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"It was largely on the basis of Toronto’s Sunnybrook disaster on April 13,when nine health workers caught SARS, that the CDC decided in favour of the precautionary approach and opted for airborne precautions."
- 2006 Canadian SARS Commission
- 2006 Canadian SARS Commission
"Currently, N95 respirators or equivalent are recommended by Health Canada, WHO and the CDC for the care of SARS patients even though the evidence shows that SARS is spread by droplet transmission.911
Since SARS, a considerable body of research and scientific opinion suggests...
Since SARS, a considerable body of research and scientific opinion suggests...
...it was wise to take a cautious approach and require the N95 respirator.
- 2006 Canadian SARS Commission Report
- 2006 Canadian SARS Commission Report
"The WHO consensus document on SARS said:
A basic reproduction number (R0) of approximately 3 is consistent with a disease spread by direct contact or larger virus-laden droplets that travel only a few meters rather than by lighter airborne particles. By contrast, if a
A basic reproduction number (R0) of approximately 3 is consistent with a disease spread by direct contact or larger virus-laden droplets that travel only a few meters rather than by lighter airborne particles. By contrast, if a
disease is transmitted by aerosols, a single person can infect an entire room by coughing, as can happen with measles and influenza.914"
- 2006 Canadian SARS Commission Report
- 2006 Canadian SARS Commission Report
Coughing and infecting a whole room?
You don't say.
"As one CDC expert told the Commission, in a hospital you never know when one of those aerosol-generated events will happen. That is one of the reasons why the CDC recommends routine airborne protection for SARS:
But in health care facilities when you have people in, you just...
But in health care facilities when you have people in, you just...
...don’t know sometimes when you’re going to have an aerosol-generating procedure happen and it could happen precipitously. And because of those issues and because of issues like this, we’re going to continue to recommend airborne precautions."
- 2006 Canadian SARS Commission
- 2006 Canadian SARS Commission
"One CDC expert told the Commission:
And it’s largely because of this event here, the Toronto cluster – not only this event though: there’s also clusters in Hong Kong and elsewhere where people have been wearing droplet-level precautions and still gotten sick.
And it’s largely because of this event here, the Toronto cluster – not only this event though: there’s also clusters in Hong Kong and elsewhere where people have been wearing droplet-level precautions and still gotten sick.
...Now, it’s usually an aerosol-generating infection as far as I’m aware. It’s always associated with some aerosol-generating procedure of some type. And in Hong Kong, it was the use of aerosized nebulized bronchodilator therapy medications and a bunch of medical students...
...all got sick who were wearing masks.
When you look at the R0,it suggests it’s probably not airborne, it’s not airborne in the same sense as measles or anything like that. And when you look at epidemiologic links, people down the hallway, around the corner, they’re not ...
When you look at the R0,it suggests it’s probably not airborne, it’s not airborne in the same sense as measles or anything like that. And when you look at epidemiologic links, people down the hallway, around the corner, they’re not ...
... getting sick. But, in health care facilities, when you have people in, you just don’t know sometimes when you’re going to have an aerosol-generating procedure happen, and it could happen precipitously. And because of those issues and because of issues like this, ...
we’re going to continue to recommend airborne precautions."
- 2006 SARS Commission Report
NOTE: So all the people still saying otherwise? Aside frm the science, this is huge legal exposure.
- 2006 SARS Commission Report
NOTE: So all the people still saying otherwise? Aside frm the science, this is huge legal exposure.
"Nothing brings home the point of airborne SARS risk better than the May 28 disaster at North York General, when workers caught SARS despite their use of the personal protective precautions they were told would keep them safe. ...
...As late as May 28,the lesson of airborne risk had not been learned. A scientific study of the incident said:
In this case, just as in previous cases, either contact, droplet, or airborne transmission might have occurred.917
The CDC reported this incident in its ...
In this case, just as in previous cases, either contact, droplet, or airborne transmission might have occurred.917
The CDC reported this incident in its ...
