Masking during the COVID-19 pandemic

Masking During the COVID-19 Pandemic Prepared by Juliette O’Keeffe Introduction Extensive debate over when, where, and what types of masks should be worn, and by whom, has emerged during the COVID-19 crisis. Protocols for the use of personal protective equipment (PPE) by healthcare workers (HCWs) are well established, but more recently, widespread use of surgical […]

Masking During the COVID-19 Pandemic

Prepared by Juliette O’Keeffe

Introduction

Extensive debate over when, where, and what types of masks should be worn, and by whom, has emerged during the COVID-19 crisis. Protocols for the use of personal protective equipment (PPE) by healthcare workers (HCWs) are well established, but more recently, widespread use of surgical and cloth masks in some Asian and European countries has been mandated, and voluntary use of face masks in public is now encouraged in the US.1 There are differences of opinion on the effectiveness of mask deployment into the general population as a preventive measure for COVID-19. The World Health Organization (WHO)2 maintain that healthy people should wear a mask only when caring for a person suspected to be infected with SARS-CoV-2, the virus responsible for COVID-19. The Public Health Agency of Canada (PHAC) similarly does not recommend the use of face masks by healthy people except when caring for the sick, particularly medical masks, but does not discourage the use of non-medical masks by those who wish to wear them, or in situations where physical distancing may be difficult, such as when one is on public transport. PHAC has provided additional advice on the limitations and safe use of masks.

Much of the controversy on mask wearing relates to limited understanding of the transmission pathway for the SARS-CoV-2 virus. Early study of the virus indicates that individual virus particles are approximately 70-90 nm in diameter,4 but virus particles in general are often found clumped together in droplets of fluids or mucous >1 μm.5 Current mitigation strategies for SARS-CoV-2 focus on the main transmission routes via contact and large respiratory droplets (> 5 μm diameter). Less is known about the relative importance of other routes such as aerosol transmission (particles and droplet nuclei < 5 μm diameter).

Most recommendations for population-wide use of masks include the use of either cloth masks or surgical masks, as compared to N95 respirators that are primarily reserved for use in healthcare settings. The function and protective ability vary widely for different mask types. This document outlines the main types of masks, their effectiveness in providing protection against pathogenic hazards, and considerations for the safe use.

Types of masks

The key groups of masks are medical masks, including respirators (commonly referred to as N95, or filtering facepieces [FFP] masks) and surgical masks, and non-medical masks including homemade cloth masks. Differences between these are summarized in Table 1.

Effectiveness of masks

Masks are worn by individuals either to provide a barrier to the inhalation of particles, or to prevent the exhalation or release of particles due to coughing or sneezing. The effectiveness of a mask is dependent on the level of filtration (determined by the size of particles that can be from seeping around the edges of the mask into the breathing area. Many studies have assessed The effectiveness of a blocked) and the fit of the mask, which can affect the percentage of particles that are prevented the performance of mask types as PPE for protection of the mask wearer, as well as their use by sick individuals for the protection of others. Most studies have been based on generic respiratory viruses and influenza, with only limited study of SARS-CoV-2 published at the time of writing.

Masks as barriers to inhalation of particles

Assessments of the effectiveness of masks to prevent the inhalation of particles have included penetration studies that measure the movement of particles from the external environment through mask material into the breathing zone of the wearer, or studies of protective effect, primarily for healthcare workers (HCWs), that compare clinical outcomes for mask wearers (e.g., incidence of respiratory illness or viral infection) based on different mask-wearing scenarios.

Penetration studies for protection of a mask wearer

Penetration studies that measure the movement of particles from the external environment into the breathing zone behind the mask include those used by agencies such as the National Institute for Occupational Safety and Health (NIOSH) to confirm the protective ability of respirators such as N95s. As expected, the consensus among these studies is that respirators provide superior protection against particles, including aerosols, as compared to either surgical or cloth masks; surgical masks are likewise more protective than cloth masks of all types. N95 or FF2 respirators, when properly fitted, provide a barrier to about 95% of particles. Some studies have found these devices can block in excess of 95%. In similar studies, surgical masks have been found to block about 60% of particles, and may allow penetration by virus particles in high concentration environments, as shown in a study using live influenza virus. Additional PPE such as an integral visor can improve the performance of surgical masks by reducing leakage into the breathing zone around the nose.

Penetration studies of cloth masks find that, in general, they provide a barrier to some larger particles, but performance varies widely depending on the fit and the type of material used. Loose-fitting cloth masks (e.g., handkerchiefs) may provide only minimal protection from inhalation of particles. Masks with conical or tetrahedral shapes that fit closely with face contours perform better than loose-fitting masks. Breathability of fabrics can be a trade-off for filterability. Studies using particles of approximately 20-1000 nm found high penetration levels for cloth masks ranging from 40% (sweatshirt material) to greater than 97% (cotton and gauze handkerchiefs). A study comparing a range of fabrics as barriers to inhalation of microorganisms found that cloth masks allowed for between 30% and 51% of bacteriophage MS2 (as a surrogate for pathogenic viruses) to penetrate the material.12 The study found the most effective cloth material (for breathability and filterability) to be tea-towel material followed by (in order of decreasing effectiveness), a cotton mix, antimicrobial pillowcase, silk, linen, pillowcase, 100% cotton T-shirt, and scarf. None of the fabrics were able to achieve the low level of penetration observed for a surgical mask (11%), which also provided good breathability. Adding multiple layers of the same material appears to provide only limited additional protection, but can reduce breathability.

Protective effect studies assess the effectiveness of masks as barriers to inhalation of infectious particles by measuring the reduced incidence of clinical respiratory illness (CRI), influenza-like illness (ILI) or laboratory-confirmed viral infection among healthcare workers (HCWs) wearing masks versus no masks. In these studies, as expected, respirators are generally found to provide a greater level of protection as compared to surgical masks, with incidence of CRI found to be lower in N95 wearers compared to surgical mask wearers. Further comparison of the incidence of CRI, ILI and viral infections shows a greater incidence of illness among cloth mask wearers compared to surgical mask wearers. Cloth masks are not recommended for health care, or high-risk settlings.

While the protective effect of respirators is difficult to argue, the less protective effect of surgical masks is not always evident. No significant difference in the incidence of laboratory confirmed influenza was found among HCWs at seven US medical centres using N95 respirators versus surgical masks.  In a recent case report from China where 41 HCWs were exposed to aerosol- generating procedures for a patient who subsequently tested positive for SARS-CoV-2, none of the HCWs, of whom 85% wore surgical masks and 15% wore respirators, tested positive for SARS- CoV-2. Mask wearing was accompanied by other controls such as hand hygiene and procedural controls. While this is a small case report, and many of the HCWs were exposed only for a matter of minutes, it indicates that surgical masks, when used in conjunction with other measures, can be protective against infection.

Masks as barriers to exhalations of particles

Assessments of the effectiveness of masks to prevent the exhalation of particles have included penetration studies that use coughing tests by healthy or sick individuals to measure movement of particles through mask material to the external environment, or secondary attack rate (SAR) studies that evaluate the effect of mask-wearing by a sick individual in preventing transmission of infection to other individuals living in close contact (e.g., household members).

Penetration studies for protection of others

The effectiveness of masks as barriers to the release of infectious particles can be assessed by measuring the number of microorganisms that can penetrate a mask during exhalation or coughing by the mask wearer. Both surgical masks and cloth masks have been found to block the release of some large droplets but are generally less effective at blocking the release of infectious aerosols.  Differences in the effectiveness of masks may depend on the type of virus. One study found that surgical masks reduced the emission of influenza virus in large respiratory droplets, but not in aerosols in exhaled breath and coughs of symptomatic individuals. The same study found that surgical masks blocked the penetration of coronavirus in both large respiratory droplets and aerosols.  The only study assessing the penetration of masks by SARS-CoV-2 found that the virus penetrated both cloth masks (2-layer cotton) and surgical masks during coughing by COVID-19 patients.

Secondary attack rate (SAR) studies

In healthcare settings, the use of surgical masks by visitors and healthcare workers has been shown to reduce the incidence of respiratory viral infections among patients.  In non-healthcare settings, several studies in France, Germany, Hong Kong, China and Australia have assessed the effectiveness of wearing surgical masks in the home by patients with influenza or ILI to reduce secondary transmission to other members of the household. Some of these studies have found a lower incidence of SAR, but the results did not show statistically significant reductions including one study that assessed the protective effect of both surgical masks and N95 equivalent masks. The greatest reductions in SAR have been observed in studies where mask wearing was implemented early after the onset of symptoms in the sick patient, or where mask wearing was combined with other measures such as hand hygiene.

