Quebec prepares to keep infected health workers on the job in case of staffing emergency

If you get COVID-19 this winter and end up in a Quebec hospital, the odds are looking increasingly likely that you could be cared for by a worker who also has the virus.

Quebec is laying groundwork to let infected health-care workers stay on the job, trying to avoid a disastrous staff shortage that could be in store given the province's current sky-high case counts.

"The government has indicated its intention to move forward with the possible return to work of asymptomatic positive employees," said Hubert Forcier, a spokesperson for the huge FSSS-CSN union, on Tuesday after a meeting with Quebec's health ministry.

Under the concept, asymptomatic but infected employees would work only with COVID-19 patients, so that new people are not exposed.

The FSSS and other unions, however, aren't happy about the idea, and are asking the province to put safeguards in place to protect their members as much as possible.

"For the FSSS-CSN, this is a worrying decision that involves many risks," said Forcier, calling the new directive "disturbing."

His union, one of the province's biggest, "calls on the government to assess other options," he said.

Tuesday and Wednesday, they also published a list of demands if the directive does go ahead, including immediately putting pregnant workers on leave because of their higher risk, and providing better masks.

The government's directive has been laid out since last March in a document that has been updated several times, most recently in May.

It's entitled "conduct for [health and social services staff] who should be removed from work, but whose services are absolutely required in compromised service delivery context and severe service disruption."

The most recent version says that managers should, as a first course of action, use a certain other government protocol to end workers' isolation, when that's appropriate -- meaning when they're legitimately cleared of an infection. They should also reorganize hours to try to make staffing work.

FOUR LEVELS OF RISK, ENDING IN 'LAST RESORT'

But if that doesn't free up enough workers, and "if it is not possible to ensure the provision of services... establishments must use a risk management approach," the directive says.

"In such a situation, institutions should call on [workers] in the following order," it continues, laying out workers in four different situations.

The first to be called back would be those in isolation because they had contact with someone who's asymptomatic but "under investigation" for COVID-19 -- someone waiting for a test result, or who had risks during travel or at work.

People in that category would simply return to the job with no additional infection control measures, and "regardless of vaccination status."

The second group to be called back would be people "who have been exposed in a significant way to a confirmed case," if they themselves are asymptomatic and if they test negative with an NAAT test.

"In the case of critical health-care workers who are contacts of cases in the health-care setting," they must wait seven days in isolation and get negative tests on day three, then again on day five or six of isolation.

If recalling those two groups still doesn't create enough staffing, the third group to come back would be workers who test positive for COVID-19 but have been asymptomatic.

"Establishments can use these workers as a last resort," the directive says, while constantly reassessing to see if there's another solution.

While such workers stay on the job, "in these extreme situations," strict risk management measures must be followed, including requiring them to take their temperature twice a day, and if they do show symptoms, removing them immediately from the workplace.

Despite calling that third step a "last resort," there's a step beyond it.

The fourth group is workers who "developed a symptomatic infection with COVID-19, whose symptoms started less than 10 days ago, but who have been asymptomatic for 24 hours and [with no fever] for 48 hours," without taking any fever-lowering drugs.

These workers could be recalled to the job "in the event of a severe breach of services," the health ministry wrote in the directive.

INFECTED WORKERS SUPPOSED TO KEPT TO HOT ZONES

Groups three and four are meant to be limited to hot zones, meaning those in hospitals or care homes that have COVID-positive patients.

"Infected [workers] subject to isolation measures should be assigned to hot areas (including hot buffer zones). It is not recommended to use these workers in cold areas or in warm zones," the directive says.

If a manager does decide to put COVID-infected staff into a cold zone, they'll be on their own, they warned.

"In a situation of severe service disruption in cold areas, establishments could take the decision to assign these [workers] in a cold zone," the directive said.

"It would then be a management decision and not a decision based on public health recommendations. Such a decision should be documented and above all justified."

Basic safety protocol under the directive includes wearing a procedural mask while at work, "with the exception of times for eating and drinking," handwashing, changing clothes between work and home, and maintaining a distance of two metres from colleagues except when a patient's care requires otherwise.

The rules also call for "maximum reduction of contact between workers in hot zones and those in cold or warm zones."

When workers share facilities like toilets, despite being assigned to different zones, the ministry is recommending to "increase the frequency of surface disinfection," and it calls for creating different rest and eating areas for the separate groups.

UNION SAYS BETTER PROTECTION NEEDED

However, for the CSSS-CSN, those rules are not enough if the government ends up going ahead with this system.

It wants a slew of tighter infection protocols, including providing N95 masks to all staff of health settings and social services, as well as for daycare workers, who are exposed every day to children too young to be vaccinated.

It also wants more proactive steps to avoid outbreaks among workers in the first place, according to a letter this week addressed to Premier Francois Legault and several ministers.

It's calling for a return to measures brought in during the first wave, including not moving workers around within facilities or between them, and creating sealed "hot" and "cold" zones inside health-care facilities.

It also wants an increase of COVID-19 testing in all workplaces. 

In a statement to CTV News, the health ministry said that the directive is only to be used in case of an emergency, "in the context of a breakdown in service."

The guidelines may also "be revised as the situation evolves along with the information available, said spokesperson Marjorie Larouche.