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Exterior of Toronto Public Health building in Toronto
Toronto Public Health’s tool kit for COVID-19 prevention in congregate living settings contains few references to ventilation, air filtration and other measures to prevent airborne transmission. THE CANADIAN PRESS/Cole Burston 

How safe are Ontario’s shelters and other shared living settings from airborne COVID-19?

In a report that went to Toronto City Council in early June, the city manager listed the measures the city has taken to limit transmission of COVID-19 in shelters. The report does not, however, substantially address a suite of crucial infection prevention and control measures: those that improve indoor air quality.

Because COVID-19 is airborne, we can’t know if the shelter system is as safe as it should be without seeing metrics related to ventilation, filtration and occupancy.

Major medical journals such as the Lancet, the Journal of the American Medical Association and the Canadian Medical Association Journal emphasize the importance of addressing airborne transmission.

The Public Health Agency of Canada, the United States Centres for Disease Control and the World Health Organization (even though they were somewhat late to the game) acknowledge that COVID-19 spreads through the air, and point to ventilation and filtration as key mitigation strategies.

Unfortunately, Ontario’s public health advice for congregate settings (which include shelters, long-term care, group homes for people living with disabilities, and prisons) has yet to put airborne transmission front and centre.

For example, in May 2021, Toronto Public Health released a congregate settings “tool kit.” Its list of resources — many of which are from Public Health Ontario — contains few references to ventilation, filtration, upper-room germicidal ultraviolet light (UV) systems or even to airborne transmission.

Nighttime exterior of Toronto city hall
A commemorative ceremony was held outside Toronto City Hall on the Day of Remembrance for Lives Lost to COVID-19 on March 20, 2021. THE CANADIAN PRESS/Chris Young

The safety of Toronto shelters is in the spotlight right now. Last week, the city used police and private security to evict people living in Trinity Bellwoods Park. City officials stated that people were offered “safe indoor space.”

The following key questions can be used to establish the relative safety of shelters in terms of indoor air quality. They can also be applied to most if not all congregate living settings in Ontario.

Have the relevant public health and government authorities taken the following steps in congregate settings such as shelters, long-term care, groups homes and prisons:

  1. Worked with facilities to suggest room and building-specific occupancy rates that take into account key variables such as ventilation rate, room volume, type of activity in room and time spent in room?

  2. Helped facilities put in place safer practices around high risk spaces such as bathrooms, sleeping areas and dining rooms? For example — examining bathroom exhaust fans to make sure they are in good working order, venting to the outside and running continuously? And, where possible, airing out communal spaces between cohorts for a minimum of two hours?

  3. Helped facilities assess, maintain and, if needed, retrofit or replace HVAC systems? Has this work been completed? What mitigation measures have been put in place if the work is still in progress?

  4. Trained facilities staff in how to strategically place and safety use portable air filters?

  5. Supported facilities in installing upper-room germicidal UV systems and in-duct UV systems where appropriate?

Most importantly, has the above been done on an emergency basis? Long-term improvements are important, but COVID-19 is here now, and lives are at stake every day. There are many short-term improvements that can be made quickly and at low cost, for example, for facilities undergoing HVAC renovations that won’t be complete for months.

Opening windows and doors when it’s safe to do so may be a good place to start. In addition, many of the suggestions above — such as using high quality portable air filters, airing out rooms between cohorts and continuously running bathroom fans that exhaust to the outside — can be done right away.

An HVAC professional may also be able to make some quick improvements to air quality through measures such as upgrading the HVAC system’s filter, ensuring the system’s filter is properly sealed so no air escapes and ensuring the system brings in the maximum amount of outdoor air.

Improvements to indoor air quality can only be good. And not just in the context of COVID-19. When congregate settings such as shelters have the infrastructure and training they need to maintain acceptable indoor air quality, they will be better-equipped to deal with everything from flu season to tuberculosis, from chronic illnesses such as asthma to future pandemics.

Right now, it’s unclear what’s happening system-wide to improve indoor air quality in shelters. It is likely that some individual shelters have done all they can to mitigate airborne transmission. It is unlikely, however, that shelters system-wide are as safe as they could be. Until we have the right evidence around indoor air quality, it is important to stop declaring that the shelter system as a whole is safe.

Read more: Improving building ventilation can help us control the spread of COVID-19 during the winter months

More generally, across the province, the stakes couldn’t be higher. Thousands of people are living and working in congregate settings in Ontario. The science is clear. To compel people to work or live in facilities where evidence-based indoor air quality measures are not in place is to be responsible for preventable illness and death.

The good news is that concrete actions both small and large will make a difference. And many interim measures can be put in place quickly and at relatively low cost.

It is time for the Toronto Board of Health, Toronto City Council and other local health units and government authorities to take an urgent, well-resourced, systematic and system-wide approach to indoor air quality in congregate settings.

This article was also co-authored by Amy Katz, a Knowledge Translation Specialist working in the health-care system.

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