Ontario Nurses’ Association tells members not to take part in ‘unethical’ Hamilton mask study

The Ontario Nurses' Association is advising its members against participating in a Hamilton study determining if medical masks provide adequate protection against COVID to health-care workers.

The union calls the trial unethical to place health-care workers at risk for the sake of research," states a letter obtained by The Spectator dated Dec. 11 and addressed to hospital and long-term care bargaining unit presidents.

ONA says participants place themselves at risk of contracting COVID-19. In particular, we are concerned that the research seeks individuals to volunteer to forego access to N95 respirators, which they would otherwise be legally entitled to access."

The union's concerns are based on misconceptions," says the McMaster University researcher leading the international study which has the support of the World Health Organization, the Canadian Institutes of Health Research, the chief public health officer of Canada and others.

If they feel they want access to an N95 respirator, they will have it," said Dr. Mark Loeb. Health-care workers who potentially may be interested should contact one of our research nurses and they will be given the facts about the trial and they can make up their own mind."

The controversy over the study demonstrates what has been one of the most contentious issues of the pandemic - health-care worker access to the increased protection of N95 respirators, which have a close facial fit and efficient filtration of airborne particles.

N95s have been in such short supply at times during the pandemic that procuring them has been described as akin to the Wild West."

When they are available, there has been widespread disagreement over when they should be used.

The World Health Organization advises a medical mask is enough protection for those caring for COVID patients. N95 respirators are reserved for aerosol-generating procedures in the interim guidance updated Dec. 1 with Loeb's input.

In contrast, Ontario gives health-care workers in hospitals and long-term care homes the option of using N95 masks when they come into contact with a suspected, probable or confirmed case of COVID-19 and can't physical distance.

But it's not clear if the directive from Ontario's chief medical officer of health Oct. 5 is well known considering Health Minister Christine Elliott herself on Tuesday still referred to N95 masks as being for aerosol-generating procedures.

We've been fighting hard for the proper personal protective equipment," said Vicki McKenna, president of ONA.

She says the study is flying in the face of that directive" because it randomizes those caring for COVID patients to either medical masks or N95 respirators.

This virus is a novel virus and we need to be very cautious," said McKenna. We have a number of questions. We aren't endorsing the study. We think this kind of study is not appropriate at this time."

But Loeb argues evidence is desperately needed to know whether medical masks are adequate protection.

It's an extremely important study and it will provide an answer that will help protect health-care workers in Canada and around the world," said Loeb. It's scrutinized and approved by the Hamilton Integrated Research Ethics Board ... there's a safety monitoring committee ... and we've also been responsive to questions that have been raised to ensure the safety of all the participants."

He stresses there is no other way to get the answer than a randomized control trial which is the highest level of evidence. However, he says even workers randomized to the medical mask group can access N95 respirators on request.

That directive said that if at any time a health-care worker feels they want to use an N95, they can do it, and that's a requirement," he said.

Loeb said the bigger problem has been workers declining because they don't want to wear the uncomfortable N95 masks and are worried they'll be randomized to that group in the study running at a number of Ontario locations including Hamilton Health Sciences, St. Joseph's Healthcare, Niagara Health Services and Brantford General Hospital.

The nurses' union says the message from SARS is clear to err on the side of caution in the absence of reliable data.

The union's concern is heightened by the Public Health Agency of Canada updating its guidance on Nov. 4 to recognize SARS-CoV-2 is transmitted by fine aerosols, as well as larger respiratory droplets.

This is a significant shift since surgical masks are not designed to protect the wearer against aerosol-transmitted diseases," states the letter. Only N95 or superior respirators are designed to protect against this type of disease. We believe this research project was approved on the understanding that COVID-19 is not known to be spread by aerosols ... This has changed."

- With files from Maria Iqbal, The Hamilton Spectator

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