HCWs have died and been disabled. Laws should have prevented this.
A version of this article was originally published in the Tyee on March 27th, 2026
By Dr. Joe Vipond, Dr. Dick Zoutman, Dr. Stephane Bilodeau
It was just going to be another routine day for a geriatric specialist. Dr. C woke up, got her three kids ready for school, kissed her wife on the way out the door. First stop was the local Long Term Care (LTC) facility; she was in charge of checking on the elderly patients one-half day per week.
There was a bit of a twist to this morning, however. COVID had been making the rounds of the seniors’ homes in the region, and this facility was no exception. She wasn’t going in unprotected, as surgical masks were provided to protect her from the patients, and vice versa. These masks, sometimes known as medical or procedural masks, were common with both health care workers (HCWs) and the public, their sky blue vivid on many faces. This, along with a plastic gown and a pair of gloves, were what she was given to protect herself from the COVID virus, which she was told was transmitted via droplets created when sick patients coughed or sneezed, falling to the ground within six feet of the unwell.
She decided to leave the sickest patient, Benny, for last. His roommate had been diagnosed with COVID, but Benny had not, though he was feeling unwell. Despite public health assurances that COVID was not airborne transmitted, someone had done some protections for it: they had placed a HEPA filter in the room and opened the window. On Benny’s bedside table was his breakfast, still uneaten three hours after being left there. Dr. C sat down and held the juice to his lips, which he sucked back greedily. “He’s too weak to eat or drink,” she thought to herself, spending the next ten minutes spoon-feeding him his morning meal and providing hydration. Although he wasn’t sneezing or coughing, and she was wearing all the right gear she had been told would protect her, she remembers thinking, “this feels dangerous”.
Four days later, she started to feel off.
Obligations of employers 3(1) Every employer shall ensure, as far as it is reasonably practicable for the employer to do so, (a) the health, safety and welfare of (i) workers engaged in the work of that employer… and (iii) other persons at or in the vicinity of the work site whose health and safety may be materially affected by identifiable and controllable hazards originating from the work site, (all bold text from Alberta Occupational Health and Safety Legislation)
Laws already exist that should have prevented COVID infections in the workplace. Known as Occupational Health and Safety (OHS) regulations, they exist across the Western world, built piecemeal over time as various illnesses and injuries were unveiled as related to the workplace. Each law, requiring employers to protect their employees from harm, exists because advocates such as labour leaders, unions, public health officials, politicians, lawyers, and bereaved families, fought for protections after harm had become obvious to all.
Initially, the primary focus was on factories, industrial sites, and mines, with heavy duty machinery and high risk activities causing serious injuries. Later, they turned to unusual illnesses such as black lung in coal workers, and lung cancer in uranium mine workers. Requirements for Personal Protective Equipment (PPE) and other safety rules dramatically improved the health of workers in these industries.
The rules are very comprehensive, stipulating every aspect of an employer’s obligation to workers, such as how to safely store explosives, how many toilets must be on a remote work site, and, yes, even how to protect workers from inhaled hazards, including asbestos, spray paint, and respiratory viruses. And they have been effective, with US records showing a sixty percent drop in workplace fatalities, and a forty percent drop in injury and illness, in the thirty years after the Occupational Health and Safety Act was enacted, despite a doubling of workers.
In Canada, HCW safety was thrust into the limelight with the 2003 SARS coronavirus epidemic. An illness transmitted almost uniquely through hospital patients, HCWs and their families, the epidemic petered out through the use of airborne precautions in the hospitals, in particular universal N95 respirator masks, which fit tight to the face to ensure any air being inhaled or exhaled must pass through the mask filter.
