Quebec unveiled details about its plan to allow some essential workers who have tested positive for COVID-19 — or have been in close contact with a confirmed case — to remain on the job.
The province announced the new policy for health-care workers on Tuesday in the face of thousands of COVID-related absences, despite a wave of backlash from health unions and experts.
At a technical briefing Wednesday, health officials explained how the policy would also affect some essential employees outside the health-care system who work in services related to health, safety and essential public services.
Quebec did not provided an exhaustive list of these sectors, preferring to leave it up to managers to judge whether the service they offer is essential, but specified that the directive applies among workers in public security, such as police forces, firefighters, and paramedics, as well as public transit, snow removal and food processing.
The decision to bring an infected or exposed worker out of isolation should only be made as a last resort, in order to maintain essential services which, if disrupted, might endanger public health and safety, the province said.
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The government devised a four-stage contingency plan to address possible breakdowns in services other than health care, and it plans to prioritize those that pose the lowest risk.
In Stage 1, to avoid a break in services, asymptomatic workers who have come into close contact with a COVID-positive person will be asked to return after five days of isolation, reduced from the standard 10, provided they present a negative COVID-19 test on the day of their return. Workers with three doses of a vaccine will be prioritized.
Workers will have to follow strict protocols on the job from day six to 10 of their isolation period, which include working in an environment that isolates them as much as possible and taking their breaks in designated areas for exposed workers.
If that's not enough to prevent a break in services, Stage 2 could see asymptomatic close-contact workers, and only those with three doses of vaccine, returning to work after just three days of isolation, provided they present a negative COVID-19 test on day four, five and six of their isolation period.
Stage 3, a step officials said they hope they won't ever reach, could see asymptomatic COVID-positive workers coming back to work amid a break in services after a minimum of five days in isolation.
If all else fails, Stage 4 will consist of employers calling their regional public health authorities to work out a return-to-work plan for symptomatic COVID-positive employees before the end of the standard 10-day isolation period on a case-by-case basis.
New rules for COVID-positive, exposed health-care workers
The province also outlined more details for health-care staff, saying vaccinated workers with at least two doses who test positive for COVID-19 could be allowed back on the job after seven days if they have no symptoms. This option will only be used as a last resort, the province said.
In the event of an imminent risk of a break in service, a worker who has been in contact with a confirmed case of COVID-19 outside their home may remain on the job under certain conditions. In all cases, they will have to follow strict self-isolation at work until the 10 standard isolation days are up.
Workers who are exposed to a positive case at home, however, are asked to isolate for seven days. Everyone must watch for symptoms within two weeks of contact, and get tested as soon as possible.
If a health-care worker has symptoms resembling those of COVID-19, they will need to receive a negative test result and see their health improve before returning to the job.
Quebec's College of Physicians weighed in on the government's plan, saying it supports the emergency measure to bring back COVID-positive, asymptomatic workers should it be necessary.
In a statement, the college says working with COVID-19 is not a violation of its code of ethics. "On the contrary, in the present extraordinary circumstances, the physician must help ensure the continuity of services and patient care."
Quebec in 'crisis mode,' says doctor
Dr. Donald Vinh, an infectious disease specialist at the McGill University Health Centre, said asking COVID-positive health-care workers to stay on the job is not ideal, but it shows that the Quebec government is in "crisis mode."
"We are in a fixed, limited number of health-care workers in every province because there's no reservoir or pool of health-care workers that we can sort of depend on to bail us out here,'' he said.
"We have to go back to our existing pool of health-care workers, which necessarily means this type of mandate where they go back to work when they're COVID-positive.''
But Dr. Judy Morris, president of the Association des médecins d'urgence du Québec, says the province needs to clarify all the logistics around bringing back these affected workers early.
"When health-care personnel come back, are they going to be at risk of infecting their colleagues? Are they going to need separate entrances? Separate rest areas?" she said.
Morris said Quebec also needs to look at other options to make sure the health-care network has enough staff, including recruiting students and health-care professionals from other sectors to help out.