June 30, 2020

Dr. David Williams
Chief Medical Officer of Health
21st Floor, 393 University Ave.
Toronto, Ontario
M5G 2M2

Re: Public health guidance on testing and clearance

Dear Dr. Williams,

We are health care professionals writing to express our concern at the guidance provided by your office on June 24th that asymptomatic workers who test positive for COVID-19 may continue to work if they are deemed “critical to operations.” In particular, we are concerned that this guidance puts migrant agricultural workers at specific, preventable risk of harm. We urge you to act in your capacity as Chief Medical Officer of Health (CMOH) as outlined in the Health Protection and Promotion Act (77.1) to immediately reverse this guidance.

By now it is clear that the COVID-19 pandemic has disproportionately harmed migrant agricultural workers, with large outbreaks on farms across Southern Ontario and the deaths of three workers: Bonifacio Eugenio-Romero, Rogelio Muñoz Santos, and Juan López Chaparro. The public health response to these outbreaks must be grounded in their root causes: poor working and living conditions. The guidance provided by the CMOH cannot be safely followed or consistently applied, and does little to address the root causes of these outbreaks.

The guidance states that asymptomatic workers may continue to work if they “adhere to public health measures.” However, migrant agricultural workers consistently report that physical distancing is difficult in the fields, greenhouses, and bunkhouses of Ontario. Media reports describe poor access to the necessities for hygiene and personal protective equipment on some farms. In the absence of change to the material conditions of these workers, it is unlikely that workers can adhere to the recommended public health measures.  

As a result, the guidance poses a specific and demonstrated public health risk to migrant agricultural workers and the communities in which they live. It is well-established that a large proportion of individuals with COVID-19 who are asymptomatic at the time of diagnosis go on to develop symptoms. In addition, we know that individuals can infect others while asymptomatic. We are not aware of another sector that routinely permits asymptomatic workers to return to work immediately following a positive test result. Given the working and living conditions of migrant agricultural workers, we are concerned that asymptomatic spread of COVID-19 will result in further outbreaks and additional deaths.

The guidance also places the burden of risk and adherence on migrant agricultural workers— a population with minimal workplace protections or autonomy, while failing to ensure that employers directly address the conditions which exacerbate the spread of COVID-19.  Workers may not feel safe to disclose symptoms if they fear loss of income or retribution from employers, including the fear of removal from Canada. Workers who wish to report symptoms and seek health care often have limited or no access to language-concordant care. The guidance does not clearly outline the responsibilities of employers to ensure that recommended public health measures are enacted or to improve the working and living conditions of their employees. Public health guidance stating that asymptomatic workers can return to work may also undermine their ability to make legitimate workplace insurance claims.

Moreover, we are deeply concerned by your statement suggesting that this guidance was prompted, in part, by employers’ concerns that mass testing of workers could lead to the detection of a large number of asymptomatic cases of COVID-19. This argument clearly trades the health and safety of employees for the interests of their employers. We are troubled by media reports that the guidance was constructed to garner buy-in from employers and designed to be a compromise. It is clear that the voice, autonomy, and dignity of workers were not considered in this guidance. Our public health leaders are entrusted with a broad range of powers which they must exercise in service of the health of all those who reside in Ontario. We are concerned that the guidance was informed by considerations other than sound public health principles and that the independence of the decision-making process may have been compromised.

We ask you to focus your efforts on establishing the workplace conditions and protections required for migrant agricultural workers to protect their own health and that of their communities using your powers under Section 77 of the Health Protection and Promotion Act. These efforts should at a minimum include:

1) Revoking the guidance that permits migrant agricultural workers with COVID-19 to continue to work if they are judged to be asymptomatic;
2) Expanding access to testing for all workers;
3) Ensuring access to paid sick leave for all essential workers at high risk of experiencing outbreaks (including migrant agricultural workers and undocumented workers);
4) Providing specific mechanisms for self-isolation through funded programs of voluntary self- isolation in hotels or other temporary housing and advocating for long-term improvements in living conditions;
5) Protection from employer retaliation for missed work due to these precautions.
 
The growing season is long, and we have already borne witness to the deaths of three migrant workers. The immediate return to work of any person with COVID-19 threatens the health and safety of workers and the entire community. We therefore ask that you exercise your powers as Chief Medical Officer of Health and reverse the guidance to help ensure that we see no further outbreaks or deaths among migrant agricultural workers.

