As provinces including Ontario ramp up their reopening plans, some experts say masks remain a key method of protection against COVID-19 — but caution that many people, including health-care workers, aren’t able to access the right kind.
“Things like surgical masks and cloth face pieces — they are not closely fitting to the face,” said Simon Smith, a retired research scientist in respiratory protective equipment and the former president of the International Society for Respiratory Protection.
“They do some good in terms of source control, but in terms of protecting the wearer, because there is no good seal to the face, particles can travel with the air that’s inhaled around the edges of the mask.”
Smith said a well-fitted respirator provides better protection against airborne viruses, especially in health-care settings such as hospitals, but they’re rarely being used.
Part of the problem, Smith said, was the reluctance of public health officials to recognize the airborne nature of COVID-19 until last fall.
An alternative to the N95
During the pandemic, the N95 respirator, so named for its ability to filter 95 per cent of airborne particles, has become the gold standard for masks in health-care settings.
N95 respirators are compact and easy to maintain, but Smith said they can be uncomfortable after long periods of wear.
An alternative, the elastomeric respirator, typically includes replaceable cartridges and filters. Traditionally, they’ve been used in construction and other workplaces where there are environmental hazards. They can be cleaned, disinfected, stored and used multiple times, making them a more economical choice.
Smith said during fit tests, where instruments are used to measure the concentration of particles inside the respirator compared to what’s outside, masks that seal to the whole face such as the elastomeric respirator have been shown to offer better protection than other cloth or surgical masks.
“And so they are better for use in situations that may be more hazardous,” Smith said.
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Some ambulance centres and dentists have already made the move to elastomeric masks, but Smith says moving to those higher forms of respirators in health care has been a hard sell.
“It’s been a bit of an uphill struggle to get this acceptance because I guess perhaps some unfamiliarity and as I say, acceptance of the threat and the necessity for that kind of equipment,” Smith said.
Health Canada has approved elastomeric respirators for use, and in a statement said it expedited access to them during the pandemic. However, during the worldwide shortage of N95 masks, the federal government chose to stockpile products that were in common use.
Pushback in workplaces
There have been several reports of pushback in workplaces in getting access to respirators, especially in health care, due to directives that state they should only be used during high-risk activities that generate aerosols.
The Ontario Nurses Association is currently engaged in a court battle with the province over the issue.
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“I don’t actually know of anyone who’s wearing an elastomeric respirator at the hospital,” said Dr. Jennifer McDonald, a physician in Ottawa who’s been calling for better airborne precautions in Canada. “The problem with that elastomeric is that it’s very unknown to the health-care setting.”
The Ontario government acquired 100,000 elastomeric masks in June 2020, but union representatives say they still haven’t seen them in use.
In an email to CBC, the Ontario Ministry of Health said those masks were made available to long-term care homes and the ministry has so far distributed 22,000 of them.
The ministry said it “currently has close to 100K elastomeric respirators in the stockpile and intends to maintain these as part of an ongoing PPE stockpile strategy.”
Elastomeric respirators “would be an excellent choice in many settings,” McDonald said, if people can get past how they look.
A coalition of occupational doctors, health specialists, engineers and other professionals has also been calling on the federal and provincial governments to step up their COVID-19 precaution efforts.
They’re lobbying for widespread use of respirators over surgical masks, not just in hospitals, but other front-line spaces as well.
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“There’s no excuse for not giving those who need them real respirators. And this doesn’t just include health-care workers. It includes anyone who is in an enclosed space with a number of people for something beyond a few minutes,” said Dorothy Wigmore, an occupational hygienist in Kitchener Ontario and a member of the grassroots coalition.
These types of precautions were recommended to governments in the SARS commission.
In a statement to CBC, Health Canada said with the lessons learned from COVID-19, there will be further consideration of what should be in the stockpile mix in the National Emergency Strategic Stockpile.