Considerations for mask use

The hierarchy of controls is used by NIOSH to grade the most effective to the least effective measures for reducing exposures to hazards and is conventionally applied to physical and chemical hazards in the workplace. This framework could be extended to infectious hazards in the general community. Within the framework, the use of PPE is considered a last resort option when other measures have been exhausted. These other measures could include steps to physically eliminate the hazard (e.g., physical isolation), engineering controls to reduce exposure to the hazard (e.g., ventilation) or administrative controls that change the way people work to reduce exposures (e.g., changes to working practices and schedules, hand hygiene). The separation of infected persons from healthy persons, good hygiene practices, cleaning and disinfection of surfaces and engineering controls are known to reduce disease transmission. Following the implementation of these measures, whether masks are used as personal protection for the wearer, or as protection of others from the wearer, there are several considerations that can impact the effectiveness of masks to prevent the spread of viral infection.

Mask fit

Where respirators are used as PPE, a fit test, and user seal check are essential for ensuring effectiveness of N95 type respirators. Fit tests are used to confirm that a specific make, model and size of respirator provides adequate respiratory protection to the user by providing a tight seal between the facepiece and the face that prevents leakage into or out of the respirator facepiece (Box 1). If the respirator does not pass a fit test, another make, model or size is tested until a suitable respirator is found. The wearer can then use the same make, model, and size of respirator, repeating the test once per year to confirm that fit is maintained, or reconfirming fit if physical changes to the face have occurred, such as weight loss or injury. If the user changes the make, model or size of respirator, a new fit test is required.

A user seal check is different from a fit test and should be performed every time a respirator is put on. Advice on user seal checks is provided by the Canadian Centre for Occupational Health and Safety (CCOHS) and can differ depending on the type of respirator. In general, the wearer identifies a good seal on inhalation by checking that there is slight collapse in the respirator and checks for leakage on exhalation by feeling around the edges or surface of the facepiece. Factors that can influence a poor fit or seal can include damage or deformation of the mask, and the presence of obstructions to fit such as facial hair. For other types of mask, a good fit that aligns to the contours of the face can reduce seepage of air around the edges of the mask. A tight but comfortable fit with effective coverage of the nose and mouth that does not restrict breathability can reduce the frequency that a user touches a mask for readjustment.

Additional PPE

For HCWs or those caring for an infected person, the use of goggles or a face shield that covers the eyes or front and sides of the face, can prevent additional exposures due to splash and spray and block some intake of particles that would occur due to leakage. The appropriate use of gloves (e.g., not touching mask surface, and frequent changing) can also reduce the chance of surface contamination of masks, and similarly washing hands when putting on (donning) and taking off (doffing) PPE, including masks, can reduce contact spread.

Length of use

The longer a mask is used, the greater the risk for infectious particles to become deposited on the surface. Surgical masks or respirators (e.g., N95) that become wet, damaged, torn, visibly dirty, or contaminated following close contact with an infected person will not provide adequate protection. A study of mask use by HCWs found that very low infection was observed for masks used ≤ 6 hours, however a greater virus positivity was found beyond 6 hours of use, and for HCWs who examined more than 25 patients. The potential presence of viruses on the outer surface suggests a need for caution during doffing practices by avoiding contact with the mask surface (Box 2), and preventing the resuspension of deposited aerosols. Frequent donning and doffing of the same mask can increase the risk of surface contamination on both the inside and the outside of masks and continuous use of respirators may reduce the potential for contamination as compared to frequent donning and doffing of the same mask. In healthcare environments, other measures such as the use of complementary PPE (e.g., face shields) can extend the usability of respirators or masks by reducing the potential for surface deposition or accidental contact with mask surfaces.

Decontamination and reuse of masks

Masks can become contaminated by the user and the external environment. For cloth masks, laundering in a hot wash and thoroughly drying is recommended by PHAC, but any damage, deterioration or reduced fit will reduce the already limited protective function of cloth masks. In general, surgical masks are considered disposable and not recommended for decontamination and reuse. Laundering or disinfection processes can potentially damage the protective layers of the surgical masks, reducing their effectiveness.

Several decontamination methods have been considered for the purpose of providing additional supplies of respirators when there is high demand. The key criteria for effective decontamination methods are stated as: the ability to remove the viral threat, maintaining the integrity of mask elements, and being harmless to the user. Decontamination methods include autoclaving; microwave steam sterilization; washing in soap and water; dry heat treatment; treatment with isopropyl alcohol, bleach, hydrogen peroxide vapour, gamma irradiation; ozone decontamination; UV germicidal irradiation (UVGI) and ethylene oxide treatment. Promising results have been observed for hydrogen peroxide vapour and UVGI; however, any reuse of decontaminated respirators should include steps to inspect respirators for deterioration and damage and to include user seal testing prior to re-use.

Expired masks

Surgical masks and respirators that have been certified by organizations such as NIOSH or the FDA have an expiry date, after which they are no longer considered to be certified. In times of high demand, expired masks may be considered for use following a visual inspection for any damage or degradation of the mask components, including the straps. For expired N95 respirators, the ability to form an effective face seal should also be confirmed by a fit test and user seal check.

Summary

The COVID-19 crisis has resulted in a large upscaling of demand across global health care systems for PPE. Maintaining supplies for healthcare and frontline workers requires judicious use of medical masks including N95 type respirators, which are shown to be the most effective face masks for reducing exposure to viruses for those working in high-risk environments. PPE remains a last line of defence amid other important measures including physical distancing, hygiene and engineering controls.

It is not clear if, or to what extent, the transmission of respiratory viruses is reduced by the population-wide use of face masks, although it is argued by some that the practice during the SARS epidemic in Asia may have provided some protective effect that reduced the transmission of influenza and SARS.  In the current COVID-19 pandemic, there is still no firm evidence that the population-wide use of face masks can significantly decrease the risk of infection for healthy individuals or contain community transmission from either infected but asymptomatic persons or from those with symptoms. Further study of the progression of the pandemic in countries that have mandated population-wide use of face masks will help to inform the debate further.

While it has been observed that the use of cloth masks can provide minimal personal protection to the wearer against viral infections, some may argue that some protective effect is better than none. Similarly, the wearing of masks by asymptomatic carriers or symptomatic individuals for the protection of others could be used to reduce the distance a plume of particles generated by a cough or sneeze could travel, similar to common respiratory etiquette recommendations of coughing or sneezing into a tissue or one’s elbow. In most cases, the use of face masks is relatively low risk, and could provide some minimal protection, but if they are used as a substitute for other measures such as maintaining physical distancing and observing good hand hygiene, they could be harmful. They should not be used as a substitute for sick individuals, or those who have returned from travel and may be asymptomatic carriers, to isolate from others Mask wearers should also be aware of the contamination risks from contact with the surface of masks, even when wearing gloves, and considerations for appropriate donning and doffing practices to reduce transfer of contamination.

Identifying airborne transmission as the dominant route for the spread of COVID-19

Research article by PNAS (Proceedings of the National Academy of Sciences of the United States of America) Significance We have elucidated the transmission pathways of coronavirus disease 2019 (COVID-19) by analyzing the trend and mitigation measures in the three epicenters. Our results show that the airborne transmission route is highly virulent and dominant for the […]

Research article by PNAS (Proceedings of the National Academy of Sciences of the United States of America)

Significance

We have elucidated the transmission pathways of coronavirus disease 2019 (COVID-19) by analyzing the trend and mitigation measures in the three epicenters. Our results show that the airborne transmission route is highly virulent and dominant for the spread of COVID-19. The mitigation measures are discernable from the trends of the pandemic. Our analysis reveals that the difference with and without mandated face covering represents the determinant in shaping the trends of the pandemic. This protective measure significantly reduces the number of infections. Other mitigation measures, such as social distancing implemented in the United States, are insufficient by themselves in protecting the public. Our work also highlights the necessity that sound science is essential in decision-making for the current and future public health pandemics.