Sincerely,


Bryan Coburn MD PhD FRCPC
Lauren Lapointe-Shaw MD PhD FRCPC
John David Neary MD FRCPC
Shail Rawal MD MPH FRCPC
Malika Sharma MD MEd FRCPC
Abhimanyu Sud MD CCFP

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Rishie Seth MD MBA FRCPC
Eliz Diaz, RN
Anjali Menezes, MBBS, MClinEd 
Abdu Sharkawy MD, FRCPC 
Christopher Draenos, RN
Kim Madden, PhD
Stephen Hwang, MD, MPH, FRCPC
Alice Gray, MD FRCPC
Cecilia Chaparro, MD
Uzma Chaudhry MD 
Divyanshi Jalan, MD
Jennifer Kwan, MD
Asha Patel, MD FRCPC
Ikramuddin Syed MD 
Nabiha Islam, MD, FRCPC 
Hedieh Molla Ghanbari MD, CCFP
Dr. Tanzil Rahman
Ivona Berger, MSc, MD Candidate
Michelle Murdock, MD candidate
Nancy Little, RN, BScN, PNC(C) seems I Is
Kasey Moss, MD candidate
Nicole Furey, registered social worker
Kyrillos Faragalla, Medical Student
Angela Li, MD Candidate
Cindy Tonn, RN
John Fralick MD MSc FRCPC
Danielle Antwi, RN
Vanessa Zannella, MD 
James Zhou, MD Candidate 2021
Moira Kapral, MD FRCPC
Roya Akbary, MD student
Elizabeth Hendren MD
Felipe Fajardo, MD
Ivneet Garcha, MPH, JD, MD student 
Lauren Codognotto RN BScN
Nicole Kozloff MD FRCPC
Meghan Holmes MD FRCPC
Aimée Bouka
Julie Hughes, MD
Amanda J Hill
Karyssa Hamann, MD Candidate 
Alex Pozdnyakov, MD student
Richard Chen, medical student
Yifan Yang, MD student
Jayoti Rana MPH, Medical Student
Alexander Popa, medical student
Jacob Ferguson, MD candidate
Christie Tan, MD Candidate
Crystal Pinto MD, FRCPC
Dee Mangin
Michael Dennis, Medical Student
Cameron Taheri, MD Candidate
Valeria Rodriguez, MD Candidate
Douglas Jang MD
Seann Seto, PharmD
Cynthia Chan, MD candidate 
Jess Sussman
Hanyan Zou, MSc
Grace Zhao
Meghan Clynick, MD
Marck Mercado, MD Candidate
Ting Cai, MD
Somin Nam, MD Candidate
Katrina Kent MD
Neha Malhotra, Medical Student
Kevin Zhang, MD Student
Fatima Khadadah MBBCh FRCPC
Emily Nguyen, MD candidate 
Cindy Cheng, MD
Alexandra Farag, MD, CCFP
Christopher Graham MD, FRCPC
Sama Anvari MD
Shubh Karman Bhatia, RN
Matthew Skelly, MD Canidate, MSc
Julia Sorbara MD FRCPC
Justice Igweze, MD student 
Graham Kasper, MD Candidate
Gillian Kennedy RN
Tianna Cunningham RPN
Monika Dalmacio, RN
Krisel Abulencia
Melissa Morgan RPN
Sumana Naidu, MD Candidate
Maxwell Tran, MD Candidate
Sarah Dales, RD
Madison Joyce, RN
Lina Elfaki, MD Candidate, UofT
Juweiriya Ahmed, MSc, MD Student
Fahad Alam MD, MHSc, FRCPC
Loredana criscenzo RN 
Sinthu Senthillmohan, B.Sc.
Jason Nickerson, RRT, PhD, FCSRT
Leonor Separi, MD Candidate
Candace Oghide, RN
Balal Lone, MD, CCFP (SEM), Dip. Sports Med
Wenna Deng, medical student
Yahia Mohammad. MBChB, FRCPC
Wilson Kwong MD
Sarah Khan MD FRCPC
Aeysha Butt MD CCFP
Katie Wilkins, BSc, Medical Student
Naheed Ali, MD, FRCPC
Gloria Leung, RN
Allison Rodrigues, MD FRCPC 
Peter Nighswander MSW, RSW
Carly Eisbrenner, Medical Student
Sadiya Mushtaq, MD
