-19 patient’s room in the ICU and was denied it. These are really serious issues that people are grappling with,” he said.
“So while there is a supply shortage, how the equipment is allocated, how are decisions made and who’s consulted about what the alternatives are… it’s something health-care workers feel locked out of.”
As hospitalizations increase and studies reveal new possibilities about how the virus spreads and how long it can remain on surfaces, Dias believes it’s becoming clear that registered nurses and physicians aren’t the only ones at increased risk anymore.
“Because I’m not in an operating room doesn’t mean that I’m not exposed,” he said. “The people cleaning the floors, the people doing the laundry… all of these people are in the same environment where people are dying. It’s hard to categorize who is more important.”
Improving the insufficient supply of PPE Canada-wide is still the natural first step, both Dias and Hurley agree. Efforts are underway in a number of ways, including new manufacturing being done in Canada and a massive order of masks from China.
Once validated, shipments of PPE will be distributed to provinces and territories “rapidly,” the Public Health Agency of Canada told Global News in an email.
The government has completed more than 23 requests from the provinces for “immediate short-term needs” of PPE items as of April 7, which were pulled from the national emergency strategic stockpile.
There is a “framework” for how the government will allocate the supplies to provinces and territories once they arrive, Canada’s deputy chief public health officer Dr. Howard Njoo said Tuesday, but he did not provide any further details.
He said due to the “fluid situation,” exact numbers on deliveries differ “from one day to the next.”
“There’s a mechanism that exists to get medical equipment to provinces who need it, depending on where the need is,” Njoo said. “We are always ready as a country to meet those needs.”
Public Services and Procurement Minister Anita Anand said Tuesday that Canada’s fight to secure PPE has become a tug-of-war with other countries facing shortages. She said that while ordering equipment does not guarantee a delivery, Canada is taking “very serious steps” to ensure what is ordered meets requirements.
Hurley acknowledged that based on sheer demand, there’s room for some conservation of PPE items as the health crisis lingers. He suggested that simply limiting the number of people who enter a COVID-19 patient’s room could help, leaving room for those “other” hospital workers to fit into the rationing.
“But the framed directive to hospitals in Ontario, at least about PPE… it really only applies to one job class. It doesn’t deal with the multiplicity of roles in this environment,” he said.
“People are very, very anxious about it.”
— With files from the Canadian Press