Abstract

Various mitigation measures have been implemented to fight the coronavirus disease 2019 (COVID-19) pandemic, including widely adopted social distancing and mandated face covering. However, assessing the effectiveness of those intervention practices hinges on the understanding of virus transmission, which remains uncertain. Here we show that airborne transmission is highly virulent and represents the dominant route to spread the disease. By analyzing the trend and mitigation measures in Wuhan, China, Italy, and New York City, from January 23 to May 9, 2020, we illustrate that the impacts of mitigation measures are discernable from the trends of the pandemic. Our analysis reveals that the difference with and without mandated face covering represents the determinant in shaping the pandemic trends in the three epicenters. This protective measure alone significantly reduced the number of infections, that is, by over 78,000 in Italy from April 6 to May 9 and over 66,000 in New York City from April 17 to May 9. Other mitigation measures, such as social distancing implemented in the United States, are insufficient by themselves in protecting the public. We conclude that wearing of face masks in public corresponds to the most effective means to prevent interhuman transmission, and this inexpensive practice, in conjunction with simultaneous social distancing, quarantine, and contact tracing, represents the most likely fighting opportunity to stop the COVID-19 pandemic. Our work also highlights the fact that sound science is essential in decision-making for the current and future public health pandemics.

The novel coronavirus outbreak, coronavirus disease 2019 (COVID-19), which was declared a pandemic by the World Health Organization (WHO) on March 11, 2020, has infected over 4 million people and caused nearly 300,000 fatalities over 188 countries. Intensive effort is ongoing worldwide to establish effective treatments and develop a vaccine for the disease. The novel coronavirus, named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), belongs to the family of the pathogen that is responsible for respiratory illness linked to the 2002–2003 outbreak (SARS-CoV-1). The enveloped virus contains a positive-sense single-stranded RNA genome and a nucleocapsid of helical symmetry of ∼120 nm. There exist several plausible pathways for viruses to be transmitted from person to person. Human atomization of virus-bearing particles occurs from coughing/sneezing and even from normal breathing/talking by an infected person (3⇓⇓–6). These mechanisms of viral shedding produce large droplets and small aerosols, which are conventionally delineated at a size of 5 μm to characterize their distinct dispersion efficiencies and residence times in air as well as the deposition patterns along the human respiratory tract. Virus transmission occurs via direct (deposited on persons) or indirect (deposited on objects) contact and airborne (droplets and aerosols) routes. Large droplets readily settle out of air to cause person/object contamination; in contrast, aerosols are efficiently dispersed in air. While transmission via direct or indirect contact occurs in a short range, airborne transmission via aerosols can occur over an extended distance and time. Inhaled virus-bearing aerosols deposit directly along the human respiratory tract.

Previous experimental and observational studies on interhuman transmission have indicated a significant role of aerosols in the transmission of many respiratory viruses, including influenza virus, SARS-CoV-1, and Middle East Respiratory Syndrome coronavirus (MERS-CoV) (8⇓⇓–11). For example, airborne coronavirus MERS-CoV exhibited strong capability of surviving, with about 64% of microorganisms remaining infectious 60 min after atomization at 25 °C and 79% relative humidity (RH). On the other hand, rapid virus decay occurred, with only 5% survival over a 60-min procedure at 38 °C and 24% RH, indicative of inactivation. Recent experimental studies have examined the stability of SARS-CoV-2, showing that the virus remains infectious in aerosols for hours and on surfaces up to days.

Several parameters likely influence the microorganism survival and delivery in air, including temperature, humidity, microbial resistance to external physical and biological stresses, and solar ultraviolet (UV) radiation (7). Transmission and infectivity of airborne viruses are also dependent on the size and number concentration of inhaled aerosols, which regulate the amount (dose) and pattern for respiratory deposition. With typical nasal breathing (i.e., at a velocity of ∼1 m⋅s−1), inhalation of airborne viruses leads to direct and continuous deposition into the human respiratory tract. In particular, fine aerosols (i.e., particulate matter smaller than 2.5 μm, or PM2.5) penetrate deeply into the respiratory tract and even reach other vital organs. In addition, viral shedding is dependent on the stages of infection and varies between symptomatic and asymptomatic carriers. A recent finding showed that the highest viral load in the upper respiratory tract occurs at the symptom onset, suggesting the peak of infectiousness on or before the symptom onset and substantial asymptomatic transmission for SARS-CoV-2.

The COVID-19 outbreak is significantly more pronounced than that of the 2002/2003 SARS, and the disease continues to spread at an alarming rate worldwide, despite extreme measures taken by many countries to constrain the pandemic (1). The enormous scope and magnitude of the COVID-19 outbreak reflect not only a highly contagious nature but also exceedingly efficient transmission for SARS-CoV-2. Currently, the mechanisms to spread the virus remain uncertain, particularly considering the relative contribution of the contact vs. airborne transmission routes to this global pandemic. Available epidemiological and experimental evidence, however, implicates airborne transmission of SARS-CoV-2 via aerosols as a potential route for the spreading of the disease.

Distinct Pandemic Trends in the Three Epicenters

To gain insight into the mechanism of the virus transmission routes and assess the effectiveness of mitigation measures, we analyzed the trend of the pandemic worldwide from January 23 to May 9, 2020 (Fig. 1). The COVID-19 outbreak initially emerged during December 2019 in Wuhan, China. The numbers of confirmed infections and fatalities in China dominated the global trend during January and February 2020 (Fig. 1A), but the increases in the newly confirmed cases and fatalities in China have exhibited sharp declines since February (Fig. 1B). In contrast to the curve flattening in China, those numbers in other countries have increased sharply since the beginning of March. The epicenter shifted from Wuhan to Italy in early March and to New York City (NYC) in early April. By April 30, the numbers of confirmed COVID-19 cases and deaths, respectively, reached over 200,000 and 27,000 in Italy and over 1,000,000 and 52,000 in the United States, compared to about 84,000 and 4,600 in China (Fig. 1B). Notably, the curves in Italy exhibit a slowing trend since mid-April, while the numbers in the world and the United States continue to increase. Remarkably, the recent trends in the numbers of infections and fatalities in the world and in the United States exhibit striking linearity since the beginning of April (Fig. 1C).

We interpreted the differences in the pandemic trends by considering the mitigation measures implemented worldwide. The curve flattening in China can be attributed to extensive testing, quarantine, and contact tracing; other aggressive measures implemented in China include lockdown of all cities and rural areas in the whole country, isolation of residents having close contact with infected people, and mandated wearing of face masks in public. However, the effectiveness of those mitigation measures has yet to be rigorously evaluated. Differentiation of the effects of those mitigation measures in China is challenging, since the implementation occurred almost simultaneously in January 2020. While similar quarantine, isolation, and city lockdown measures were also implemented on March 9 in Italy after the country became the second epicenter, the curve of infections has yet to show complete flattening. In the United States, guidelines for social distancing, quarantine, and isolation were issued by the federal government on March 16, and stay-at-home orders were implemented by many state and local governments starting, for example, on March 19 and April 3 and on March 22 in NYC. The social distancing measures implemented in the United States include staying at least 6 feet (∼2 m) away from other people, no gathering in groups, staying out of crowded places, and avoiding mass gatherings. Obviously, the continuous rise in the US infected numbers casts doubt on the effectiveness of those preventive measures alone (Fig. 1 B and C).

In contrast to China, wearing of face masks was not mandated and was unpopular in most of the western world during the early outbreak of the pandemic. Advice on the use of face masks was not issued until April 6, 2020 by the WHO, claiming that it is important only to prevent infected persons from viral transmission by filtering out droplets but that it is unimportant to prevent uninfected persons from breathing virus-bearing aerosols. The regions heavily plagued by COVID-19 in northern Italy, such as Lombard, ordered face covering in public starting on April 6, and the Italian authorities required nationwide mandatory use of face masks on May 4. All New Yorkers were mandated to use face covering in public starting on April 17, when social distancing was not possible. With measures implemented in the United States seemingly comparable to those in China, social distancing, quarantine, and isolation exhibited little impact on stopping the spreading of the disease in the United States, as reflected by the linearity from April 1 to May 9 (Fig. 1C). It is possible, however, that these measures likely alter the slope of the infection curve, that is, by reducing the rate of infections during the early stage of the pandemic (Fig. 1). Notably, the recommended physical separation for social distancing is beneficial to prevent direct contact transmission but is insufficient (without face masks) to protect inhalation of virus-bearing aerosols (or even small droplets at intermediate proximity), owing to rapid air mixing.