...journal Emerging Infectious Diseases. The authors,918 some of them well-known figures in the SARS outbreak, concluded that the mechanism of transmission of the virus from patient to worker could have been airborne rather than droplet:
Two explanations may account for the ...
Two explanations may account for the ...
... transmission observed in this case: 1) an unrecognized breach in contact and droplet precautions occurred, or 2) an airborne viral load was great enough to overwhelm the protection offered by droplet precautions, including non–fit tested N95 disposable respirators. If the ...
... last form of transmission was responsible, airborne virus may have been generated by the coughing patient before her cardiopulmonary arrest or due to a “cough-like” force produced by the airway pressures created during asynchronous chest compressions and ventilations ...
using the bag-valve-mask …
- 2006 Canadian SARS Commission Report
- 2006 Canadian SARS Commission Report
15 Having said that, attention to infection
16 control precautions with this particular virus must be
17 meticulous. The droplet contamination of surfaces is very
18 important in transmission for this virus. It is not a
...
16 control precautions with this particular virus must be
17 meticulous. The droplet contamination of surfaces is very
18 important in transmission for this virus. It is not a
...
19 forgiving virus. We've been able to get away with less than
20 meticulous attention to infection control; we cannot with
21 this virus. It's not forgiving.
- Dr Mary Vearncome testimony, SARS Commission.
20 meticulous attention to infection control; we cannot with
21 this virus. It's not forgiving.
- Dr Mary Vearncome testimony, SARS Commission.
1 It was described as an atypical pneumonia; it
2 was described as affecting healthcare workers. It was from
3 an unidentified cause ,at that time, and it was believed to
4 be spreading through South East Asia.
2 was described as affecting healthcare workers. It was from
3 an unidentified cause ,at that time, and it was believed to
4 be spreading through South East Asia.
5 The name SARS did not appear until the second
6 directive from the World Health Organization on March the
7 15th, and you'll recall that the index patient in Toronto
8 died on the 13th of March.
6 directive from the World Health Organization on March the
7 15th, and you'll recall that the index patient in Toronto
8 died on the 13th of March.
9 In fact, despite the isolation that was put on
10 at the Scarborough Grace Hospital, unfortunately, other
11 patients did become infected with SARS, initially, and this,
12 what looks like a confusing graph, illustrates that the first
10 at the Scarborough Grace Hospital, unfortunately, other
11 patients did become infected with SARS, initially, and this,
12 what looks like a confusing graph, illustrates that the first
13 patient gave it to her son, her son gave it to a series of
14 relatives and unfortunately, while he was unprotected in the
15 Scarborough Grace Hospital, several other -- two (2) other
16 patients became infected and they, in turn, infected a large
14 relatives and unfortunately, while he was unprotected in the
15 Scarborough Grace Hospital, several other -- two (2) other
16 patients became infected and they, in turn, infected a large
17 number of - of other patients and healthcare workers.
18 It was at this point, as this row and the next
19 row were appearing in the hospital, that it became obvious to
20 the authorities that they had a serious problem on their
18 It was at this point, as this row and the next
19 row were appearing in the hospital, that it became obvious to
20 the authorities that they had a serious problem on their
21 hands and that illustrates part of the problem with this
22 entire illness. One is looking at -- one - one sees today
22 entire illness. One is looking at -- one - one sees today
23 not what happened today. What happened today, in fact, won't
24 be seen for somewhere between a week and ten (10) days later.
- James Young, Ontario Commissioner of Public Safety
24 be seen for somewhere between a week and ten (10) days later.
- James Young, Ontario Commissioner of Public Safety
22 So in planning something and combating
23 something like this, it's not like a forest fire which, in
24 and by itself, can be difficult enough to control, but if I
25 want to know the size of a forest fire, I can get above the
23 something like this, it's not like a forest fire which, in
24 and by itself, can be difficult enough to control, but if I
25 want to know the size of a forest fire, I can get above the
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1 forest fire, see where it is and build a barrier so that the
2 forest fire does not jump over that barrier and even if it
3 does, I may be able to have a series of smaller fires I can
4 put out.
