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Open Letter – Bring Back Universal Masking in BC Emergency Departments

To Drs. Doan, Fedder and McInnes and the BC Section of Emergency Medicine

Thank you for your commitment and dedication to caring for emergency patients in British Columbia during a very stressful time. As emergency physicians and the co-presidents of the Section of Emergency Medicine, Doctors of BC, what you do matters and sets the tone for your emergency and hospital colleagues. There is no more essential service than the Emergency Department.

In the absence of timely action by BC Health Authorities, we are writing to ask you to take action in the face of another looming health crisis. We urge you to take the initiative and enforce universal masking in BC’s Emergency Departments - all healthcare workers, patients and visitors - and to “choose wisely” when faced with airborne viruses: N95 or equivalent masks.  

As stated by Dr Gord McInnes, “Our patients need and deserve better. They deserve to know that they will be safe, and that they will be cared for when they go to an emergency department for help.”

Covid is now surging in BC. According to Dr. Tara Moriarty’s data modelling, approximately  1 in 13 British Columbians will be infected with the virus in the period September 23 to October 6, 2023. 

The number of patients with Covid in BC hospitals is rising. Hospital admissions are a lagging indicator, we know this number is going to increase.

Image from  CTV News Vancouver

As of September 8 2023, 9,700 acute base beds were occupied. This is 700 beds above the seasonal average of 9,000. We all understand that surge beds without health care workers to look after patients are nothing more than furniture.

Case numbers went from 366 in the week of August 20-26, 2023 (epi-week 34) to 628, for September 10-16, 2023 (epi-week 37). This is an exponential rise. With very restricted testing in BC, the true number of Covid infections is many times higher. Once again BC seniors, 60 years and older, are being (re)infected

Deaths are increasing. Covid is not “mild.” The number of deaths per week increased from 10 in epi-week 34 (August 20-26, 2023) to 22 in epi-week 37 (September 10-16, 2023). This trend is not going in the right direction.

Healthcare workers are part of the larger health ecosystem. Hospital-acquired infections (HAIs) contribute to higher levels of Covid in the community, which in turn further burden hospitals in a vicious circle. Back in November 2021, we learned that 1619 patients had been infected in hospitals and 274 had died. This was prior to the arrival of more contagious and vaccine evading variants and while masking in healthcare was still the rule. We cannot expect things to be better today.  

The hospital system was already at breaking point before the pandemic; any increase worsens the problem, leading to closed EDs around the province in rural areas as well as urban. We are all aware of the ED overcrowding crisis in Langley last May. 

Every surge in Covid cases leaves in its wake more burnt out health care providers, more Long Covid in health care workers and an exodus of experienced senior nurses. 

In the vacuum left by public health authorities, you as emergency physicians can help decrease the number of cases society-wide by reintroducing masks in your ED. By wearing masks, you are protecting yourself, your ED staff and your patients while ensuring the smooth functioning of your ED. We all know that EDs are the safety net of the healthcare system, we cannot afford anymore threads being unravelled.

The ED is not an island. Rampant infections in the ED seed the rest of the hospital, infecting other hospital staff and hospitalized patients. Prolonged hospitalizations and health care workers sick at home have downstream effects, including an inability to provide care. 

Every British Columbian knows someone who is affected by delays in medical treatments, surgeries and cancer care. You have the influence to help us avoid more cancellations and the lengthening of already unacceptably long wait lists. 

This fall we are also faced with the additional problem of an entire population with waned vaccine immunity. As we write this letter on September 27th, vaccine roll out has yet to be announced in BC despite the fact that the whole of BC’s COVID strategy relies on vaccines and no other measures. 

Last fall was marked by a poorly executed vaccination rollout that resulted in a deadly tripledemic. This year, we are not only equally unprepared but we have the additional disadvantage that vaccine immunity has waned in the population and there is no masking in healthcare settings. The BC medical system is already struggling, influenza has only just started spreading in some Long Term Care facilities while RSV hasn’t even hit BC yet. On top of all the above, we no longer separate Covid positive from negative cases and we don’t test or even ask patients if they have Covid symptoms. We separate patients by only a curtain, a barrier that airborne viruses don’t respect. 

As emergency physicians you can control what happens in your emergency department and you can influence what happens in the rest of the hospital. Emergency physicians’ groups can dictate what their members do and can sway their emergency nursing colleagues. You can also pressure your hospital administration with the arguments we have laid out. Remind administrators that several hospitals in Canada and beyond have already restored masking, including  many across Ontario and most recently Seattle Children’s Hospital. It is not just good health practice to mask. Modelling safe practices for the public is part of your role.

In addition to being emergency physicians, you are also the leaders and health advocates that this burning crisis needs. We need you to swim against the prevailing current and fill the void of public health in this province. There is currently no plan to avert the worst case scenario of ED waiting rooms over-filled with too many sick British Columbians. BC health authorities’ failure to plan amounts to planning to fail. Don’t wait for public health: please step up, protect yourselves, protect your patients, and protect our medical system. 

At the beginning of the pandemic, you asked the public to support you by keeping safe and not burdening the hospital system. Now we must turn the table and ask you to protect health care users, protect yourselves and your own staff, and safeguard the hospitals’ capacity to provide care.

Signed by Protect our Province BC members, including:

Dr. Christopher Applewhaite

Dr. Lyne Filiatrault

Dr. Brenda Hardie

Dr. Susan Kuo

Dr. Karina Zeidler

Protect Our Province BC is a grassroots group of physicians, nurses, health scientists, health policy specialists and community advocates. We are working together to help people in BC stay safe by sharing accurate information about the COVID-19 pandemic in BC, and advocating for policies based on the best available science. Our ultimate goal is to end this pandemic through a vaccine-plus strategy that includes addressing how this virus spreads through aerosols.

Archived Briefings from Protect Our Province BC

A Protect Our Province BC panel discussion with A panel discussion about how we as a community can pull together to create a safer learning environment for kids when school starts again in September! We can avoid another ‘tripledemic’ if we work together! Ready for Fall 2023? video: Briefing video:
“COVID-19 vaccination is safe during pregnancy and may protect newborns from infection, especially if vaccines are given in the second or third trimester. This is similar to what we are already doing with other maternal vaccines, including TDaP and seasonal influenza.” – Dr. Eastabrook
“If we had an epidemic of people with broken limbs and we saw people in plasters and crutches, it would be more evident. But there is a lot of disability that is happening, which is a hidden disability often, which is why we need to talk about it more, for people to understand what the consequences are. And that will help to make better decisions.” - Lynette

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