Understanding the Impacts of Face Covering

Compared to the simultaneous implementation of measures in China, intervention measures were successively implemented in the western world (Fig. 2A), providing an opportunity for assessing their relative effectiveness. We quantified the effects of face covering by projecting the number of infections based on the data prior to implementing the use of face masks in Italy on April 6 and NYC on April 17 (Fig. 2A; see Methods). Such projections are reasonable considering the excellent linear correlation for the data prior to the onset of mandated face covering (Fig. 2 B and C). Our analysis indicates that face covering reduced the number of infections by over 78,000 in Italy from April 6 to May 9 and by over 66,000 in NYC from April 17 to May 9. In addition, varying the correlation from 15 d to 30 d prior to the onset of the implementation reveals little difference in the projection for both places, because of the high correlation coefficients. Notably, the trends of the infection curves in Italy and NYC contrast to those in the world and in the United States (Fig. 1C), which show little deviation from the linearity due to the nonimplementation of face-covering measures globally and nationally, respectively. The inability of social distancing, quarantine, and isolation alone to curb the spread of COVID-19 is also evident from the linearity of the infection curve prior to the onset of the face-covering rule in Italy on April 6 and in NYC on April 17 (Fig. 2 B and C). Hence, the difference made by implementing face covering significantly shapes the pandemic trends worldwide.

We further compared the numbers of daily new cases between NYC and the United States (excluding the data in NYC) from March 1 to May 9 (Fig. 3). The daily numbers of newly confirmed infections in NYC and the United States show a sharp increase in late March and early April. There exists a slower increase in the number after implementation of the stay-at-home order (about 14 d in New York and shortly after April 3 in the United States), which is attributable to the impacts of this measure. After April 3, the only difference in the regulatory measures between NYC and the United States lies in face covering on April 17 in NYC. We applied linear regression to the data between April 17 and May 9 in NYC and between April 5 and May 9 in the United States. While the daily numbers of newly confirmed infections fluctuate considerably, the slope of the regression unambiguously reflects the trend in both data. The daily new infection in NYC decreases with a slope of 106 cases per day after April 17, corresponding to a decreasing rate of ∼3% per day (relative to April 17). For comparison, the daily new infections in the United States (excluding NYC) increase, with a slope of 70 cases per day after April 4, corresponding to an increasing rate of ∼0.3% per day (relative to April 5). Hence, the decreasing rate in the daily new infections in NYC with mandated face covering is in sharp contrast to that in the United States with only social-distancing and stay-at-home measures, further confirming the importance of face covering in intervening the virus transmission.

Dominant Airborne Transmission

We further elucidated the contribution of airborne transmission to the COVID-19 outbreak by comparing the trends and mitigation measures during the pandemic worldwide and by considering the virus transmission routes (Fig. 4). Face covering prevents both airborne transmission by blocking atomization and inhalation of virus-bearing aerosols and contact transmission by blocking viral shedding of droplets. On the other hand, social distancing, quarantine, and isolation, in conjunction with hand sanitizing, minimize contact (direct and indirect) transmission but do not protect against airborne transmission. With social distancing, quarantine, and isolation in place worldwide and in the United States since the beginning of April, airborne transmission represents the only viable route for spreading the disease, when mandated face covering is not implemented. Similarly, airborne transmission also contributes dominantly to the linear increase in the infection prior to the onset of mandated face covering in Italy and NYC (Fig. 2 B and C and SI Appendix, Fig. S1). Hence, the unique function of face covering to block atomization and inhalation of virus-bearing aerosols accounts for the significantly reduced infections in China, Italy, and NYC (Figs. 1–3), indicating that airborne transmission of COVID-19 represents the dominant route for infection.

Recent measurements identified SARS-Cov-2 RNA on aerosols in Wuhan’s hospitals and outdoor in northern Italy, unraveling the likelihood of indoor and outdoor airborne transmission. Within an enclosed environment, virus-bearing aerosols from human atomization are readily accumulated, and elevated levels of airborne viruses facilitate transmission from person to person. Transmission of airborne viruses in open air is subject to dilution, although virus accumulation still occurs due to stagnation under polluted urban conditions. Removal of virus-bearing particles from human atomization via deposition is strongly size dependent, with the settling velocities ranging from 2.8 × 10−5m⋅s−1 to 1.4 × 10−3 m⋅s−1 for the sizes of 1 and 10 μm, respectively. For comparison, typical wind velocity is about 1 m⋅s−1 to 3 m⋅s−1 indoors and is ∼1 m⋅s−1 horizontally and 0.1 m⋅s−1 vertically in stable air. Under those indoor and outdoor conditions, the residence time of virus-bearing aerosols reaches hours, due to air mixing.

We also examined ambient conditions relevant to the outbreaks in Wuhan, Italy, and NYC. The initial outbreak of COVID-19 in Wuhan coincided with the winter haze season in China, during which high levels of PM2.5 were prevalent in air (SI Appendix, Figs. S2 and S3). On the other hand, the daily average PM2.5 concentrations were much lower during the outbreaks in Rome, Italy, and in NYC (SI Appendix, Fig. S2). The airborne transmission pathways (i.e., indoor or outdoor) as well as the effects of ambient PM2.5 levels on virus transmission may be variable among urban cities. For example, the winter haze conditions in China likely exacerbated outdoor virus spreading, because of low UV radiation, air stagnation (lacking ventilation on the city scale), and low temperature. Also, there may exist a synergetic effect of simultaneous exposure to the virus and PM2.5 to enhance the infectivity, severity, and fatalities of the disease. In addition, nascent virus-bearing aerosols produced from human atomization likely undergo transformation in air, including coagulation with ambient preexisting PM and/or growth on a time scale of a few hours in typical urban air (27⇓–29). Such transformation, as recently documented on coarse PM in Italy, may mitigate virus inactivation, by providing a medium to preserve its biological properties and elongating its lifetimes. However, key questions remain concerning transformation and transmission of virus-bearing aerosols from human atomization in air. Specifically, what are the impacts of transformation of human-atomized aerosols on viral surviving and infectivity in air?

While the humidity effect on viral surviving is uncertain, the conditions during the outbreaks in Wuhan, Rome, and NYC correspond to high RH yet low absolute humidity because of low temperature. Early experimental work showed remarkable survival for the analogous coronavirus MERS-CoV at the RH level characteristic of the COVID-19 outbreaks in Wuhan, Rome, and NYC. For comparison, indoor temperature and RH typically range from 21 °C to 27 °C and 20 to 70%, respectively.

Of particular importance are the considerations that render airborne SARS-CoV-2 the most efficient among all transmission routes. Even with normal nasal breathing, inhalation of virus-bearing aerosols results in deep and continuous deposition into the human respiratory tract, and this transmission route typically requires a low dose. Also, airborne viruses have great mobility and sufficiently long surviving time for dispersion, and residents situated in densely populated environments are highly vulnerable. In addition, nascent micrometer-size aerosols produced from coughing/sneezing of infected people have the potential of containing many viruses, particularly for asymptomatic carriers.

Future research is critically needed to assess the transmission, transformation, and dispersion of virus-bearing aerosols from human atomization under different environmental conditions, as well as the related impacts on virus infectivity. It is equally important to understand human atomization of airborne viruses: What are the number and size distributions of nascent aerosols as well as the viral load per particle from coughing/sneezing? It is also imperative to evaluate human inhalation of airborne viruses: How are aerosols deposited along the respiratory tract, and what is the minimum dose of airborne viruses required for infection? It is also important to evaluate the performance of face masks to quantify the efficiency to filtrate airborne viruses relevant to human atomization and inhalation. Elucidation of these mechanisms requires an interdisciplinary effort.

A Policy Perspective

The governments’ responses to the COVID pandemic have so far differed significantly worldwide. Swift actions to the initial outbreak were undertaken in China, as reflected by nearly simultaneous implementation of various aggressive mitigation measures. On the other hand, the response to the pandemic was generally slow in the western world, and implementation of the intervention measures occurred only consecutively. Clearly, the responsiveness of the mitigation measures governed the evolution, scope, and magnitude of the pandemic globally (Figs. 1 and 2).

