Systematically omitting indoor air quality: sub-standard guidance for shelters, group homes and long-term care in Ontario during the COVID-19 pandemic

Public Health Ontario (PHO) is mandated by legislation to share scientific advice during infectious disease outbreaks and help reduce health inequities in Ontario, Canada. PHO was founded in part to address the failures of Ontario's public health system during the 2003 outbreak of SARS-CoV-1, which included the failure to address airborne transmission. By January 2021, public health authorities had access to a body of literature suggesting SARS-CoV-2 was airborne, and had received urgent warnings from scientists. We set out to document how PHO responded to the likelihood - and, eventually, the certainty - of airborne transmission in the context of its guidance for congregate settings such as long-term care and shelters. In October 2021, we reviewed PHO's public, written COVID-19 guidance for these settings, with a focus on indoor air quality (IAQ) measures that mitigate airborne transmission, such as ventilation. We identified 11 PHO documents for congregate settings. They contained no references to IAQ measures. We did, however, find references to IAQ measures in parallel documents for schools, summer camps, and clinical offices. Our findings demonstrate PHO omitted key infection prevention measures from its COVID-19 guidance for congregate settings, putting workers and residents at greater risk of exposure, illness and death, and exacerbating health inequities.