Published on January 31, 2022 as a pre-print, the paper “Systematically omitting indoor air quality: sub-standard guidance for shelters, group homes and long-term care during the COVID-19 pandemic,” shares findings that demonstrate that Public Health Ontario (PHO) does not recommend evidence-based indoor air quality measures such as ventilation, portable air filtration or ultra-violet disinfection in its public, written COVID-19 guidance to long-term care homes and congregate settings. This is particularly concerning given the high number of COVID-19 outbreaks in facilities such as long-term care homes and shelters in Toronto right now. Researchers found no references to HVAC systems, portable air filtration, upper-room ultra-violet disinfection or natural ventilation (such as opening windows) in guidance specifically targeted to long-term care and congregate settings, including COVID-19 checklists. They did, however, find references to indoor air quality measures in COVID-19 checklists for schools, summer camps and doctor’s offices.
PHO is mandated by the 2007 Ontario Agency for Health Protection and Promotion Act to “to provide scientific and technical advice and support to the health care system and the Government of Ontario in order to protect and promote the health of Ontarians and reduce health inequities”. The Ontario Agency for Health Protection and Promotion Act tasks PHO with specific responsibilities in the context of infectious disease, and respiratory outbreaks in particular. These include: informing provincial policy related to infection prevention and control; providing “scientific and technical advice and operation supports” during outbreaks; and “evaluating the modes of transmission of febrile respiratory illnesses…”
In accordance with their findings from the intensive thematic analysis of 11 COVID-19 guidance documents developed specifically for long-term care homes and congregate settings, the study authors conclude that PHO has provided sub-standard COVID-19 guidance to long-term care and congregate settings, putting workers and residents at greater risk of illness and death, and exacerbating health inequities in Ontario.
The researchers have also advised that long-term care homes and congregate settings must look to sources other than PHO for evidence-based guidance on COVID-19 and indoor air quality. In all cases, it is recommended that facilities work with experts to improve ventilation and filtration. There are many reliable sources of guidance. These include:
- Guidance on COVID-19 risk reduction in residential buildings from the American Society of American Society of Heating, Refrigerating and Air-Conditioning Engineers;
- Indoor air quality fact sheets from the Clean Air Crew;
- Guidance on ventilation and COVID-19 from the Public Health Agency of Canada;
- Specific guidance for community spaces from Dr. Jeffrey Siegel;
- Best practices for choosing portable air filters from CBC Marketplace.
This research study was led by a multi-institution, interdisciplinary partnership funded in part by the School of Cities, and conducted by researchers affiliated with MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Unity Health Network; Department of Civil and Mineral Engineering, U of T; Dalla School of Public Health, U of T; and the Centre for Health Innovation, School of Computing and Department of Biomedical and Molecular Sciences, Queen’s University.
Study authors:
Amy Katz, (amy.katz@unityhealth.to): Amy Katz is a Knowledge Translation (KT) Specialist at St. Michael’s Hospital in Toronto. Currently, her research is focused on increasing the accessibility of evidence with the capacity to reduce harm in the context of the COVID-19 pandemic.
Amy (Tianyuan) Li: Dr. Li has a PhD from the Department of Civil and Mineral Engineering, University of Toronto. Her research focuses on the role of portable air cleaners and filtration systems associated with central forced-air HVAC systems in improving indoor air quality.
LLana James: LLana James’ research illuminates the ways in which technology can undermine or bolster human rights in the context of clinical care, rehabilitation science and public health. Her interdisciplinary and applied approach is designed to critically appraise current applications of technology, while developing and implementing interventions that seed new, ethical futures. To accomplish this, LLana brings together academic and community scholars across disciplines and sectors to work at the intersections of medicine/clinical care, public health, data, AI, law, and race-ethnicity across multiple axes, e.g., gender, class, able-bodiedness. LLana is wrapping up her PhD in the Faculty of Medicine at the University of Toronto. As a result of her ground-breaking work, she is the inaugural AI, Medicine and Data Justice Post-Doctoral Fellow at Queen’s University.
Jeffrey Siegel: Dr. Siegel (PhD) is a Professor of Civil and Mineral Engineering at the University of Toronto and a member of the university’s Building Engineering Research Group. He holds joint appointments at the Dalla Lana School of Public Health and the Department of Physical & Environmental Sciences. Dr. Siegel is internationally recognized for his work on indoor air quality generally and air cleaning specifically and is a fellow of ASHRAE and a member of the Academy of Fellows of the International Society for Indoor Air and Climate. He has published over 100 peer-reviewed journal articles on indoor air quality and related subjects and has been active in disseminating information about filtration and ventilation solutions for COVID-19.
Patricia O’Campo: Dr. O’Campo (PhD) is an international leader in social epidemiology and Tier 1 Canada Research Chair in Population Health Intervention Research. Dr. O’Campo’s research focuses on upstream determinants of health, quantifying the impacts of structural issues and social programs, and working to propose concrete solutions. Over her career, Dr. O’Campo has published over 300 papers/book chapters/reports. She is Executive Director of the Li Ka Shing Knowledge Institute at Unity Health Toronto and a Professor of Epidemiology at the Dalla Lana School of Public Health, University of Toronto. She is a member of the Canadian Academy of Health Sciences and the Royal Society of Canada.