Curbing the COVID-19 relies not only on decisive and sweeping actions but also, critically, on the scientific understanding of the virus transmission routes, which determines the effectiveness of the mitigation measures (Fig. 5). In the United States, social distancing and stay-at-home measures, in conjunction with hand sanitizing (Fig. 5, path a), were implemented during the early stage of the pandemic (March 16). These measures minimized short-range contact transmission but did not prevent long-range airborne transmission, responsible for the inefficient containing of the pandemic in the United States (Figs. 1 and 3). Mandated face covering, such as those implemented in China, Italy, and NYC, effectively prevented airborne transmission by blocking atomization and inhalation of virus-bearing aerosols and contact transmission by blocking viral shedding of droplets. While the combined face-covering and social distancing measures offered dual protection against the virus transmission routes, the timing and sequence in implementing the measures also exhibited distinct outcomes during the pandemic. For example, social distancing measures, including city lockdown and stay-at-home orders, were implemented well before face covering was mandated in Italy and NYC (Fig. 5, path b), and this sequence left an extended window (28 d in Italy and 32 d in NYC) for largely uninterrupted airborne transmission to spread the disease (Figs. 2 and 3). The simultaneous implementation of face covering and social distancing (Fig. 5, path c), such as that undertaken in China, was most optimal, and this configuration, in conjunction with extensive testing and contact tracing, was responsible for the curve flattening in China (Fig. 1). Also, there likely existed remnants of virus transmission after the implementation of regulatory measures, because of circumstances when the measures were not practical or were disobeyed and/or imperfection of the measures. Such limitations, which have been emphasized by the WHO , spurred on controversial views on the validity of wearing face masks to prevent the virus transmission during the pandemic. However, it is implausible that the limitations of mitigation measures alone contributed dominantly to the global pandemic trend, as exemplified by the success in China. Our work suggests that the failure in containing the propagation of COVID-19 pandemic worldwide is largely attributed to the unrecognized importance of airborne virus transmission.

Conclusions

The inadequate knowledge on virus transmission has inevitably hindered development of effective mitigation policies and resulted in unstoppable propagation of the COVID-19 pandemic (Figs. 1–3). In this work, we show that airborne transmission, particularly via nascent aerosols from human atomization, is highly virulent and represents the dominant route for the transmission of this disease. However, the importance of airborne transmission has not been considered in establishment of mitigation measures by government authorities. Specifically, while the WHO and the US Centers for Disease Control and Prevention (CDC) have emphasized the prevention of contact transmission, both WHO and CDC have largely ignored the importance of the airborne transmission route. The current mitigation measures, such as social distancing, quarantine, and isolation implemented in the United States, are insufficient by themselves in protecting the public. Our analysis reveals that the difference with and without mandated face covering represents the determinant in shaping the trends of the pandemic worldwide. We conclude that wearing of face masks in public corresponds to the most effective means to prevent interhuman transmission, and this inexpensive practice, in conjunction with extensive testing, quarantine, and contact tracking, poses the most probable fighting opportunity to stop the COVID-19 pandemic, prior to the development of a vaccine. It is also important to emphasize that sound science should be effectively communicated to policy makers and should constitute the prime foundation in decision-making amid this pandemic. Implementing policies without a scientific basis could lead to catastrophic consequences, particularly in light of attempts to reopen the economy in many countries. Clearly, integration between science and policy is crucial to formulation of effective emergency responses by policy makers and preparedness by the public for the current and future public health pandemics.

Methods

Projection of the pandemic trend without implementing face covering in Italy and NYC was performed first by establishing the linear correlation between the infection number and date. We considered the data for both 15 and 30 d prior to the onset of face covering. The slope and the reported infection number were used for the projections. The avoided infection number due the face covering was determined from the difference between the projected and reported values on May 9, 2020.

The data for accumulative confirmed infections and fatalities in Wuhan, Italy, and NYC were taken from the reports by Wuhan Municipal Health Commission (http://wjw.wuhan.gov.cn/), European CDC (https://www.ecdc.europa.eu/en), and NYC government (https://www1.nyc.gov/site/doh/covid/covid-19-data.page), respectively. The data of accumulative confirmed infections and fatalities worldwide were taken from WHO COVID-19 situation report (https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports) (1), and the numbers in China, Italy, and United States were from taken from European CDC.

Ground-based measurements of PM2.5 and RH in Wuhan were taken from the China National Environmental Monitoring Centre (http://beijingair.sinaapp.com/). The PM2.5 data in NYC were taken from US Environmental Protection Agency (https://www.epa.gov/outdoor-air-quality-data). The PM2.5 data in Rome were taken were from Centro Regionale della Qualità dell’aria (http://www.arpalazio.net/main/aria/). The RH data in Rome and NYC were taken from the 6-hourly interim reanalysis of the European Centre for Medium-range Weather Forecasts (https://www.ecmwf.int/en/forecasts/datasets/reanalysis-datasets/era5).

We used spaceborne measurements of aerosol optical depth (AOD) to characterize the regional aerosol pollution during the COVID-19 outbreak (January 23 to February 10, 2020) in China. The green band AODs at 0.55 μm are available from Terra and Aqua combined Moderate Resolution Imaging Spectroradiometer Version 6 Multiangle Implementation of Atmospheric Correction (https://lpdaac.usgs.gov/products/mcd19a2v006/). The Level-2 product has daily global coverage with 1-km pixel resolution. The AOD retrieval is only available for the clear sky.

IUOE Local 793 Endorsed Safety Protocol for JOBSITE MEASURES to Protect Against COVID-19

IUOE Local 793 Endorsed Safety Protocol for JOBSITE MEASURES to Protect Against COVID-19 WHY THIS PROTOCOL IS IMPORTANT This protocol has been developed because of the urgent need to ensure that construction workers on a project are able to go to work and come home again safely in this time of international health crisis. The COVID-19 virus is […]

IUOE Local 793 Endorsed Safety Protocol for JOBSITE MEASURES to Protect Against COVID-19

WHY THIS PROTOCOL IS IMPORTANT
This protocol has been developed because of the urgent need to ensure that construction workers on a project are able to go to work and come home again safely in this time of international health crisis.

The COVID-19 virus is highly contagious and, although symptoms are mild in the majority of cases, it is serious and can even cause death.

Construction employees moving from project to project or employer to employer have a right to a consistent, predictable, and very high level of care for their health and safety throughout the industry.

“Community transmission” is now a reality in Ontario and elsewhere. Because early stages of COVID-19 infection often have few to no symptoms, people who have no idea they may be infectious may well be present on a worksite. The only safe response to such a situation is to assume that infectious individuals do exist in the
workforce and to create a plan that will protect workers even working on the same site as an unknowingly infectious person.

For that reason, this is a very stringent and necessary protocol. Every protective measure contained in it is based on advice from provincial, national and
international experts, including information/publications by the Ministry of Labour, Training and Skills Development, Public Health Ontario, Health Canada, the Centers for Disease Control and Prevention in the United States and the World Health Organization.

HOW THIS PROTOCOL WORKS
This protocol divides the process for creating a safe workplace into the Four Ps:

Preparation – Prevention – Protection – Policing

The first step is Preparation. All work sites must be prepared to meet the new reality of working during a pandemic. Layouts must be adjusted. Shift schedules and crew arrangements must be modified to allow all workers to follow Health Official guidelines for social distancing and health hygiene while continuing to work. New cleaning processes and procedures must be put in place and enforced.

The next step is Prevention. Anything that increases a risk to workers on site must be prevented from getting onto the site. This step requires strict screening and monitoring of all individuals coming onto the site and behaviour on and off the site.

The third step is Protection. Every resource necessary to ensure the safety of all workers on site must be present and used by all workers. This includes appropriate PPE, handwashing, and other resources to allow all workers to meet Public Health guidelines while at work.

The final step is Policing. Without adequate enforcement the best planned safety measures are ineffective. All employees must be engaged in the process of identifying and correcting unsafe workplace practices.

The details of this protocol’s requirements at each step are set out further below.

STEP 1: PREPARATION
1. Schedule Adjustments
2. Work Process Assessments
3. Social Distancing On-Site Rules

STEP 2: PREVENTION
1. Restricted Site Access
2. Daily Health Review
3. Encouragement of Self-Reporting – Access to Income Replacement
4. Rules Regarding Off-Site Conduct

STEP 3: PROTECTION
1. Regular Cleaning of Equipment and Surfaces
2. Use of Protective Eyewear, Gloves and Masks
3. Disinfectants and Sanitizers
4. Toilet Facilities
5. Reinforcement of Basic Hygiene Rules

STEP 4: POLICING
1. Enforcement

STEP 1 PREPARATION

The Public Health Officials of Ontario and Canada are unanimous that effective social distancing is a key component to avoiding infection.

Maintaining a safe distance from all other individuals is of high importance. Changes to the way the workplace is set up to make it possible for workers to work at a safe distance from each other as much as possible will be necessary.

