Just over a week ago, Ontarians could venture into public indoor spaces fairly secure in the knowledge that people around them were vaccinated, not ill with symptomatic COVID, and curtailing their potentially virus-spreading breath with masks.
That’s all about to change. On Wednesday, Ontario announced all pandemic public health measures would end in April. Starting with mandatory masking, gone 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 did with the flu. But many aren’t willing to return to the dark age of respiratory virus proliferation. The soon-to-be-lifted public health measures not only reduced COVID cases and deaths, but incidence of the flu and other respiratory viruses, too, which killed hundreds of thousands of people annually pre-pandemic.
Some businesses have, at great cost, invested in air quality improvements that experts say will blunt 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 for and subsidize improvements to indoor air quality. Doing so, they say, will not only slow further spread of COVID, but decrease deaths from other respiratory viruses and prepare us for the next pandemic after COVID.
“To me, saying we need to ventilate and filtrate air, that is being shared in environments full of people who are sitting there for long periods of time, is as obvious as saying we should move our drinking water intake pipe upstream from our sewage,” said infection control epidemiologist Colin Furness.
Ontario certainly has the capability to improve its indoor air quality, said HVAC engineer Joey Fox, but lacks the will.
“There hasn’t been enough of a focus on ventilation and filtration,” said Fox. “There has been a strong delay in acknowledging that COVID is airborne, followed by what I believe is a lack of clear communication about it. We need a societal rethink of how we approach this virus. Good ventilation will significantly reduce transmission and significantly lower the risk of people going to places like movie theatres and restaurants.”
In Japan, restaurants and movie theatres display real-time air quality measurements to patrons. 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 admonished by Ontario’s chief medical officer of health, Dr. Kieran Moore.
Hirji wanted to, as Boston does, monitor CO2 levels in the classroom. The poorer the ventilation in a room, the more CO2 there is in the air from people exhaling. The more CO2 there is in a given space, the more of another person’s breath you are taking in when you inhale. Studies have shown that the risk of COVID transmission rises with CO2 levels indoors.
Moore disagreed, writing in a letter responding to Hirji that Ontario is “not aware at present of any correlation between CO2 levels and viral transmission.”
“Of course there is (a correlation), I don’t know why he would make a statement like that,” said Furness. “Ontario has not acknowledged airborne transmission of COVID. Dr. Moore has almost, I mean, he’s said it could be in the air, but he’s undecided — I think that’s appalling.”
(Moore said on Dec. 15 that Omicron “is much more infectious and there is the potential that it can spread in the air … We’re very concerned that there could be much more aerosol spread than other strains.”)
Franz Hochholdinger, owner of the Apricot Tree Cafe in Mississauga, is decided on the matter.
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 he install HEPA filters. Hochholdinger now has four filters working to purify the air and even has a CO2 monitor on display for customers to see.
(HEPAs use fans to move air through a filter, which work to remove 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 his restaurant’s air, if only to enhance the safety of his customers and staff, it was costly. He estimates he spent $15,000.
The only remediation offered by the government for an undertaking like that is the federal small businesses air quality improvement tax credit, which provides a refundable credit of 25 per cent for ventilation and filtration expenditures up to $10,000 paid between September 2021 and the end of this year.
Hochholdinger started making air quality improvements in August.
Prices like what Hochholdinger paid are beyond what much the restaurant industry can bear after two years of financial brutalization from the pandemic, he said. That’s why he hopes more subsidies and incentives will come for air quality improvement.
“In order for restaurants to get their customers back they need to show that indoor dining can be safer,” said Hochholdinger. “We see this on a daily basis, our customers appreciate our efforts.”
Furness said while Ontario’s inability to contact-trace makes it difficult to calculate how much safer Hochholdinger and other air-conscious restaurateurs like him have made their businesses, he knows it’s where he wants to eat.
“It’s very difficult to measure effect,” he said. “I can’t say, for example, ‘Oh, (Hochholdinger has) solved the problem. Let’s do everything he’s doing.’ However, he very well may have. He’s gone to great, great lengths. It may even be overkill. But his restaurant is a place I would feel comfortable.”
But subsidies on their own aren’t enough to stop other people’s breath from making us sick, Furness said. We need indoor air quality regulations, just as we do with water quality.
“I have been beating the drum to say we need indoor air quality standards if we ever want to take masks off, if we want to have restaurants considered safe,” he said. “Even when there aren’t nasty viruses circulating like COVID, we need them.”
And air standards shouldn’t just apply to businesses, Furness said. They need to be in homes, too.
“It would be enormously useful for us to have indoor air quality standards in public places, but it would be even better if we can extend them to residential buildings,” he said. “Simply targeting restaurants, gyms, workplaces and schools, that would put a dent into it. But if you really want to make a difference, you need to really think about shared indoor air more broadly.”
Until standards are set, Fox said people should look for the presence of HEPA filters and a CO2 level of less than 800 ppm as an indicator that a place is “generally safe to go.”
Standards and subsidies need to come soon. “We need an Operation Warp Speed for clean indoor air,” Fox said, referring to the U.S. vaccine development program. The end of the mask mandate and other public health measures means seasonal respiratory viruses will come roaring back 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 in the 2020-21 season.
That same absence was observed the world over.
In 2019, the U.S. Centers for Disease Control estimated there were 22,000 flu deaths in the country that year.
But in 2020, when COVID surfaced and public health measures sprang up, 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 breathed out by a sick person linger in the air and can infect people who inhale them. Air filtration and ventilation works to mitigate that.
And so the same infection prevention techniques work on both COVID and the flu. Researchers believe millions of deaths the world over were averted because of public health measures.
It’s highly likely, Furness said, that many lives can be saved, from the respiratory viruses we have now and from new ones certain to arrive in the future, if air quality improvements become mandated and paid for by the government.
“We can’t ask restaurants to spend money on this,” said Furness. “I don’t think we can even really ask landlords to spend money on this. I think government needs to step up and do that. And it’s cheaper to buy HEPA filters than it is to pay for ICU beds. So I think there’s probably a really good business case for it.”
Ben Cohen is a Toronto-based staff reporter for the Star. Follow him on Twitter: @bcohenn
Ben Cohen is a Toronto-based staff reporter for the Star. Follow him on Twitter: @bcohennJOIN THE CONVERSATION
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