In an effort to learn from this horrifying experience (438 cases, and 44 deaths), the Ontario government created the Campbell Commission. It noted the strong resistance among many medical practitioners to acknowledge that SARS spread predominantly through airborne transmission. In its 1200 page report, the commission highlighted the following: The point is not who is right and who is wrong about airborne transmission. The point is not science, but safety. Scientific knowledge changes constantly…When it comes to worker safety in hospitals, we should not be driven by the scientific dogma of yesterday or even the scientific dogma of today. We should be driven by the precautionary principle that reasonable steps to reduce risk should not await scientific certainty. Until this precautionary principle is fully recognized, mandated and enforced in Ontario’s hospitals, workers will continue to be at risk.
It is painfully apparent that we didn’t learn the lesson in time for Dr. C’s visit to the nursing home. Although based in the Eastern US, her experience is echoed by HCWs across North America, including Alberta. With rare exception, almost no jurisdiction used the lessons of the past to inform their response to the new virus. Indeed, six years later, we still haven’t learnt it.
Four days after her nursing home work, Dr. C went out for her usual run, prepping for her next marathon. She felt increasingly unwell and tired during her normal route, so much so that mid-run she had to call her eldest son to come pick her up and take her home. Over the next 36 hours she continued to worsen, with sore throat, cough, diarrhea, and extreme fatigue but unlike many, never became severely unwell. And she infected her wife, too.
A colleague attending the same LTC facility, also wearing a medical mask, was infected and spent eleven days in the ICU, retiring from medicine shortly after. Many nursing colleagues were also infected, including some who were ill and tired for much longer, months to years. A symptom complex now called Long COVID.
228(1) If the hazard assessment indicates the need for personal protective equipment, an employer must ensure that (a) workers wear personal protective equipment that is correct for the hazard and protects workers, (b) workers properly use and wear the personal protective equipment, (c) the personal protective equipment is in a condition to perform the function for which it is designed, and (d) workers are trained in the correct use, care, limitations and assigned maintenance of the personal protective equipment.
247 An employer must ensure that respiratory protective equipment used at a work site is selected in accordance with CSA Standard Z94.4-02, Selection, Use, and Care of Respirators.
In reading the OHS legislation, it is clear that the employer has a responsibility to protect HCWs like Dr. C from bioaerosol hazards. There is no mention anywhere, in any OHS legislation, including the quoted Alberta version, that the medical masks issued to Dr. C constitutes protection from an airborne-transmitted hazard like the SARS-CoV2 virus.
It’s important to recognize that medical masks were never designed as respiratory PPE and, until recently, were never purported to be such. They were designed as splash guards: to keep the wearer’s respiratory droplets from flying into a patient’s surgical field, and to keep blood and other body fluids from spraying into the wearer’s nose and mouth (that is why they are fluid resistant).
Respirator masks, which are explicitly referred to in OHS legislation as the appropriate PPE for airborne hazards, are designed explicitly to prevent inhalation of threats like asbestos or COVID-19. They have a much better filter than medical masks but, more importantly, they fit tight to the face, so that all air inhaled into the lungs must first pass through the filter. Loose-fitting medical masks allow air to enter through the sides, making them inherently much less safe. Ironically, it is why they are sometimes preferred by wearers: the loose fit means less breathing resistance, and less pressure on the face. But that also makes them inadequate for the purpose.
Dr. C continued to work remotely a few hours a day through her illness. Her sore throat and cough quickly cleared, but the malaise and the fatigue persisted beyond the expected two weeks of recovery. She began working one day a week, but that would wipe her out for the next six days… until she tried one more time to push through.
One month into this cycle, she started reading in earnest about possibilities. It reminded her a lot of her teenage self’s recovery from Mono, which took about 18 months. Going through medical school she had had a single lecture on myalgic encephalomyelitis (ME, formerly known as chronic fatigue syndrome), and had never even heard of Postural Orthostatic Tachycardia Syndrome (POTS). But going through her symptoms, these two syndromes correlated with her symptoms pretty well. And the new entity of long COVID.
244(2)…the employer must consider (a) the nature and exposure circumstances of any contaminants or biohazardous material, (b) the concentration or likely concentration of any airborne contaminants, (c) the duration or likely duration of the worker’s exposure, and (d) the toxicity of the contaminants
How is it possible for hospitals, nursing homes, and other health care employers, to allow respiratory PPE that doesn’t fit the legal standard previously set for protecting workers against an airborne hazard?