       1. SCHEDULE ADJUSTMENTS
Fewer people on-site at the same time will mean fewer opportunities for too-close proximity. All worksites must review their staffing policies to reduce the number of workers on-site at any given time to levels which will enable effective social distancing.

Preparing the Job site by adjusting schedules may mean:

o Reducing the number of crews on-site at any one time;
o Extending work deadlines to allow tasks to take place at separate times rather than all at the same time;
o Staggered work start and work end times to avoid gathering at entry and exit ways and other pinch points;
o Staggered break and lunch times to avoid gatherings; and
o Building in time to appropriately sanitize worksites and materials into the daily schedule

       2. WORK PROCESS ADJUSTMENTS
Fewer tasks requiring employees to work close beside each other will also enable effective social distancing.

Preparing the job site by adjusting work processes may mean:

o Rearranging the physical site to ensure proper ventilation in all work spaces;
o Imposing limits on the total number of workers allowed on site or in a hoist to enable social distancing, and limits of one person to a vehicle or in or on the cab of other equipment;
o Creation of designated work areas for certain tasks to reduce unnecessary gatherings;
o Rearrangement of the site to eliminate ‘pinch points’ such as narrow entry and exit ways, cramped site trailers, narrow pathways;
o Elimination of unnecessary areas of gatherings such as food trucks or indoor cafeterias; and
o Removal of objects likely to be shared from hand to hand by employees like commonly available reusable mugs or bottles

Finally, tasks which require employees to work in close proximity to each other and which cannot be postponed must be stopped until a work plan can be developed to find the safe way of performing that task.

Such a work plan may include:

• Alternatives ways of completing the task;
• Ways to complete the task with fewer people;
• Ways to complete the task in shorter time; and/or
• Additional PPE and sanitation measures to be used while completing the task.

       3. WORK RULE ADJUSTMENTS
New rules about on-site behaviour will mean individual employees aren’t solely responsible for making sure social distancing is practiced by all workers.

Rules must be implemented, communicated, and enforced that all workers shall remain a minimum of two (2) metres apart from each other. Unnecessary close contact shall be prohibited.

Where on-site meetings are necessary to share information, worksites must limit the number of participants meeting to no more than five (5) people at a time. This includes at breaks and lunch hours. Meetings must be held in locations capable of allowing attendees to maintain their minimum distance from each other during meetings.

Alternative formats for the sharing and communicating of information shall be used to ensure all unnecessary contact is prevented.

STEP 2: PREVENTION

Once the site is set up and good practices and rules are in place, steps must be taken to ensure that to the maximum extent possible, no contagious persons or objects make their way into the worksite.

       1. RESTRICT SITE ACCESS
All employees, subcontractors, union site representatives and visitors to the project must be required to complete a Coronavirus (COVID-19) Questionnaire (see Appendix 1) before entering the worksite.

The questionnaire should be comprised of these three main questions.

1. Have you travelled outside Canada in the last 14 days?

Yes _____ No _______

If Yes – Date of Return?_________ (must be 14 days minimum to stay on site)

2. Do you currently have any symptoms consistent with COVID-19, including the following symptoms: fever, coughing and difficulty breathing, diarrhea, muscle aches/headaches?

Yes _____ No _______

3. Have you been exposed to a person who has a confirmed or suspected case of the COVID-19 infection?

Yes _____ No _______

Anyone who answers “yes” to any of the three questions must not be permitted access to the worksite until that person has completed a 14 day self-isolation period with no symptoms manifesting at which time they will be entitled to be recalled to their original position with no loss of seniority, if applicable. The rights of Union Representatives to attend on site in the course of their duties will not be curtailed other than in accordance with this Protocol or the applicable collective agreement. Site management must notify the Health & Safety Advisor or the Superintendent and applicable union representative immediately.

       2. DAILY HEALTH REVIEW
Every person, including visitors and union representatives, who attends on a project site must be subject to temperature screening upon arrival at the jobsite.

All employees shall be provided with wearable thermometer patches daily and temperature readings will be reviewed three times daily – at the outset of the shift, at the mid-shift break, and before leaving at the end of the day.

If wearable thermometer patches are not available, temperature screening shall be conducted by a qualified medical practitioner or an individual properly trained to administer tests and shall include an initial forehead thermometer temperature check and a follow up confirmatory check five minutes later. Any employee with signs of heightened temperature once the confirmatory check has been performed will be sent home that day.

Best practices for hygiene shall be followed with respect to this screening process. Illness reporting shall be required as described above.

The health of each worker under each foreperson’s supervision will be reviewed at least three times daily for all employees and subcontractors: prior to entry, at lunch and before leaving work. A foreperson shall also be responsible for reviewing the health of all workers under his or her care during pre-shift meetings and will require forepersons to assess the health of each worker.

       3. ENCOURAGE SELF-REPORTING
Employees must self-monitor and must voluntarily leave the job site if they experience any signs of illness. The symptoms of COVID-19 are shared with many other illnesses including the cold and the flu. Any worker or visitor who begins experiencing symptoms of cold or flu while on site will be sent home.

No reprisals will be taken against any employee for doing so and doctor’s notes will not be required from an employee who is sent home or experiences symptoms.

Employees with heightened risk of a life threatening response to infection (such as asthma, diabetes, heart condition) will be offered a job-protected layoff for reasons of sickness and an ROE will be issued to enable that employee to access income replacement during the layoff. These individuals will be encouraged to identify themselves and not be on site for their safety.

In addition, all workers experiencing symptoms will be advised to complete the self-assessment on the Ontario COVID website and follow instruction there, or call telehealth (1-866-797-0000), their local public health unit or their family physician.

       4. MANDATORY PIBLIC HEALTH REPORTING
Public Health is the leading authority for all issues related to COVID-19 and only they can provide detailed instructions to employees and employers.

Occupational illnesses among employees on site including COVID-19 will be reported:

a. to the Ministry of Labour, Training and Skills Development (in writing) within four (4) days;
b. to the joint health and safety representative;
c. to Local 793; and
d. to WSIB

If any employee is confirmed to have tested positive for COVID-19, the jobsite to which the employee reported will be shut down immediately until a safety and risk assessment is completed. That assessment shall be completed in conjunction with the Ministry of Labour, Training and Skills Development. Work crews who have been in contact with the infected employee will be required to self-isolate away from the workplace for fourteen (14) days, among other measures which at a minimum shall include thorough cleaning and disinfecting of all common surfaces.

Any recommendations of Public Health Officials will be followed. Subject to any recommendations of Public Health Officials, employees who have completed a fourteen (14) day self-isolation period without experiencing any symptoms consistent with COVID-19 shall be entitled to be recalled immediately to their original position, with no loss of seniority, if applicable.

   5. RULES REGARDING OFF SITE CONDUCT
Certain off-duty and off-site behaviour during the pandemic has the potential to bring serious health and safety concerns onto worksites. All individuals who will be working on active job sites, employees, supervisors, contractors, visitors and union representatives are expected to respect the advisories of Public Health Officials and must respect any self-isolation and social distancing recommendations at all times, including when they are off work. Individuals will be removed from site if there is any reason to believe off-duty conduct is inconsistent with social distancing and self-isolation during off-duty hours as this has the potential to expose many other workers to risk of infection.

STEP 3: PROTECTION

Effective social distancing, site cleaning, PPE, and hygiene practices that ensure the virus is not transmitted through commonly touched objects are important to the protection of all workers.

The following practices must be undertaken to protect workers from crosscontamination.

       1. REGULAR CLEANING OF EQUIPMENT AND SURFACES
All ‘high-touch’ surfaces must be cleaned using soap and water or an alcohol-based rub on EVERY shift. The Health Canada List of Approved hard surface disinfectants shall be consulted for this purpose.

This includes door-way entrances, door handles, light switches, ladders, elevator buttons, keyboards, phones and all construction equipment handles, consoles, controls and seats, subject to any risk to damage to such equipment.

Offices, trailers, containers, workshops and other facilities will be properly cleaned. The frequency of cleaning each work area and surface will depend on the number of people who use it, the duration of use, and the presence of any objects which people might handle with their hands.

       2. USE OF PROTECTIVE EYEWEAR, GLOVES AND MASKS

Safety Eyewear

If employees are required to wear protective glasses or face shields in the course of their work, such glasses or face shields shall be for the use of that employee only and shall be clearly identified as such.

PPE must be issued for individual use only.

