A Burlington hospital where there have been two outbreaks of COVID-19 is telling workers who test positive for the virus to return to work “immediately” if they are asymptomatic.

A spokesperson for Joseph Brant Hospital told the Star this is consistent with province-wide guidance provided by the Ministry of Health.

While GTA hospitals have been bracing for a surge in patients, a physician and two epidemiologists said the provincial recommendations are confusing and concerning.

“All employees are managed on a case-by-case basis through Employee Health Services,” Joseph Brant Hospital spokesperson Hollie Dobson said in an email. “Staff at the hospital who are asymptomatic are asked to follow Ministry of Health guidelines which include returning to work under work self-isolation — where staff are wearing appropriate PPE (personal protective equipment) to prevent the spread of the virus and are being actively screened for symptoms of infection twice a day.”

In a memo sent to staff on April 6, Joseph Brant Hospital’s chief human resources officer, Leah Martuscelli, outlined the protocol for returning to work, including that anyone who had tested positive but had no symptoms was to “return to work immediately” and continue to wear “appropriate” PPE.

On Monday, Hayley Chazan, spokesperson for Minister of Health Christine Elliott, referred to a ministry guidance document on testing and clearance that says those who were not symptomatic at the time they took a test but who are positive for COVID-19 “may return to work” 14 days after the test or “may return to work” if they remain asymptomatic for 72 hours after the test and continue with appropriate PPE at work until they have two consecutive negative test results.

Chazan noted the guidance only contains recommendations, and decisions about staff returning to work is still “at the discretion of the hospital.”

Asked about the difference between the hospital’s direction to return to work “immediately” and the province’s guidance on returning only after being asymptomatic for 72 hours after a test, Dale Kalina, medical director of infection prevention and control at Joseph Brant, said in a statement that they discussed the timing and felt it was still safe and “within best practices, especially given the level of PPE being worn by all staff at Joseph Brant Hospital.”

On April 11, the hospital reported outbreaks in two units, leading to positive cases in at least two workers and three patients, according to a news release.

A daily debrief sent to staff on April 12 appears to blame the outbreaks on staff not properly following protocols.

“This occurred because there was not strict adherence to (infection prevention and control) precautions during donning and doffing of PPE,” the document said about the outbreaks.

Dobson, when asked about the connection between staff and the outbreak, said in the emailed statement that they continue to investigate the cause.

“Earlier communication with staff addressed the ease at which someone can become infected with COVID-19, while reinforcing the need for adherence to infection prevention and control practices and protocols,” she said. “The purpose was to underpin the appropriate use of PPE to ensure personal safety and the safety of others.”

Isaac Bogoch, an infectious disease expert at the Toronto General Hospital Research Institute who was on the front line during the SARS outbreak, said the guidance from the province makes him nervous.

He said three hospitals he’s worked with in the GTA are requiring workers to test negative before returning.

“They will not let people back in the building until they have two negative nasopharyngeal swabs,” 24 hours apart, he said.

He said that may be overly conservative, but in a health-care setting with vulnerable people, some of whom may have underlying medical conditions including compromised immune systems, “the bar should be set high.”

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“You shouldn’t be in the health-care setting as a health-care worker if you’re infected, PPE or not,” he said.

Timothy Sly, an epidemiologist and professor at Ryerson University who also worked during SARS, said the guidance worried him, referencing ongoing research on the possible spread by people who are asymptomatic.

“I can tell you I would not want anyone in my family being worked on by someone who is breathing out the virus and hoping the surgical mask or even worse the N95 mask will prevent the virus escaping into the room,” he said, noting N95 masks should not be worn by infected people, but rather to protect others from becoming infected.

Researchers around the world are still studying the spread of the virus, including those with no or mild symptoms.

A report published April 10 by the U.S. Centers for Disease Control and Prevention looking at 243 cases in Singapore between Jan. 23 and March 16 found seven “clusters” where presymptomatic transmission was the “most likely explanation” for the spread, and discussed the challenges that posed to containing the virus, according to a summary posted on the CDC website.

David White, a family physician and professor in the faculty of medicine at the University of Toronto, said he believes there was some concern on the part CEOs of major hospitals in Toronto about staffing levels if workers were self-isolating.

He said health-care workers train on how to put on and take off PPE, but it’s hard to be perfect at it.

Of the provincial guidance, he said he understands the concerns about asymptomatic workers returning to a hospital setting.

“That’s pretty hard to square with the concerns that people can spread it before they’re symptomatic,” he said, adding hospitals need to be transparent about how they’re protecting staff and patients at all times.

According to Public Health Ontario, there were 857 cases in health-care workers as of April 13.

At least one other hospital network that responded to questions from the Star said they are following the same provincial guidance when it comes to asymptomatic workers. Jennifer Stranges, a spokesperson for Unity Health Toronto, which includes St. Michael’s and St. Joseph’s hospitals and the Providence health-care facility, referred to the ministry document and said each scenario is handled on a “case-by-case basis.”

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