• Sebastian Leck

FACT CHECK: Did the Ontario government instruct care home staff to downgrade their masks?

MISLEADING. The Ontario government told personal support workers to use non-medical cloth masks in residential facilities where there is no active COVID-19 outbreak, but workers in facilities with active outbreaks will still use medical-grade masks.

On May 16, Ontario’s New Democratic Party (NDP) tweeted that personal support workers (PSWs) in the province “are forced to work under hazardous conditions and are told to downgrade to non-medical cloth masks.” The NDP used the claim to push for an investigation into long-term care in the province (the Ontario government has since launched an independent commission to investigate the sector).

A tale of two memos

The NDP’s claim regarding cloth masks is based on a May 8 memo that the Ministry of Children, Community and Social Services sent to residential services providers, such as care homes for people with developmental disabilities. For basic prevention, staff should wear cloth (non-medical) masks at all congregate care sites regardless of infection status,” the memo reads.

Because an earlier memo from April 27 didn’t mention cloth masks, the provincial leader of the NDP, Andrea Horwath, said in a press release that Doug Ford’s government had chosen to “water down” safety recommendations. “The Ford government is now encouraging staff in residential facilities, like care homes for people with disabilities, to downgrade to non-medical cloth masks, even where there’s an active COVID-19 outbreak,” the statement reads.

Here’s what the evidence tells us. The first memo reads: “Please begin requiring staff to wear masks at all congregate care sites regardless of infection status. Limit this preventative masking to 1 mask per person, per shift to ensure conservation.” The wording suggests—but does not make explicit—that the government recommends using surgical masks, which are normally disposed of after each use.

The second memo from May 8 says that staff should wear cloth, non-medical masks at care homes, but tells them to use more precautions if there is an outbreak at the facility. If staff come within two metres of a person suspected or confirmed to have COVID-19, it recommends that “enhanced PPE [personal protective equipment] must be worn (surgical mask, eye protection, gown, gloves).”

It remains unclear whether cloth masks are effective

A spokesperson for the Minister of Children, Community and Social Services says the new instructions are based on advice from David Williams, Ontario’s chief medical officer of health. In April, Williams, along with Canada’s other chief medical officers, told the public that, while cloth masks have not yet been proven to protect the wearer, they can be an “additional measure” to protect people around you if you can’t follow physical distancing guidelines.

Very little research on the effectiveness of cloth masks exists, according to a review by the Boston Medical Journal. However, one clinical trial done in 2015 reported that using cloth masks led to far higher rates of infection for healthcare workers compared to medical-grade masks.

The NDP may be right that the government has an obligation to do more. An Ontario commission that reviewed the 2003 SARS crisis argued that healthcare providers should follow the “precautionary principle,” which states that “action to reduce risk need not await scientific certainty.” Even if cloth masks are found to offer some protection, the government could be legally required to provide more than that.

It’s true that the Ontario government instructed PSWs to wear cloth masks in care homes without outbreaks, even though there’s little evidence that they prevent the spread of infections. However, this does not apply to facilities with active COVID-19 outbreaks, which have been instructed to use medical masks and other personal protective equipment.