A group of 239 scientists and physicians urging the World Health Organization to recognize the potential for airborne transmission of the novel coronavirus have sparked debate over how COVID-19 is spreading.
But some Canadian infectious disease experts say not to get hung up on the term “airborne,” and that the safety precautions we’re already taking to slow the spread of the virus are working.
“To the general public the word (airborne) can be pretty confusing because it suggests that COVID is gonna come through the keyhole and get you in your sleep. And well, it isn’t,” said Colin Furness, an epidemiologist with the University of Toronto.
“No one is suggesting COVID behaves anything like measles… That’s not the point (the scientists) are trying to make.”
Story continues below advertisement
In an open letter to the WHO published Monday, scientists across 32 countries called for the organization to revise its safety recommendations to mitigate possible spread of COVID-19 through aerosols — tiny, light particles expelled when people cough, sneeze or breathe that stay suspended in the air for longer periods of time.
The WHO currently classifies SARS-CoV-2 as a droplet virus, spreading through larger, heavier particles that can travel one to two metres before hitting the ground. While the organization acknowledged in a press briefing Tuesday that there is “some evidence emerging” for aerosol spread, they also say it is “not definitive.”
Furness says from what we’ve seen of COVID spread in clinical practice, it’s droplet based, but the scientists behind the letter have a point, too.
5:22 Should masks become mandatory in public spaces across the country?
Should masks become mandatory in public spaces across the country?
He said people release particles of all sizes when they breathe, and SARS-CoV-2 can be found in smaller droplets. But that doesn’t mean they are effective in trasmitting the virus, he added.
Story continues below advertisement
The scientists’ letter mentions a COVID-19 outbreak at a Chinese restaurant where customers at tables further than two metres apart became infected. While the authors use that as an argument for COVID’s spread through aerosols, Furness said that’s not necessarily the case.
“It could be (evidence of aerosol spread) but it also could be that they touched the same thing. We don’t know,” he said. “Also one would need to explain why didn’t everyone in the restaurant get sick?”
“So WHO is right that there isn’t a clear case. And the scientists who signed that letter are right saying we do need to look at this … because it could have an impact on what we say is safe.”
Dr. Bonnie Henry, B.C.’s provincial health officer, praised WHO on Monday for “doing an amazing job trying to keep up with what’s going on,” and said she thought the scientists’ letter was “trying to foment a bit of controversy.”
Henry added that while COVID does seem to be released in small droplets as well as large droplets, we don’t know how potent those smaller particles are.
“Where there’s some challenges is how much is due to the small aerosols which are transmitted when I’m close to you, or the larger droplets that tend to fall out more readily,” Henry said. “So it’s really a bit of nuance, I think.”
Dr. Zain Chagla, an infectious disease physician and an associate professor at McMaster University in Hamilton, doesn’t believe the novel coronavirus is transmitting through aerosols, at least not to an extent we should be worried about.
4:36 Majority of Canadians are uncomfortable flying, debate around whether virus is airborne
Majority of Canadians are uncomfortable flying, debate around whether virus is airborne
If it was “we’d be in trouble,” he said.
“We would have seen huge rates of transmission if this was a predominantly aerosol virus. We would have not been able to control it as well as we did.
“In reality, there is probably some degree of small aerosols that would carry COVID-19 in average day-to-day contact, but it’s probably very minimal.”
Chagla also believes the argument for aerosol versus droplet transmission is “more of a discrepancy on the exact scientific terminology” of what airborne actually means.
COVID-19 does have the potential to transmit through small particles when patients in hospital are undergoing “aerosol-generating procedures” like being intubated, Chagla said, and WHO also acknowledges that.
In those instances, health-care workers are given proper personal protective equipment (PPE), including N95 masks, which protect against small airborne particles.
But Chagla highlighted a specific case from early in the pandemic, before evidence of community spread, when health-care workers treated a COVID patient in California without proper PPE. Out of 121 health-care workers that treated the patient and performed “multiple aerosol-generating procedures,” only three got sick.
“So you had 118 individuals that … did not wear N95 masks which would be the only protection against aerosol viruses, and they did not get infected,” he said.
3:48 Coronavirus: WHO acknowledges ’emerging evidence’ that coronavirus may be airborne
Coronavirus: WHO acknowledges ’emerging evidence’ that coronavirus may be airborne
Chagla compared the situation to measles, which has a reproduction number of about 18 –meaning one infected person will infect 18 others. Measles particles can stay suspended in the air of a room for hours after an infected person leaves it, Chagla said, and you can catch the virus from a much further distance away.
