PPE, message fatigue among health workers could erode public trust: expert

Manitoba's top public health official says he's noticed messaging and personal protective fatigue among health-care workers at personal care homes with COVID-19 outbreaks — and that could impact public health for the duration of the pandemic if it doesn't change, one expert says.

There are outbreaks at four personal care homes in Manitoba. Three in Brandon, Man., announced outbreaks after a staff member tested positive for COVID-19, while an outbreak at Bethesda Place, a care home in Steinbach, Man., infected seven staff members and three residents — two of whom have died.

Chief Provincial Public Health Officer Dr. Brent Roussin said there's "a lot of fatigue out there" when it comes to sticking to the guidelines that protected Manitobans when the pandemic first arrived in the province.

"When we see the spread within some of these personal care homes, we can see that it's challenging to be using PPE consistently. It's challenging to do it for so long," he said at a news conference Monday.

"We have to get back to that fundamental where not going to work when you're sick, wearing that PPE even though it's tough, constantly, because we can see the results of that."

Two Manitoba union leaders, though, say they were surprised by Roussin's words on Monday.

"None of either the employer or the employees have come to the union saying, 'Hey, there's a problem,'" Shannon McAteer, health care coordinator of CUPE Local 204, which represents over 14,000 health-care workers in the province.

"The staff, as far as we know, are still adhering to [protocol] and still asking for PPE, to make sure that they're not either contracting [COVID-19] or spreading it."

The union has received many complaints from workers about visitors at personal care homes not adhering to the public health guidelines properly, McAteer noted.

Darlene Jackson, president of the Manitoba Nurses Union, believes that message fatigue would only be one of various reasons for the current outbreaks at care facilities in the Prairie Mountain Health Region.

"I don't think it's attributable simply to the issue of message fatigue," said Jackson. "But I can tell you that it's certainly not for a lack of caution and concern among staff providing care."

"Those frontline providers out there providing care during the pandemic puts them at higher risk for exposure. So nurses absolutely take appropriate donning of PPE and wearing appropriate PPE extremely seriously."

If what Roussin says is true, though, then there could be consequences for public health for the duration of the pandemic if not immediately corrected, says Michelle Driedger, professor of community health sciences at the University of Manitoba, whose expertise is health risk communication.

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"Health-care workers have to model the behaviour that they want everybody else to also be engaging in, in order to help keep our [COVID-19] case rates low," said Driedger.

Health-care workers are among the most essential in society because the vast majority of people have to rely on their expertise, she explained. But this means that during the pandemic, health-care workers must lead by example, because "people are going to be following and adopting a lot of that guidance themselves."

"If they don't see health professionals wearing their PPE appropriately or regularly, it's going to start to erode that trust in the public health guidance generally," said Driedger, adding that the rule applies from wearing PPE, to getting in line for a vaccine when one is eventually developed.

Trust in health care could also be shaken if a patient, who is visiting the doctor for a reason unrelated to COVID-19, ends up contracting the illness from a health-care worker who showed up to work despite being symptomatic, or wasn't wearing their PPE properly, she cited.

Despite all of that, though, both messaging and PPE fatigue is understandable, Driedger said, given the messaging from public health officials has stayed relatively the same since March, and health-care workers are wearing more PPE than they were accustomed.

To any workers at personal care homes who may be feeling fatigued, McAteer reiterates that wearing the PPE protects them and the residents in their care.

Jackson said the current outbreaks at personal care homes are a reminder that Manitobans, including health-care workers, must remain vigilant of the threat of COVID-19.

"We have to follow proper procedure. We're seeing outbreaks in long-term care facilities. We've seen what's happened in other provinces in Ontario and Quebec, the tragedy that unfolded in their long term care facilities," she said.

"We have to be incredibly vigilant to ensure that our most vulnerable populations are kept safe."