Employers must give instruction on how to remove glasses and or face shields without touching a worker’s face. Sterilization wipes or disinfecting liquid must be readily available at stations on site to assist workers removing or cleaning protective glasses or face shields.

Work Gloves

If employees are required to wear protective work gloves in the course of their work, such gloves will be issued to that employee only. Gloves must not be shared and should be marked with the name of the individual to whom they are issued.

Infection can adhere to gloves. Because the use of gloves can discourage regular handwashing, notices must be posted in the workplace confirming that gloves are no substitute for handwashing and handwashing stations must be made available to all employees using gloves. High alcohol content cleanser must also be applied to all work gloves at regular intervals throughout the shift.

Masks

All employees will be issued and required to use N95 type face masks or equivalent while on the jobsite. In the event that due to mask shortages an employer is temporarily not able to obtain N95 or equivalent masks, employees will be provided with non-medical masks for use for periods of time when and if physical distancing is not possible. Non-medical masks must meet the recommendations for such masks published by Health Canada. Masks should fit well, should not be shared with others, and must be changed as soon as they get damp or soiled. Cloth masks can be laundered with other items using a hot cycle and then dried thoroughly.

Employees must be instructed on how to put on the mask in order to make a proper seal. Employees must be instructed on how to remove and put on masks without touching their faces.

Lined disposal bins with closing lids should be made available on site for disposable masks. Disposable masks will be disposed of and replaced immediately if they become damp and otherwise after a maximum of three (3) days of use.

Employees must be instructed that mask use is ONLY effective in combination with handwashing immediately before putting it on and immediately after taking it off. Handwashing stations and breaks to perform appropriate hand washing will be provided for all employees.

       3. DISINFECTANTS AND SANITIZERS
Alcohol wipes or liquid to be used in wiping down thoroughly all gloves at end of workday will be provided. Alcohol content must be minimum 70% for cleaning. The Health Canada List of Approved Hand-Sanitizers shall be consulted and followed.

Wash stations provided on site shall be in easily accessible locations. There shall be wash stations on every floor of a building. All workers will be required to wash their hands before entering an elevator or stairwell. Before exiting the jobsite, all workers will likewise wash their hands. All workers will be advised that their clothes must be washed upon returning home and their steering wheels and handles in the car must be disinfected to prevent any potential community transmission.

A supply of disinfectants and hand sanitizers will be provided throughout the site for general use and will be replenished as needed.

       4. ADDITIONAL MEASURES FOR TOILET FACILITIES
Soap / paper towel dispensers, hand dryers and hand sanitizing stations on site will be checked frequently and replenished as needed.

Garbage bins will be placed near toilet’s exit doors to encourage people to use a paper towel to open/close the door.

Paper towel dispensers will be placed near high-touch surfaces such as water coolers, kitchen/break room counters, conference rooms, and other locations with shared high-touch surfaces.

       5. REINFORCEMENT OF BASIC HYGIENE RULES FOR ALL WORKERS
All persons on a jobsite will be directed and reminded to take the following individual hygiene measures. Notices and recommendations will include:

• Wash your hands often with soap and water for at least 20 seconds, especially after using the washroom – use alcohol-based hand sanitizer if soap and water are not available;
• Avoid touching your eyes, nose and mouth with unwashed hands;
• When coughing or sneezing: cough or sneeze into a tissue or the bend of your arm, not your hand, and dispose of any tissues used as soon as possible in a lined waste basket and wash hands afterwards;
• Avoid hugs and handshakes;
• Avoid commonly touched areas including handrails and public transit poles;
• Wash your clothes as soon as you get home and shower;
• Take outside shoes off before entering your home and do not allow them in your house; and
• Notify your supervisor immediately if you feel sick

STEP 4 – POLICING

1. ENFORCEMENT

The final step is Policing. Without adequate enforcement the best planned safety measures are ineffective. All employees must be engaged in the process of identifying and correcting unsafe workplace practices.

The Government of Ontario, the Ministry of Labour, Training and Skills Development, Employers and IUOE Local 793 all agree that these stringent standards must be adhered to in order to protect employee and community safety.

All employers shall make clear to employees the process for reporting concerns or violations in regard to this policy or COVID-19 risks at their workplace. No reprisal shall be taken against any individual for reporting concerns with respect to this policy or COVID-19 protections.

This policy is appended to and shall be deemed a part of the Collective Agreement. It is enforceable under the Occupational Health and Safety Act, the Labour Relations Act, and in the same manner as a violation of the Collective Agreement.

Appendix 1 – Coronavirus (COVID-19 ) Preventative Measures

Questionnaire to be completed by all personnel entering the site

All employees assigned to this site must complete this form and submit to ____________ prior to entering the site.

Personal information –

First and last name: ____________________________
Email: ____________________________
Cell Phone: ____________________________
Employer: ____________________________

1. Have you travelled outside Canada since March 12th?

Yes _____ No _______

If Yes – Date of Return?_________ (must be 14 days minimum to stay on site)

2. Do you currently have any symptoms consistent with COVID-19, including the following symptoms: fever, coughing and difficulty breathing, diarrhea, muscle aches/headaches?

Yes _____ No _______

3. Have you been exposed to a person who has a confirmed or suspected case of the COVID-19 infection?

Yes _____ No _______

Declaration:

I hereby confirm that the information provided herein is accurate, correct and complete and that the responses submitted within this form are genuine.

I undertake to inform ________________in writing of any changes to the information already provided and to update the information on this form whenever requested to do so.

Signature Date

___________________________ ______________________________

EMPLOYER ENDORSEMENT

IUOE Local 793 Endorsed Safety Protocols for JOBSITE MEASURES to Protect Against COVID-19

I, the undersigned employer, agree to abide by the minimum protocols outlined in the IUOE Local 793 Endorsed Safety Protocols for JOBSITE MEASURES to Protect Against COVID-19.

I recognize that members of Local 793 have the right to refuse unsafe work and in accordance with that right, any failure to abide by any of the policies above may lead to members of Local 793 refusing to perform unsafe work. I agree that no member of Local 793 shall suffer any loss as a result of any member of Local 793 refusing unsafe work as a result of the employer’s failure to abide by the above policy.

I further recognize that the failure to abide by any of the policies above may be considered a violation of the collective agreement between Local 793 and the employer and may be enforceable as such.

Dated this ___ day of ________, 2020.

Employer Name: ____________________________________

Employer Signature: _________________________________

Name (Printed): _____________________________________

Safety Protocol For Jobsite Measures To Protect Against Covid-19 Checklist For Business Representatives

SAFETY PROTOCOL FOR JOBSITE MEASURES TO PROTECT AGAINST COVID-19 CHECKLIST FOR BUSINESS REPRESENTATIVES The Ontario Government has declared construction an “essential service”. Many Local 793 members continue to work. To ensure the health and safety of our members and their families, Local 793 has developed a comprehensive Safety Protocol for Jobsite Measures to Protect Against COVID-19 (the […]

SAFETY PROTOCOL FOR JOBSITE MEASURES TO PROTECT AGAINST COVID-19 CHECKLIST FOR BUSINESS REPRESENTATIVES

The Ontario Government has declared construction an “essential service”. Many Local 793 members continue to work.

To ensure the health and safety of our members and their families, Local 793 has developed a comprehensive Safety Protocol for Jobsite Measures to Protect Against COVID-19 (the “Protocol”). The Protocol lists health and safety measures that Local 793 expects signatory employers to put in place. Every safety measure is based on advice from provincial, national and international experts, including information/publications by the Ministry of Labour, Training and Skills Development, Public Health Ontario, Health Canada, the Centers for Disease Control and Prevention in the United States and the World Health Organization.

This checklist allows business representatives to evaluate the health and safety practices and policies of signatory employers and compare them against our Protocol. If you want further information about any specific safety practice, look at that part of the Protocol.

This checklist follows the Four Ps: Preparation – Prevention – Protection – Policing.

How to complete the checklist:

Step 1 – Lead by example. Know the Protocol and this checklist and wear all PPE before you enter a jobsite. Complete the checklist by visual inspection and speaking to the steward and members on site. Take pictures if necessary.

Step 2 – Review and/or complete your checklist with a management representative. For each “No” or “In Progress” answer, determine and make notes on how and when (specific date) the employer will comply which must be as soon as possible.

Step 3 – Complete the Section 5, Evaluation and Enforcement. If the result is a “Pass”, advise the employer of the result. If the result is a “Fail” or “Conditional Pass”, contact your area supervisor immediately and follow his instructions.