Story continues below advertisement
Dr. Howard Njoo, Canada’s deputy chief public health officer, said Wednesday that evidence so far has not shown COVID to be airborne “in that classic definition in a sense as measles.”
“And certainly based on what we’ve done so far in terms of public health measures, they’ve been proven effective,” he added.
Furness said COVID-19 has a reproduction number of two, while Njoo believes that number to be in the “3, 4 or 5” range, based on the most recent epidemiology.
Other coronaviruses have smaller reproduction numbers (0.5 for SARS and 1.5 for H1N1), so Furness says that could mean there’s more going on with COVID.
“COVID is doing something to be more infective than your average respiratory virus,” Furness said. “And I’m nowhere near saying it’s airborne, because I don’t think that’s an appropriate statement. But I think those aerosols, those smaller droplets that we’re disregarding, they might be important.”
Both Furness and Chagla say there’s no indication that the general public will need to do any more to protect from potential aerosol spread of the virus.
1:13 Coronavirus: Hundreds of scientists say virus is airborne
Coronavirus: Hundreds of scientists say virus is airborne
Chagla says the points emphasized by the scientists in the letter mirror what we’re already doing, like having events outdoors rather than indoors to ensure proper air flow.
Story continues below advertisement
Face coverings become more important if we have to worry about aerosols, Furness says. And even though smaller particles can get through cloth masks, the fabric will slow them down.
“The more we can slow down the trajectory of what comes out of your mouth, the less it disperses,” he said.
Patients who are older, don’t speak English, and don’t have a high school education are more likely to experience harm during a hospital stay in Canada, according to new research.
The Canadian Institute for Health Information measured preventableharmful events from 2023 to 2024, such as bed sores and medication errors,experienced by patients who received acute care in hospital.
The research published Thursday shows patients who don’t speak English or French are 30 per cent more likely to experience harm. Patients without a high school education are 20 per cent more likely to endure harm compared to those with higher education levels.
The report also found that patients 85 and older are five times more likely to experience harm during a hospital stay compared to those under 20.
“The goal of this report is to get folks thinking about equity as being a key dimension of the patient safety effort within a hospital,” says Dana Riley, an author of the report and a program lead on CIHI’s population health team.
When a health-care provider and a patient don’t speak the same language, that can result in the administration of a wrong test or procedure, research shows. Similarly, Riley says a lower level of education is associated with a lower level of health literacy, which can result in increased vulnerability to communication errors.
“It’s fairly costly to the patient and it’s costly to the system,” says Riley, noting the average hospital stay for a patient who experiences harm is four times more expensive than the cost of a hospital stay without a harmful event – $42,558 compared to $9,072.
“I think there are a variety of different reasons why we might start to think about patient safety, think about equity, as key interconnected dimensions of health-care quality,” says Riley.
The analysis doesn’t include data on racialized patients because Riley says pan-Canadian data was not available for their research. Data from Quebec and some mental health patients was also excluded due to differences in data collection.
Efforts to reduce patient injuries at one Ontario hospital network appears to have resulted in less harm. Patient falls at Mackenzie Health causing injury are down 40 per cent, pressure injuries have decreased 51 per cent, and central line-associated bloodstream infections, such as IV therapy, have been reduced 34 per cent.
The hospital created a “zero harm” plan in 2019 to reduce errors after a hospital survey revealed low safety scores. They integrated principles used in aviation and nuclear industries, which prioritize safety in complex high-risk environments.
“The premise is first driven by a cultural shift where people feel comfortable actually calling out these events,” says Mackenzie Health President and Chief Executive Officer Altaf Stationwala.
They introduced harm reduction training and daily meetings to discuss risks in the hospital. Mackenzie partnered with virtual interpreters that speak 240 languages and understand medical jargon. Geriatric care nurses serve the nearly 70 per cent of patients over the age of 75, and staff are encouraged to communicate as frequently as possible, and in plain language, says Stationwala.
“What we do in health care is we take control away from patients and families, and what we know is we need to empower patients and families and that ultimately results in better health care.”
This report by The Canadian Press was first published Oct. 17, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
CALGARY – Alberta’s health minister says a new agency responsible for primary health care should be up and running by next month.
Adriana LaGrange says Primary Care Alberta will work to improve Albertans’ access to primary care providers like family doctors or nurse practitioners, create new models of primary care and increase access to after-hours care through virtual means.
