Do medical masks protect health-care workers enough from COVID?

A Hamilton study to determine if medical masks are sufficient to protect health-care workers from COVID-19 got funds to expand from the World Health Organization to speed up the desperately needed results.

The World Health Organization is asking us for the data as soon as possible," said Hamilton infectious disease researcher Dr. Mark Loeb, who is leading the international study. We're doing a rigorous, randomized control trial that's extraordinarily important that will inform this whole question."

The urgency to ensure workers have proper personal protective equipment (PPE) was highlighted Wednesday by the Canadian Union of Public Employees (CUPE), which reported infections on Ontario's front lines rose by 1,929 - nearly 25 per cent - from Nov. 1 to Dec. 4.

In Hamilton's ongoing outbreaks alone, 133 staff at seniors' homes are infected.

Words ... cannot convey the level of emotion we heard in the voices of health-care workers we interviewed," said University of Windsor researcher James Brophy, who worked with CUPE on the study Sacrificed: Ontario Health Care Workers in the Time of COVID-19.

We did not expect to hear the degree of anger and desperation that came out. The stories they told us were tinged with anguish, frustration and fear."

Fellow University of Windsor researcher Margaret Keith described a worker providing their own N95 respirator for increased protection and hiding it underneath their medical mask to avoid getting in trouble.

One worker told the researchers, There's no way you would send a firefighter into a burning building without protection."

CUPE says a pregnant cleaner at an area hospital was denied an N95 respirator when working in the rooms of COVID patients. The Ministry of Labour sided with the hospital, said Michael Hurley, president of CUPE's Ontario Council of Hospital Unions and co-author of the Sacrificed study.

He also says hospital workers found PPE under lock and key" at an understaffed area retirement home where they were redeployed to provide aid. Hurley says two of the workers later tested positive for COVID.

The sad reality is that in many instances where health-care workers request the kind of equipment that is required ... they're told they don't need it," said Hurley.

But what qualifies as the proper PPE is hotly disputed, with CUPE arguing the virus should be treated as airborne and workers given N95 respirators.

There are many good-hearted community members who are praising our staff as heroes ... but the fact of the matter is they don't have to be so much at risk," said Keith. They need to be given proper protection."

Guidance updated on Dec. 1 by the World Health Organization continues to recommend a medical mask is enough protection for those caring for COVID patients. N95 respirators are reserved for aerosol generating procedures. Loeb provided input for the interim guidance.

If N95s were to make a difference ... we would typically see our outbreaks on (hospital) COVID units but we don't," said Dr. Dominik Mertz, associate professor of infectious diseases at McMaster University. In terms of epidemiological evidence, I would say medical masks still continue to be appropriate."

The hope is that Loeb's study will answer whether health-care workers need the added protection of an N95, which has a close facial fit and efficient filtration of airborne particles.

It's significant because N95 respirators have been in such short supply worldwide over the pandemic that Loeb's study was delayed until enough could be found.

I would argue if there was a policy ... that for every contact with any possible COVID-19 patient you would have to don an N95, you would have introduced a lot of harm into the system because we wouldn't have had the N95s available for those patients where we really need them," said Mertz.

Loeb's study is recruiting 576 health-care workers in various sites around the world - including some in Hamilton - who will be randomly assigned to either wear N95 respirators or surgical masks. So far over 200 have signed up for the research that also has funding from the Canadian Institutes of Health Research.

There's still a lack of N95 respirators and that's why it's important to find this the answer," said Loeb. We need evidence."

In addition, his research so far has found health-care workers find it difficult to wear N95s for long periods of time so it's important to make sure it's only done when necessary.

Loeb's past research on influenza and seasonal coronaviruses has shown that a medical mask is sufficient protection. But COVID hasn't been studied until now.

CUPE points out that one of the main lessons from SARS is erring on the side of caution in the absence of reliable data.

Keith says one health-care worker interviewed for the Sacrificed study said, All we're asking is please protect us. Give us what we need ... That's not too much to ask."

Joanna Frketich is a Hamilton-based reporter covering health for The Spectator. Reach her via email: jfrketich@thespec.com