‘Loblaws up the street had better sanitary precautions than we did at Toronto Public Health’

Picture this: It's Friday, March 13. The Toronto Public Health war room in downtown Toronto. Forty public health nurses jammed shoulder to shoulder in one room for the day being trained on how to track the outbreak of COVID-19. No masks, no hand-washing protocol, no social distancing. Toronto Public Health did not even have an "active screening protocol" for people entering its main building until March 27.

"Loblaws up the street had better sanitary precautions than we did at Toronto Public Health," said one nurse insider who works for the city.

"I would say it was as if nobody wanted to be Chicken Little and say the sky is falling," said another nurse insider. "Guess what? It was."

By March 13, universities were going online in Ontario. Elementary and secondary schools were not planning to return after March Break. Social distancing was taking hold. The Toronto Maple Leafs and all other NHL teams had pressed pause on their season the day before.

This story will deal with the lack of precautions the managers of Canada's biggest municipal public health agency had in place for their staff during much of the month of March. In response to a series of detailed questions posed by the Star, Toronto's two top health officials said they are constantly working to improve the situation.

"I deeply regret there are some people on my team that expressed to you that they feel unsupported," said Dr. Eileen de Villa, Medical Officer of Health.

"As soon as I learned of this, I immediately reached out to my entire team. I directed a review of all of our protections in place to ensure that we are doing everything that we can and to the very best of our ability to protect our staff doing this essential work at this critical time."

A word about public health departments. Toronto and other municipalities employ nurses and other staff who do both proactive work (providing instructions and guidance on health issues, healthy baby visits, harm reduction strategies for drug users) and respond to issues such as the current pandemic.

In an outbreak, "contact tracing" is a huge part of figuring out who has a disease, who needs to self-isolate, who needs to be tested, among other functions. The tracing work is done by telephone mostly and Toronto Public Health wanted it done by staff working together, rather than from home. There is a lot of "paperwork" involved, nurses said they were told.

Ultimately, some nurses and other staff contracted COVID-19. At least eight staff have a confirmed diagnosis, an unknown number of other workers have symptoms, and as of last week 67 people were self-isolating because of contact with the confirmed cases.

Toronto Public Health was slow to publicly confirm there was hard evidence of community transmission of the virus in Toronto (as opposed to travel-related cases), although front-line nurses and doctors have told the Star they believe community transmission began roughly around March 1. TPH made a public statement Monday, March 16 that there was community transmission in Toronto.

By Friday, March 13, a few days before, Toronto Public Health had determined that its nerve centre for combating the outbreak would be in its main building at 277 Victoria St., on the northeast end of Dundas Square. To that end, TPH managers called in staff from satellite offices. That Friday was a full day of training in contact tracing, which is done by TPH staff working the phones, speaking to people who have the virus and figuring out where they have been - perhaps an office, a dinner party or a sports event.

Large parts of the building were accessible to anyone wanting to walk in, including the cafeteria and washrooms on each floor, though passcards were needed for sensitive areas. There was no screening at the front entrance, no sanitizing station, no warnings.

Dr. Michael Finkelstein, Toronto's associate medical officer of health, confirmed there was no "active screening protocol" checking for symptoms of the virus at 277 Victoria until March 27.

"Correct," said Finkelstein, responding to the Star's question. "However, since we first learned of COVID-19 in January 2020, we consistently advised staff to stay home if they were sick. He said they did have screening at the safe injection sites TPH runs as far back as Feb. 5.

What irked many of the nurses and other workers packed into the March 13 training session is that there seemed to be little concern given to the workers' safety. Finkelstein said TPH was working to quickly train as many of its workers as possible and used "the largest room in our office building."

The Star has spoken to several front-line TPH workers who were present but has agreed not to identify them - including the exact number the Star has interviewed - because the workers are concerned they will lose their jobs for speaking out.

At the March 13 meeting, people present said they were told by managers leading the training sessions "the risk is low" that any of the TPH workers would fall ill. Questions were raised about social distancing requirements. Again, according to people present, managers said "the risk is low."