COMPANY INFORMATION

Company name:
Jobsite Address:
Telephone and fax numbers:
Contact email:
Management Rep I spoke to:
Phone or Email for Mgmt. Rep:
Name of Steward:
Does the Company currently have a policy for COVID-19?  Yes _____ (Review and keep the policy)  /. No _____
If so, has the Company policy been posted on site where employees can review it? Yes _____  /  No _____ (Review placement with management rep)

Video Update: Business Manager Mike Gallagher for June 19, 2020

Local 793 Business Manager Mike Gallagher delivers a video message from outside OEBAC head office in Oakville for Friday, June 19, 2020. In this video, Business Manager Gallagher delivers the following updates: [00:05] Introduction – Back To Work [01:30] Masks Prove To Be Effective [02:03] Members Will Soon Receive KN95 Masks [03:14] Ontario Moves to […]

Local 793 Business Manager Mike Gallagher delivers a video message from outside OEBAC head office in Oakville for Friday, June 19, 2020.

In this video, Business Manager Gallagher delivers the following updates:

[00:05] Introduction – Back To Work
[01:30] Masks Prove To Be Effective
[02:03] Members Will Soon Receive KN95 Masks
[03:14] Ontario Moves to Stage 2 of Reopening
[03:58] Working to Make OEBAC More Effective
[08:43] President Joe Redshaw Appointed as Acting Executive Director of OEBAC
[10:55] Closing Remarks

Onsite with Mike Gallagher: Episode 1

Join business manager Mike Gallagher, as he travels across the province visiting various job sites and interviewing Local 793 members working in the field. In this episode, Gallagher heads to Ottawa and speaks to members at the LRT Phase 2 – Confederation Line East Extension. Operators are doing bridge work at the Montreal Station, located at Montreal Road […]

Join business manager Mike Gallagher, as he travels across the province visiting various job sites and interviewing Local 793 members working in the field.

In this episode, Gallagher heads to Ottawa and speaks to members at the LRT Phase 2 – Confederation Line East Extension. Operators are doing bridge work at the Montreal Station, located at Montreal Road and Highway 174.

The Confederation Line East is one of the three major extensions to the city’s light rail transit system.

A limited time rate offer on a TD Home Equity FlexLine for members of Local 793

Limited time rate offer on a TD Home Equity FlexLine for members of Local 793 Now more than ever, we’re helping you save on interest while borrowing with our TD Home Equity FlexLine with a special rate offer of TD Prime + 0.20%. Here’s what you need to know: You can apply between Monday, June […]

Limited time rate offer on a TD Home Equity FlexLine for members of Local 793

Now more than ever, we’re helping you save on interest while borrowing with our TD Home Equity FlexLine with a special rate offer of TD Prime + 0.20%.

Here’s what you need to know:
You can apply between Monday, June 8 and Friday, July 10.
This limited time offer is only available in Ontario through a TD Mobile Mortgage Specialist.

To find a TD Mobile Mortgage Specialist and start your application, you can visit mms.tdcanadatrust.com.
  • Please have your Union registration number handy. It can be found on your Union Membership Card.
  • This rate offer is only available on the revolving portion for new first priority TD Home Equity FlexLines.
  • This rate offer is only available for already built, owner-occupied properties with amortization periods of 25 years or less that are also subject to meeting our credit granting criteria.
  • This offer is not available through our Branches and excludes Second Position FlexLine behind other financial institution mortgages and Progress Advance FlexLine.
  • Rates may be subject to change, extension or withdrawal at any time without notice.
  • If you’d like to learn more about how a TD Home Equity FlexLine works, visit our TD Home Equity FlexLine page.

TD Helps Program: Helping Canadians Impacted by COVID-19

If you’d like to learn more, or if you need help, visit td.com/covid19.

Statement from Business Manager Mike Gallagher on racism

Local 793 Stands in Solidarity Against Racism In the past week, we have seen massive protests erupt across the United States and around the world, including here in Canada, spurred by the murder of a black man named George Floyd by a Minneapolis police officer named Derek Chauvin. An article in Rolling Stone magazine pointed […]

Local 793 Stands in Solidarity Against Racism

In the past week, we have seen massive protests erupt across the United States and around the world, including here in Canada, spurred by the murder of a black man named George Floyd by a Minneapolis police officer named Derek Chauvin.

An article in Rolling Stone magazine pointed out that the police officer, now charged with the third-degree murder of Floyd, may not have intended to kill him while kneeling on his neck for over eight minutes, “but simply didn’t care whether or not Floyd died.” In the widely circulated video, Chauvin can be seen with his hands in his pockets while nonchalantly pressing his knee to the neck of Floyd and ignoring his pleas that he could not breathe, eventually calling out for his mama in desperation.

The Rolling Stone article also points out that the Minneapolis police department had recently had its budget increased by $2.4 million, allowing them to hire an additional 14 police officers. This is a police force that has killed black people at a rate 13 times higher than their white counterparts from 2013-2019.

It is obvious that arresting one racist police officer for third-degree murder will not solve the systemic racism in the United States, since sadly the murder of Floyd is not a one-off situation. With the prevalence of video, deaths like Floyd, Ahmaud Arbery and Eric Garner that are filmed by concerned citizens will continue to expose wrongdoing by the police. Police officers need to be better trained to not exert unnecessary force in arresting suspects of crime and racist individuals should not be hired in the first place.

Unfortunately, violence and murder against black people in America, like mass shootings, has been all too common throughout history. Whether in Canada or the United States, the problem goes much deeper than individual prejudiced beliefs against people of colour, and the true systematic nature of racism ensures that black people are consistently disadvantaged personally, economically and socially.

I believe that the root cause of racism is simple hate. Statistics have been showing in both Canada and the United States that the COVID-19 virus is killing poor people and people of colour at a much higher rate than the rest of the population. Likely due to the fact that they disproportionately make up those employed in low-paid work deemed essential during this health crisis, the irony of which should not be lost on anyone.

The issue of racism will be impossible to solve once the protests begin to subside if we do not also address the issue of inequality. Poverty and inequity have been growing at an increased rate as corporate CEOs and upper management get uber rich, pay little tax, and continue moving their manufacturing to countries like Mexico, China and other low wage non-Union parts of the world. While here in North America, the loss of jobs, growing poverty and hopelessness becomes a breeding ground for the right-wing populism that led to the election of President Trump in the first place.
It is to state the obvious to say that “Black Lives Matter,” and I believe that to be true. Black lives matter. As a white man, I cannot say that I know what it feels like to be a victim of racism. Although I support the Black Lives Matter movement against racism, I am opposed to the violence and looting that has occurred during some of these protest. But I am also opposed to the violence and pepper spraying and tear gas deployed by police against peaceful protesters.

As a Union, we have members who we continue to welcome who are black, First Nations, Métis, and Inuit, as well as a growing number of female members. We are not sexist, nor racist and we cannot ignore it when our members suffer discrimination. They are our brothers and sisters and we will always stand shoulder to shoulder with them and fight for a better, more just society absent of the hate and racism demonstrated in police brutality videos across the Unites States.

I chose not to be silent on the issue of racism and I recommend each of you get the conversation going amongst yourselves. Unions have long played the role of representation for human rights issues. We in the labour movement have to be part of the solution, which means being inclusive and rejecting racism whenever we see or hear it.

In solidarity,

Mike Gallagher
Business Manager

IUOE Local 793 2020 Nomination and Election Update – June 2

June 2, 2020 Dear Brothers and Sisters: Re: IUOE Local 793 2020 Nomination and Election Update I am writing further to my letter dated May 8, 2020 with a further update on behalf of the IUOE Local 793 Election Committee (“Election Committee”). As you are aware, union election nominations will be held throughout June on […]

June 2, 2020

Dear Brothers and Sisters:

Re: IUOE Local 793 2020 Nomination and Election Update

I am writing further to my letter dated May 8, 2020 with a further update on behalf of the IUOE Local 793 Election Committee (“Election Committee”).

As you are aware, union election nominations will be held throughout June on the dates when regularly scheduled monthly meetings would normally have occurred in each district. Please be advised that nominations will be open for 90 minutes at each scheduled meeting. If any members are still in line at the end of 90 minutes, they will be allowed to make a nomination.

Please familiarize yourselves with the COVID-19 procedures being put in place for your protection prior to arriving at the meeting. The procedures were outlined in the Election Committee’s previous correspondence.

Yours truly,

Alex Law
Chair, IUOE Local 793 Elections Committee