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Linda Silas

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  1. Critical staffing shortages and lack of basic protections are creating unhealthy conditions for nurses. AS THE ANNIVERSARY OF THE COVID-19 PANDEMIC has come and gone, nurses across Canada are at their breaking point. We are exhausted, burned out—and angry. Nurses are on the frontlines of the pandemic and our health-care system every day. We see its problems in brutal detail, and we have the experience to know what’s needed to fix them. We have repeatedly called on decision-makers to address critical staffing shortages and provide basic protections to keep workers safe. We continue to be disregarded, and the result has been devastating. According to the Canadian Institute for Health Information, the number of COVID-19 cases among health workers has tripled since July 2020. As of January 15, 65,920 health workers have been infected with the COVID-19 virus, representing 9.5 percent of all infections in Canada. More than 40 health workers are known to have died from the illness. In our troubled long-term care system, insufficient staffing and safety protocols have contributed to a national tragedy. About 25,000 health-care worker infections are in long-term care. More than 14,000 vulnerable residents have died from COVID-19, representing about 70 percent of all deaths in Canada. It didn’t have to be this way. As early as January of last year, the Canadian Federation of Nurses Unions began urging governments across Canada to heed the lessons of SARS and adopt a precautionary approach. This meant assuming the virus was airborne and protecting health-care workers—potential vectors of transmission – accordingly. Despite similar efforts by unions across the country, health-care workers have been put at unacceptable risk, with implications for their families, patients and communities. Most health-care workers, even those caring for COVID-19 patients, were only provided flimsy surgical masks, and in many jurisdictions, masks were reused until they were soiled and damaged. Faced with supply issues, N95 respirators were often locked away. It took the Public Health Agency of Canada (PHAC) until January 2021 to acknowledge what unions and many experts have said all along. Health-care workers are at risk of airborne transmission when in close proximity to an infected person. Yet PHAC still does not require health-care workers in COVID-19 units and “hot zones” to wear protection from airborne transmission, such as N95 respirators. Similarly, provinces across Canada have failed to update their guidance to adequately reflect what we now know about the virus and how its spreads. Only Quebec has followed the scientific evidence to its natural conclusion: As of February 11, 2021, Quebec requires health-care workers in COVID-19 hot zones to wear an N95 respirator or superior level of protection. As new variants circulate in Canada, dramatically increasing the rate of transmission, burned out health-care workers are under even more pressure. Without action, health staffing, which is already in short supply, could become depleted even further. We must not let this happen. We know from experts and evidence that there is a desperate need for more staff, not less. The long-standing cycle of budget cuts, short staffing, and higher workloads has eroded the health care workforce and quality of patient care. A major investment in the retention and recruitment of nurses is needed now or it is likely we will see an exodus from the profession as burnout takes its toll. It’s time for governments across Canada to take their heads out of the sand and show their respect and appreciation for health care workers. A good first step would be to act on our calls for better workplace safety and safe staffing. Had decision makers heeded the nurses’ warnings prior to the pandemic, perhaps many more lives could have been saved. Linda Silas is a nurse and president of the Canadian Federation of Nurses Unions.
  2. March 2, 2020 OUTSIDE ASIA, Canada was the country hardest hit by the SARS coronavirus. By the end of the 2003 global epidemic, there were 438 cases of SARS in Canada, resulting in 44 deaths. Most cases were concentrated in Toronto, as were all fatalities. More than 100 health care workers became ill and three died, including two nurses. Ontario’s independent commission to investigate the introduction and spread of SARS identified a key lesson: in the absence of scientific certainty about how an infectious illness is transmitted, reasonable precautions must be taken. Justice Campbell, who served as the commission’s chair, explained that this precautionary principle places the emphasis on safety, rather than science. In other words, if we don’t know exactly how a virus spreads, we shouldn’t wait for the science to be settled to protect health care workers. Despite this important lesson from the SARS epidemic, the Canadian government now seems content to wait for conclusive evidence on how the 2019 novel coronavirus (COVID-19) is transmitted before taking the necessary steps to protect front line health care workers. As provinces brace for a potential outbreak of COVID-19, nurses’ unions are speaking out about the threat to health care workers. Notably, the Public Health Agency of Canada is failing to properly prepare frontline workers in acute care settings and overlooking the clear lessons learned from our previous experience with pandemics. The federal agency was created in the wake of the SARS epidemic to provide national leadership and clarity during public health crises. However, it has never embraced this mandate. During the 2003 pandemic, frontline workers received conflicting messages and were often confused about how best to protect themselves and their patients. History may repeat itself if the Public Health Agency of Canada continues to provide weak leadership. In particular, it’s disappointing that the Public Health Agency of Canada has failed to advise acute care facilities to adopt the precautionary principle –the key lesson from SARS. Meanwhile, national public health agencies in the United States, the European Union and the United Kingdom have called for contact, droplet and airborne precautions to protect health care workers, deeming the illness of one health care worker to be one too many. In response to COVID-19, these agencies are recommending an N-95 respirator, which is custom-fitted to a health care worker’s face to prevent any leakage. The province of Ontario, which experienced the worst of SARS, is also choosing to mandate the N-95 respirator for health care workers, in light of the current scientific uncertainty about how the virus is transmitted. In contrast, the Public Health Agency of Canada is recommending surgical masks for health care workers – a device designed to protect the patient from the wearer’s respiratory issues, not the reverse. Canada can and should do better. The agency’s position is quite simply an abdication of leadership. Unprotected, health care workers can easily transmit viruses throughout acute care facilities. Recent evidence published in the Lancet, a peer-reviewed medical journal, recommends “aggressive” protection for health care workers caring for presumed and confirmed cases of COVID-19. The study noted that even a non-symptomatic person can spread COVID-19 “with high efficiency”; face masks and other conventional forms of protection, according to the article, “provide insufficient protection.” As nurses, we know that patient safety starts with worker safety. If our health care workers are safe, then our patients are safe. The Canadian Federation of Nurses Unions has asked the Public Health Agency of Canada and the Health Minister of Canada to act out of an abundance of caution and carefully consider the lessons learned from the SARS epidemic. Canada should follow the precautions being taken in the United States, the European Union and the United Kingdom, as well in the province of Ontario. We can and should do our best to protect our health care workers, and by extension, our vulnerable patient populations. Linda Silas is a nurse and President of the Canadian Federation of Nurses Unions, representing nearly 200,000 nurses and student nurses across the country.
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