As some who spoke to the Star pointed out, Loblaws and other stores were already putting in sanitary precautions, including handwashing stations, screening at the door and encouraging social distancing. Some nurses asked if a jar of sanitary wipes was available to clean hands that day at TPH. "It hasn't been implemented yet," nurses were told.

TPH's Finkelstein explained why TPH was slow to act.

"Early in March, COVID-19 was not circulating in Toronto and while there were local COVID-19 cases in Toronto, there was no community spread at that time, so the risk to staff was considered low," said Finkelstein.

To that response, front-line TPH nurses have pointed to situations in Toronto well known at that time, including an apparent outbreak at two synagogues the week before. Yes, they traced to a person who had been in Washington at a conference, but it was believed by TPH staffers that it sparked community transmission.

"It should have been lift-off (for tough protocols for TPH and across the city) when that synagogue closed for cleaning," said one front-line TPH nurse, referring to an event on March 9.

Front-line staff expressed concern at the training meeting and at other times that members of the public with symptoms, quite often and mistakenly, visited 277 Victoria thinking it was the place to get tested for COVID-19. There is a security station, but there was no screening until the last week of the month. Testing was not being done at head office.

Dave Mitchell, president of CUPE Local 79, which represents nurses, health inspectors, dietitians and other front-line and administrative staff at TPH, said he heard concerns "throughout March about COVID-19 safety concerns, mainly focusing on inadequate screening and distancing protocols." Mitchell said that while he wished managers had been more "proactive," the union appreciates the work done more recently to address the safety concerns.

As to why there was no active screening protocol for everyone entering the TPH nerve centre until March 27, the TPH's Finkelstein said it was not until March 19 that the city's Emergency Operations centre "identified buildings" that required screening. It took until March 27, when an external company was hired to do the screening.

By March 13, when the first training meeting was held, universities - Laurentian on March 11, Western, University of Toronto, Dalhousie and others by March 13 - were closing and elementary and secondary schools were following suit. Physical or "social" distancing was being discussed openly.

"Yet here we were, jammed into that room, shoulder to shoulder," said one person present.

Another concern was that TPH had not tested protective masks since 2017 to ensure they fit properly, and that the person who would wear them was comfortable and properly protected. COVID-19 and other viruses are spread by particles expelled by coughs and sneezes.

TPH's Finkelstein said TPH "moved to a just-in time fit testing policy because outbreaks cannot be predicted. Over time there is staff turnover and as a result, it is difficult to anticipate who is going to need fit testing before an outbreak."

The first two weeks of March was a tense time for TPH and other inside city workers for other reasons. About 1,700 front-line staff at TPH and other city workers were mired in contract talks. Saturday March 14 was the day of a potential lockout.

As a result, at the end of Friday, TPH nurses and other staff were instructed to turn in the cellphones and laptops they would use to battle the pandemic. City managers vowed that management would deal with the virus. Ultimately, a tentative agreement was reached and the equipment returned.

Finkelstein said TPH has now "taken every reasonable precaution to ensure that we are protecting our staff." Those include allowing staff to work from home where possible, conducting proper screening at 277 Victoria and other sites, and making sure social distancing protocols are being enforced at all sites where people have to come to work.

Finkelstein also said TPH has consulted Public Health Ontario for guidance on what to do if there is COVID-19 spread in the workplace; ensuring self-isolation of all close contacts of those exposed to the virus while working at 277 Victoria, and using personal protective equipment in the workplace "to reduce the risk of further transmission."

In a statement to the Star, de Villa, the medical officer of health, said she considers herself "accountable" for any of the previous situations. "We can always do better, of course, and when presented with those facts, we immediately make necessary changes to continue protecting our workforce. The health, safety and well-being of my team and that of our city is sincerely my top priority."

Kevin Donovan can be reached at kdonovan@thestar.ca or 416-312-3503