Her announcement comes as the provincial government continues to divide Alberta Health Services into four new agencies.
LaGrange says Alberta Health Services hasn’t been able to focus on primary health care, and has been missing system oversight.
The Alberta government’s dismantling of the health agency is expected to include two more organizations responsible for hospital care and continuing care.
Another new agency, Recovery Alberta, recently took over the mental health and addictions portfolio of Alberta Health Services.
This report by The Canadian Press was first published Oct. 15, 2024.
Rana Van Tuyl was about 12 weeks pregnant when she got devastating news at her ultrasound appointment in December 2020.
Her fetus’s heartbeat had stopped.
“We were both shattered,” says Van Tuyl, who lives in Nanaimo, B.C., with her partner. Her doctor said she could surgically or medically pass the pregnancy and she chose the medical option, a combination of two drugs taken at home.
“That was the last I heard from our maternity physician, with no further followup,” she says.
But complications followed. She bled for a month and required a surgical procedure to remove pregnancy tissue her body had retained.
Looking back, Van Tuyl says she wishes she had followup care and mental health support as the couple grieved.
Her story is not an anomaly. Miscarriages affect one in five pregnancies in Canada, yet there is often a disconnect between the medical view of early pregnancy loss as something that is easily managed and the reality of the patients’ own traumatizing experiences, according to a paper published Tuesday in the Canadian Medical Association Journal.
An accompanying editorial says it’s time to invest in early pregnancy assessment clinics that can provide proper care during and after a miscarriage, which can have devastating effects.
The editorial and a review of medical literature on early pregnancy loss say patients seeking help in emergency departments often receive “suboptimal” care. Non-critical miscarriage cases drop to the bottom of the triage list, resulting in longer wait times that make patients feel like they are “wasting” health-care providers’ time. Many of those patients are discharged without a followup plan, the editorial says.
But not all miscarriages need to be treated in the emergency room, says Dr. Modupe Tunde-Byass, one of the authors of the literature review and an obstetrician/gynecologist at Toronto’s North York General Hospital.
She says patients should be referred to early pregnancy assessment clinics, which provide compassionate care that accounts for the psychological impact of pregnancy loss – including grief, guilt, anxiety and post-traumatic stress.
But while North York General Hospital and a patchwork of other health-care providers in the country have clinics dedicated to miscarriage care, Tunde-Byass says that’s not widely adopted – and it should be.
She’s been thinking about this gap in the Canadian health-care system for a long time, ever since her medical training almost four decades ago in the United Kingdom, where she says early pregnancy assessment centres are common.
“One of the things that we did at North York was to have a clinic to provide care for our patients, and also to try to bridge that gap,” says Tunde-Byass.
Provincial agency Health Quality Ontario acknowledged in 2019 the need for these services in a list of ways to better manage early pregnancy complications and loss.
“Five years on, little if any progress has been made toward achieving this goal,” Dr. Catherine Varner, an emergency physician, wrote in the CMAJ editorial. “Early pregnancy assessment services remain a pipe dream for many, especially in rural Canada.”
The quality standard released in Ontario did, however, prompt a registered nurse to apply for funding to open an early pregnancy assessment clinic at St. Joseph’s Healthcare Hamilton in 2021.
Jessica Desjardins says that after taking patient referrals from the hospital’s emergency room, the team quickly realized that they would need a bigger space and more people to provide care. The clinic now operates five days a week.
“We’ve been often hearing from our patients that early pregnancy loss and experiencing early pregnancy complications is a really confusing, overwhelming, isolating time for them, and (it) often felt really difficult to know where to go for care and where to get comprehensive, well-rounded care,” she says.
At the Hamilton clinic, Desjardins says patients are brought into a quiet area to talk and make decisions with providers – “not only (from) a physical perspective, but also keeping in mind the psychosocial piece that comes along with loss and the grief that’s a piece of that.”
Ashley Hilliard says attending an early pregnancy assessment clinic at The Ottawa Hospital was the “best case scenario” after the worst case scenario.
In 2020, she was about eight weeks pregnant when her fetus died and she hemorrhaged after taking medication to pass the pregnancy at home.
Shortly after Hilliard was rushed to the emergency room, she was assigned an OB-GYN at an early pregnancy assessment clinic who directed and monitored her care, calling her with blood test results and sending her for ultrasounds when bleeding and cramping persisted.
“That was super helpful to have somebody to go through just that, somebody who does this all the time,” says Hilliard.
“It was really validating.”
This report by The Canadian Press was first published Oct. 15, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