Simple. They just stated (and continue to state) it isn’t airborne.
Despite the strong evidence of the 2003 SARS virus being airborne, and the 2007 Campbell Commission’s strong recommendation to treat future pandemics as airborne, the WHO explicitly asserted, over and over again, in the early pandemic that COVID-19 was not airborne spread, but instead contact/droplet. Meaning you get it by touching surfaces, or getting sprayed from drops flying from sneezes and coughs. (Remember wiping down your groceries in March of 2020? For the public, that lasted about two months, when we realized it was not useful to prevent infection.)
Contact/droplet means it is not airborne– medical masks are okay and only necessary if someone is coughing or sneezing those droplets into your vicinity.
Except, on top of the evidence generated by 2003 SARS epidemic, there was soon a substantial increase in the evidence that SARS-CoV2 was similarly spread by airborne means. And there was also a clear lack of evidence of spread by contact/droplet: the CDC famously came out with a statement that the risk of contracting COVID-19 from contact was extremely low, at one in 10000.
By April 2021 the US CDC and the WHO were forced to acknowledge the significant role airborne transmission played. It took until November 2021 for the Public Health Agency of Canada (PHAC) to follow suit. So how is it still possible that the Canadian OHS laws don’t apply, requiring the appropriate PPE for airborne spread?
PHAC, to this day, has never used the word airborne.
It’s implied. The “announcement” by PHAC that COVID was airborne came in a statement (notably, not in a press conference) in November 2021, describing how “how the virus can linger in fine aerosols and remain suspended in the air we breathe, much as expelled smoke lingers in poorly ventilated spaces”, which describes aerosols causing airborne transmission.
Today, the PHAC website on COVID transmission mentions breathing in particles that can linger in the air, a euphemism for airborne transmission. The section on preventing infection includes improving ventilation in indoor spaces, again only useful to prevent airborne transmission (by decreasing the concentration of aerosols).
But in all cases the word airborne is strangely missing.
For years, the advice to the public is to wear the “best made, best fitting mask”, terminology which only describes a respirator-style N95 mask, essential for mitigating airborne transmission. Thankfully, more recently PHAC is now explicitly recommending respirator masks (along with medical masks) for the public. Ironically, and tragically, the general public is advised to take better precautions than HCWs, many of whom are still caring for COVID patients.
It isn’t possible to determine why the word “airborne” is avoided so consistently, but the impact is clear: without that word, OHS requirements can be evaded.
Even today, if you were to walk into a room in a hospital with a COVID-19 patient, the warning on the door would say that PPE requirements are to prevent contact/droplet transmission. No mention of airborne. No need to use an N95 respirator mask.
It results in the very strange situation of walking through hospital wards under renovation and seeing construction workers in full PPE (including an N95 respirator to protect them from construction related aerosols) while HCWs wear no mask, or an inadequate (as per OHS regulations) medical mask.
Dr. C hasn’t worked as a physician since three months after her illness onset. She is only upright for one to two hours per day. Her symptoms haven’t really improved over time, but she’s gotten better at managing them. Something as simple as attending an online medical conference, sweeping the floor, or reading a book can cause her to “crash”, a long COVID term that means a setback causing severe fatigue, worsening symptoms such as headache, GI distress, and sore throat, and increased disability for days to weeks. It took two years to find a physician replacement for her.
In addition, the infection she passed onto her wife has also given her long COVID, albeit not as severe. Imagine the challenges of running a household with kids with two parents needing caretaking.
As a work-related illness, an investigation about her illness was done. As part of the interview, her boss told her it was likely that she had made a mistake putting on or removing her PPE, resulting in her infection. At no point has the facility acknowledged that inadequate PPE, insufficient to prevent the airborne transmission of COVID, might have been a factor in her occupational illness.
