Just over a week ago, Ontarians could venture into fairly safe public indoor spaces knowing that the people around them were vaccinated, not sick with symptomatic COVID, and limiting their breath potentially spread by masks.
Everything is about to change. On Wednesday, Ontario announced that all pandemic public health measures would end in April. Starting with mandatory masking, which disappeared in non-medical settings on March 21, and extending to COVID screening and self-isolation.
We will have to “live with” COVID-19 as we have with the flu. But many are unwilling to return to the dark ages of respiratory virus proliferation. Public health measures soon to be lifted have not only reduced COVID cases and deaths, but also the incidence of influenza and other respiratory viruses, which killed hundreds of thousands of people each year before the pandemic. .
Some companies have, at great expense, invested in air quality improvements that experts say will mitigate the resurgence of COVID and other respiratory viruses as masks come off.
But business owners can’t do it alone.
Experts in infection control, occupational health and ventilation engineering say Ontario needs to set standards and subsidize indoor air quality improvements. This, they say, will not only slow the spread of COVID, but reduce deaths from other respiratory viruses and prepare us for the next pandemic after COVID.
“To me to say that we have to ventilate and filter the air, which is shared in environments full of people who sit there for long periods of time, is as obvious as saying we should move our drinking water intake pipe upstream of our sewers,” infection control epidemiologist Colin Furness said.
Ontario certainly has the ability to improve indoor air quality, said HVAC engineer Joey Fox, but doesn’t have the will.
“There hasn’t been enough attention paid to ventilation and filtration,” Fox said. “There has been a strong delay in the acknowledgment that COVID is airborne, followed by what I believe is a lack of clear communication about it. We need a societal overhaul of how we approach this virus. Good ventilation will greatly reduce transmission and greatly reduce the risk of people going to places like cinemas and restaurants.
In Japan, restaurants and cinemas display real-time air quality measurements to customers. Boston Public Schools has a detailed Indoor Air Quality and Ventilation Plan, which tracks various air quality metrics in each of its 4,350 classrooms and makes all information available online. .
When Niagara’s Acting Medical Officer of Health, Dr. Mustafa Hirji, wanted to do something similar with schools in his district in January, he was tipped off by Ontario’s Chief Medical Officer of Health, Dr. Kieran Moore.
Hirji wanted, as Boston does, to monitor CO2 levels in the classroom. The worse the ventilation in a room, the more CO2 there is in the air of people exhaling. The more CO2 there is in a given space, the more you breathe in another person’s breath when you inhale. Studies have shown that the risk of COVID transmission increases with indoor CO2 levels.
Moore disagreed, writing in a letter responding to Hirji that Ontario “is not currently aware of any correlation between CO2 levels and viral transmission.”
“Of course there is (a correlation), I don’t know why he would make such a statement,” Furness said. “Ontario has not recognized airborne transmission of COVID. Dr. Moore almost, I mean, he said it might be in the air, but he’s undecided – I think it’s appalling.
(Moore said Dec. 15 that Omicron “is much more infectious and has the potential for airborne spread…We are very concerned that there could be much more spread aerosols than other strains.”)
Franz Hochholdinger, owner of the Apricot Tree Cafe in Mississauga, is decided on the question.
He said he “followed the science”, which led him to have the air quality in his restaurant assessed by a team of environmental scientists and industrial hygienists, who recommended that he install HEPA filters. Hochholdinger now has four filters that purify the air and even has a CO2 monitor in view of customers.
(HEPAs use fans to move air through a filter, which removes harmful particles from the air, including fungi, bacteria, dust and respiratory droplets and particles that contain COVID and other viruses.)
While it was worthwhile for Hochholdinger to invest in the air in his restaurant, if only to improve the safety of his customers and staff, it was expensive. He estimates that he spent $15,000.
The only relief offered by the government for such a business is the federal Small Business Air Quality Tax Credit, which provides a 25% refundable credit for ventilation and filtration expenses up to to $10,000 paid between September 2021 and the end of this year. .
Hochholdinger began improving air quality in August.
Prices like what Hochholdinger paid are beyond what much of the restaurant industry can bear after two years of financial brutality due to the pandemic, he said. That’s why he hopes more grants and incentives will come for air quality improvements.
“For restaurants to get their customers back, they need to show that indoor dining can be safer,” Hochholdinger said. “We see it every day. Our customers appreciate our efforts.
Furness said while Ontario’s inability to trace contacts makes it difficult to calculate the safety of Hochholdinger and other air-conscious restaurateurs like him, he knows that’s where he wants. to eat.
“It’s very difficult to measure the effect,” he said. “I can’t say, like, ‘Oh, (Hochholdinger has) solved the problem. Let’s do whatever he does. However, it may very well have. He has gone very far. It may even be exaggerated. But his restaurant is a place where I would feel comfortable.
But grants alone aren’t enough to stop other people’s breath from making us sick, Furness said. We need regulations for indoor air quality, just as we do for water quality.
“I beat the drum to say that we need indoor air quality standards if we are ever going to take the masks off, if we want restaurants to be considered safe,” he said. “Even when there are no malicious viruses circulating like COVID, we need them.”
And air standards shouldn’t just apply to businesses, Furness said. They must also be in the houses.
“It would be extremely helpful for us to have indoor air quality standards in public places, but it would be even better if we could extend them to residential buildings,” he said. “Just targeting restaurants, gyms, workplaces and schools, that would put the brakes on that. But if you really want to make a difference, you really need to think about shared indoor air more broadly.
Until standards are established, Fox said people should look for the presence of HEPA filters and a CO2 level below 800ppm as an indicator that a place is “generally safe”.
Standards and subsidies should arrive soon. “We need Operation Warp Speed for clean indoor air,” Fox said, referring to the US vaccine development program. The end of the mask mandate and other public health measures means that seasonal respiratory viruses will return after two years of dormancy – and people will die.
The Lancet, a peer-reviewed medical journal, reported that there was an “effective absence of the annual seasonal epidemic of most seasonal respiratory viruses” in Canada during the 2020-21 season.
This same absence has been observed all over the world.
In 2019, the United States Centers for Disease Control estimated that there were 22,000 flu deaths in the country that year.
But in 2020, when COVID surfaced and public health measures kicked in, there were only 748 flu deaths.
COVID is more virulent and transmissible than the flu, but both can spread in the same way. Virus particles exhaled by a sick person linger in the air and can infect people who inhale them. Air filtration and ventilation help to mitigate this.
And so the same infection prevention techniques work on both COVID and flu. Researchers believe millions of deaths around the world have been averted through public health measures.
It is highly likely, Furness said, that many lives could be saved, from the respiratory viruses we have now and new ones that will certainly arrive in the future, if air quality improvements become mandatory and paid for by the government.
“We can’t ask restaurants to spend money on this,” Furness said. “I don’t think we can really ask owners to spend money on this. I think the government needs to step in and do that. And it’s cheaper to buy HEPA filters than to pay for intensive care beds. So I think there’s probably a pretty good business case for that.
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