1 forest fire, see where it is and build a barrier so that the
2 forest fire does not jump over that barrier and even if it
3 does, I may be able to have a series of smaller fires I can
4 put out.
5 The theory in controlling something like SARS
6 is the same but the difficulty and the problem is, I have no
7 idea where it is. I only know where it was ten (10) days ago
8 and I have to not only catch up that ten (10) days, I must
6 is the same but the difficulty and the problem is, I have no
7 idea where it is. I only know where it was ten (10) days ago
8 and I have to not only catch up that ten (10) days, I must
9 get further ahead.
10 And so, in my view, the only way of combatting
11 something like this, is to go after it very hard and very
12 fast and attempt to get far enough ahead that, in fact, if we
13 have any breakout it's very limited.
- same
10 And so, in my view, the only way of combatting
11 something like this, is to go after it very hard and very
12 fast and attempt to get far enough ahead that, in fact, if we
13 have any breakout it's very limited.
- same
17 And the logic and my thinking, at that point
18 in time, in fact, was that we had to protect each and every
19 hospital. If we didn't and we began to lose hospitals one
20 after another, we would very quickly find we had large
18 in time, in fact, was that we had to protect each and every
19 hospital. If we didn't and we began to lose hospitals one
20 after another, we would very quickly find we had large
21 numbers of healthcare workers affected and we would have a
22 healthcare system, in fact, that was simply unmanageable.
- James Young, again
22 healthcare system, in fact, that was simply unmanageable.
- James Young, again
23 We had to immediately put staff into gowns and
24 gloves and masks and we chose, for means of protection, to
25 use the =FB95 mask. We believed from the beginning that it was
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24 gloves and masks and we chose, for means of protection, to
25 use the =FB95 mask. We believed from the beginning that it was
p42
1 droplet spread but we believed, until we were more certain,
2 that we should use the more protective =FB95 mask. This posed
3 problems for us because, in fact, hospitals didn't
4 traditionally use large numbers of =FB95 masks and we scoured
2 that we should use the more protective =FB95 mask. This posed
3 problems for us because, in fact, hospitals didn't
4 traditionally use large numbers of =FB95 masks and we scoured
5 the world looking for =FB95 masks and trying to, in fact,
6 supply the hospitals and doctors' offices with these things.
7 We clearly learned lessons out of this about
8 inventory control on the future and maintaining supplies of
6 supply the hospitals and doctors' offices with these things.
7 We clearly learned lessons out of this about
8 inventory control on the future and maintaining supplies of
9 infectious control materials, but that, again, in the world
10 we lived in in those days, did not exist and we had to create
11 those systems and create those systems for delivering
12 supplies to doctors' offices. Those systems were simply not
13 in place.
- same
10 we lived in in those days, did not exist and we had to create
11 those systems and create those systems for delivering
12 supplies to doctors' offices. Those systems were simply not
13 in place.
- same
18 In other jurisdictions, for example in China,
19 workers were not allowed into patient care areas without
20 wearing full suits with respirators, but those suits emerged
21 only late in the outbreak in Ontario as though we were a
19 workers were not allowed into patient care areas without
20 wearing full suits with respirators, but those suits emerged
21 only late in the outbreak in Ontario as though we were a
22 developing country, and it wasn't the other way around.
- Michael Hurley, for CUPE (union)
- Michael Hurley, for CUPE (union)
Don't quibble in a pandemic. (Yet still people are quibbling right now.) https://twitter.com/jmcrookston/status/1292492102199377920
CDC SARS guidance from the SARS era.
Note "possibly airborne" - and remember there weren't that many cases worldwide. And use N95.
Note "possibly airborne" - and remember there weren't that many cases worldwide. And use N95.