(6) If an injury, illness or incident or worker exposure occurs at a work site, the employer shall (a) carry out an investigation into the circumstances surrounding the injury, illness, incident or worker exposure, (b) prepare a report outlining the circumstances of the injury, illness, incident or worker exposure and the corrective action, if any, undertaken to prevent a recurrence of the injury, illness, incident or worker exposure
None of this would matter if HCWs weren’t being hurt. Data is extremely hard to come by, but when Alberta stopped reporting HCW deaths in March 2022, 12 had died from COVID. A report from the Canadian Institute for Health Information stated that by March of 2022, 150000 HCWs had been infected, and there had been “at least” 46 deaths.
Disability from long COVID is also rampant among HCWs, in a profession long recognized as one of the most affected. Again, data is sparse in Canada. However, a recent UK analysis of long COVID in HCWs indicates a prevalence of as high as 40%. Because the infection prevention protocols were identical there to here, it is likely our Canadian HCWs would have fared similarly. This likely has contributed to the significant, persistent post-COVID HCW shortage.
Is it possible that HCWs were inadequately protected during the pandemic (and currently)? That the PPE used was inappropriate for the hazard?
Embedded within all OHS legislation is a system for identifying improvements to an organization’s OHS plan. Each major injury, illness, or incident is to have a full investigation, and “corrective actions undertaken to prevent a recurrence.”
Mid-pandemic, in Alberta in 2021 there were twenty-five workplace fatality investigations by the government. None of them were for the HCWs that died from workplace infections. It is unclear why dying from an occupational injury is deemed worthy of an investigation to prevent future occurrences, while dying from an occupational disease is not. Especially with the numbers involved.
Dr. C knows there is no going back to a time before her workplace-acquired long COVID disability. She wishes she could have been fully informed of the risks, and methods of preventing infection. She dreams of a future where all HCWs are fully informed about airborne transmission and the risks of long COVID, and are provided with the right PPE. She hopes not a single other HCW has to suffer the preventable challenges she faces every day — yet even now she continues to meet other HCWs with a recent acquisition of disabling long COVID.
The purposes of this Act are (a) the promotion and maintenance of the highest degree of physical, psychological and social well-being of workers, (b) to prevent work site incidents, injuries, illnesses and diseases, and (c) the protection of workers from factors and conditions adverse to their health and safety
People are tired of the COVID pandemic. There is a desire to move on. But even today, as I write this, there continue to be outbreaks in Alberta hospitals and LTC facilities. It really has become more like the original 2003 SARS-1, a predominantly nosocomial (health care facility acquired) disease–except this has now lasted six years, not a few months.
Although our discussion focused on HCW occupational diseases, unlike accidents, these infections can also be transmitted to vulnerable patients. Government data shows that in the week ending January 11, 2026, 44% of Covid patients in hospital acquired Covid while in hospital. We equally need to do our best to ensure a minimum of nosocomial infections for our vulnerable, often elderly, patients. It is worth noting that studies have also shown respirator masks to be better at source control (preventing an infected person from infecting someone else).
And along with the ongoing preventable HCW infections is the ever-present danger of a new, more severe COVID wave, or god forbid, another deadly pandemic pathogen accosting the world and our health care system. We absolutely did not learn the OHS lessons of the past from our 2003 SARS-1 (practice) epidemic. We must learn the lessons from the COVID-19 pandemic to prevent future Dr. Cs, and the thousands like her, from acquiring a preventable workplace-acquired illness.
Dr. Joe Vipond is an emergency doctor in Calgary, and Clinical Assistant Professor, Cumming School of Medicine, University of Calgary.
Dr. Dick Zoutman is Emeritus Professor in the School of Medicine at Queen’s University and a recently retired Infectious Diseases Specialist.
Stephane Bilodeau is an engineer, PhD, Adjunct Professor in Bioengineering at McGill University, and Chief Science Officer at the Integrated Bioscience and Built Environment Consortium (IBEC).
