Confusion over seemingly conflicting messages from Toronto hospitals and the provincial government about the need for self-isolation after travelling overseas is causing alarm among health-care workers, says the association representing nurses and nurse practitioners in the province.

The Registered Nurses Association of Ontario (RNAO) says that policies enacted by some hospitals instructing employees who have travelled abroad in the last two weeks to report to work immediately have left nurses worried for their safety and that of their patients in the midst of the COVID-19 pandemic.

“They’re concerned that the organizations are…putting them, putting their colleagues and putting their patients and in fact communities and families at risk,” said Doris Grinspun, CEO of the RNAO.

In the last few days, Grinspun says she’s heard from dozens of her members concerned that the hospital policies seem at odds with what the provincial government has been telling Ontarians: to self-isolate for 14 days as soon as they return home after travelling overseas.

In a memo to the health system late last week, David Williams, the chief medical officer of health for Ontario, said he was recommending that health-care workers who have travelled outside the country in the last two weeks “self-isolate for a period of 14 days starting from their arrival in Ontario.”

He added that if some workers are deemed critical for continued operations, he recommends they “undergo regular screening, use appropriate personal protective equipment for the 14 days and undertake active self-monitoring, including taking their temperature twice daily to monitor for fever, and immediately self-isolate if symptoms develop.”

Hayley Chazan, a spokesperson for Health Minister Christine Elliott, told the Star Sunday that it is the provincial government’s expectation “that hospitals abide by our guidance, but it’s not a directive at this time.”

Hospitals that have told employees who have travelled within the last 14 days to return to work include Michael Garron (formerly Toronto East General) and Sinai Health, which includes Mount Sinai Hospital and Bridgepoint Active Healthcare, Mount Sinai.

Dr. Ian Fraser, chief of staff at Michael Garron Hospital, told the Star Sunday that Williams’s advice to self-isolate for 14 days after returning to Ontario “was based on the perception that the risk for COVID-19 was related mainly to travel.”

“But as we know right now, and certainly as Dr. Eileen de Villa, Toronto’s chief medical officer of health, identified we have community transmission. So that doesn’t discriminate people who are potentially at risk and those who are not,” said Fraser.

As of Sunday evening, Toronto Public Health said it had 220 cases of COVID-19 reported in the city, 11 of which have resulted in hospitalization.

In a statement to the media earlier Sunday, Fraser said his institution is conducting enhanced screening of every individual entering the building and that this approach is focused on symptoms rather than travel.

“We are asking asymptomatic health-care workers returning from international travel to return to work based on several robust safety measures and strategies we have put in place from the beginning of the COVID-19 outbreak,” he said.

On Friday, Sinai Health sent a memo to staff saying that because there is now community transmission of the virus, “travel is no longer the driving risk factor.”

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“People who have not travelled may now be at similar risk for having COVID-19 as those who have travelled,” reads the memo. “All health-care workers who are asymptomatic, regardless of travel, are to report to work and it is not necessary to wear a procedure mask while at work.”

Similarly, Sunnybrook hospital has told its health-care workers who have travelled within the last 14 days that they “may continue to work if they do not have symptoms.” In a message sent to staff last Thursday, the hospital said those workers who have travelled within the time frame and who are asymptomatic must self-monitor for fever or any respiratory symptoms, however mild and take their temperature twice a day. Those who develop any symptoms or have a fever of greater than 38 C, “must exclude themselves immediately” and report to the hospital’s occupational health and safety department.

“COVID-19 is in the community, which makes travel history less relevant but makes monitoring for symptoms, even mild, highly important,” the message said.