Hon. Doug Ford, Premier of Ontario Legislative Building
Queen’s Park
Toronto, ON M7A 1A1

Hon. Christine Elliott
Deputy Premier and Minister of Health 5 – 777 Bay St.
Toronto, ON M7A 2J3

Anthony Dale, President and CEO Ontario Hospital Association
200 Front Street West, Suite 2800
Toronto, ON M5V 3L1

Dr. Kieran Moore
Chief Medical Officer of Health 393 University Ave., 21st Floor
Toronto, ON M5G 2M2

The following letter was sent by SEIU Healthcare and CUPE to the Ford government regarding our response to the “Covid-19 Interim Guidance: Omicron Surge Management of Critical Staffing Shortages in Highest Risk Settings”.

Dear Premier Ford, Minister Elliot, Mr. Dale, and Dr. Moore:

We are respectively the Presidents of the Ontario Council of Hospital Unions/Canadian Union of Public Employees (“OCHU/CUPE”) and the Service Employees International Union Heathcare (“SEIU”). Together, we represent some 100,000 healthcare workers at some 200 hospitals and long-term care facilities in Ontario.

We write to express our deep concern with the Province’s January 13 guidance document entitled “Covid-19 Interim Guidance: Omicron Surge Management of Critical Staffing Shortages in Highest Risk Settings.” The guidance document sets out a plan for addressing potential staffing shortages in hospitals and other high-risk settings, in which health care employees may be ordered back to work while potentially sick and/or infectious with Covid-19.

This plan, in our view, creates an unacceptable level of risk for hospital patients, employees and by extension all Ontarians, who have every right to expect hospitals to serve as bulwarks against, not links in, the chain of transmission.

We draw your attention to the comments of Chief Medical Officer of Health for Canada that “the period of communicability” for Omicron is “no shorter than the other variants.”

We also draw your attention to the fact that hundreds of Ontario patients have died from Covid that they contracted in hospital. Many of these deaths could certainly have been prevented with better infection control practices.

The Guidance document sets out three categories of staffing options, categorized according to escalating levels of risk. Under the “moderate” and “higher” risk options, Covid-19 positive employees may be returned to work with Covid-19 patients on or prior to day 7 of their 10-day isolation period, without a negative PCR or RAT test, and with ongoing symptoms (if such symptoms are “improving”).

Shortening the isolation period for healthcare workers is misguided and dangerous, in light of growing evidence suggesting that those infected with Omicron may be infectious for longer (see “Covid-19: Peak of viral shedding is later with omicron variant, Japanese data suggests” at https://doi.org/10.1136/bmj.o89 and “Study of NBA Omicron Cases Finds Many Still Infectious After CDC-Recommended Self-Isoloation Period Ends” at
https://www.forbes.com/sites/dereksaul/2022/01/15/study-of-nba-omicron-cases-finds-many-still-infectious-after-cdc-recommended-self-isolation-period-ends/?sh=fb680113948e).

We believe that returning an employee back to work while sick with Covid-19 imperils the health and safety not only of that employee’s patients and colleagues, but of the employee themselves, by depriving them of the opportunity to recover from what can be a dangerous and deadly infection.

Moreover, contrary to what is assumed by this plan, the risk of infection is not eliminated by assigning Covid-19 positive employees to work with Covid-19 positive patients. The risk of re-infection remains, especially when there are different variants at play and when patients and the worker ill with Covid are in a physically weakened state.

While the Guidance document states that hospitals should utilize alternative staffing strategies to avoid or mitigate staffing shortages before proceeding with early return to work options, there is no requirement that they do so, nor are there any mechanisms for ensuring that they do
so. Indeed, we are aware of at least many hospitals that have announced plans to proceed with an early return to work program without having first pursued all available alternatives such as offering enhanced premium pay, not terminating unvaccinated employees who are still working or redeploying staff from other work, other workplaces or other locations.

We respectfully ask that before employees who are Covid positive are returned to work, these alternatives must be fully deployed.

The Guidance document suggests “additional precautions” to be applied in the case of early return to work, such as not eating meals in a shared space. Again, there is no requirement or enforcement measure for this, and we are aware of hospitals that have not established separate eating, break or changing facilities for sick or infectious staff members. At a minimum, separate changing, eating, break facilities in a venue which does not share air supply with areas of the hospital where uninfected patients and staff are working is a prerequisite.

The Guidance document also addresses PPE and lists as a potentially acceptable option “a well-fitting medical mask.” This completely disregards evidence that surgical masks are inadequate to prevent transmission of Omicron even in non-high-risk settings, and even amongst people who are not known to be sick or infectious. The document fails to recommend PPE appropriate to the situation of extreme risk that it contemplates. At a minimum, an elastomeric respirator, which has a higher rating than an N95 mask, must be standard for anyone returned to work who may still be contagious.

As you are aware, the Guidance document does not and cannot prevail over employers’ obligations under the Occupational Health and Safety Act, nor does it trump orders made by medical officers of health under s. 22 of the Health Protection and Promotion Act.

In our view, any healthcare employer would be in breach of these fundamental obligations if they were to (a) require employees to return to work while sick and/or infectious with Covid; or (b) begin implementing any early return to work plan without having first explored all reasonable alternatives, and without adequate protections and precautions, including PPE.

OCHU/CUPE, SEIU and our member locals will be considering every legal avenue at our disposal, including under OHSA, through the grievance process, and through the courts, to ensure the safety of our members, hospital patients, and by extension, the broader public.

We urgently request an immediate meeting of all parties to this correspondence to discuss these vitally important concerns.

Sincerely,

Michael Hurley
President
The Ontario Council of Hospital Unions/CUPE

Sharleen Stewart President
SEIU Healthcare