Katy Shufelt, MD
Nina Vujovic, Medical Student
Ying Ling MD
Hamza Jalal, MD
Chelsea Braun RN
Cherie Durksen, RN, BCN, MHE
Jan Dungog, RPN
Melissa de Souza, MD MHSc MSc CCFP
Zachary Gowanlock, MD
Heather Prescott, NP
Tina Mansoori, RN
Alice Tan, MD Candidate
Kathrin Turchin
Iwa Kong, MD, MSc , FRCPC
Jennifer Tung, pharmD
Lorene Rodgers RN
Kelly Bourdeau RN BScN
Tracy Xavier, PT
Katie Marchington MD CCFP(PC)
Hyder Fazal , MD, FRCPC, FAAP
Kelly Sequeira, RPh
Cassandra Yantha, SW
Sharan Lail, RPh
Alex Yeung, MASc, MD, FRCPC
Jessica Chan, MD
Milad Anwari HBSc, RRT
Stephanie Napoleone, MD, MSW
Victoria Zhang, MD, Family Medicine Resident
Emily Kay, MD, FRCPC
Hannaneh Faghfoury MD FRCPC 
Andrea Hunter, MD, FRCPC
Alexandra Saltman MD FRCPC
Astra Teo, MD, CCFP
Mahmood Kara, MD, FRCSC
Firas Al-Dhaher, MD, CCFP
Tammy Byrne RN, BScN
Tenzing C Sharngoe, MD 
Hazal Mustafa, MD
Maurana Brush MD
Shera Vania MD
Meb RASHID MD CCFP
Laura Lockau, PhD, MD student
Ifor Doolittle 
Alex Louie, MD, MSc, PhD, FRCPC
Lou Stool, MD FRCPC
Kate Rath-Wilson, MD
Tenzin Namgyal, RN
Jordana Compagnone, MSc
Bruce Li, MD Candidate
David Berger-Richardson, MDCM, MSc, FRCSC
Padmaja Sreeram, MD/MSc Candidate
Daniel Voloshin, Medical Student
Bolade Shipeolu, Medical Student, University of Toronto
Cheryl Rosen
Andrea Chittle, MD, CCFP
Tim Rindlisbacher, MD
Ciara Whelan, MD, CCFP(PC)
Layli Sanaee MD MPH FRCPC
Rosemary Killeen, BScPhm, PGCert, RPh
Justin Soegandi, Physiotherapist 
Julie Tan, MD PhD
Karen Leslie MD MEd FRCPC
Sabrina Mellor, RPh
Jane Luft, medical student
Roy Wyman
Hayman Buwan, MD
Emily Groot, MD, MPH, FRCPC
Richard Tunstall ND (retired)
Terry Boak
Jovana Milic, MD
Ashley Jensen MD MPA (PGY3 Resident)
Vaibhav Kamble, MD, CCFP, FRCPC
Christianna Facey-Crowther, RN
Giovanna Sirianni, MD, CCFP (PC), FCFP, MScCH 
Catherine Boudreau RN MScN
Katie Roposa, MEd, RN, CMQ/OE, CRM
Susie Kim MD, CCFP
Tejal Patel MD CCFP
Jane McLeod, RN
Katie Connolly MD FRCPC
Katrina Kent
Rochelle Melvin, MD
Sharanya Ramesh MD PhD
Michael Elfassy, MD MSc
Jasreen Cheema MD CCFP
Charlotte Osler, RN
Cynthia Whitehead, MD, PhD, CCFP, FCFP
Anna Mackenzie, MD, CCFP
Danielle Meschino, MD
Max Deschner, MD
Roocha Vyas DDS
Karthiga Balakumaran- ED
Stephanie Kim, MD
Alisa Rachlis MD FRCPC
Amanda Selk MD MSc FRCSC
Katie Boone MD, MBT, Paediatrician
Elaine Bradley, MD,
Yasmin Kazemi, MD
Jordyn Vernon, MD
Lindy Romanovsky MD
Brent Crawford, MD, CCFP
Kim Haberer MD
Stephen Hale, MD
Kelly Leung MSW, Medical Student
Sabina Freiman MD
Jessica Kapralik MD FRCPC
Michael Chang MD CCFP(EM)
Jodie Pritchard, MD, MPH
Phyllis Cohen, accent coach
David Katz MSc, MD, FRCPC
Alexandra Binnie MD DPhil FRCPCP
Shelley McLean 
Elizabeth Powell
Lauren Welsh, MD, CCFP-AM
Genevieve Eastabrook
Daniella Dávila Aquije, MPP MSc
Carli Blanchard, NP-Adult
Kathy Huang, MD Student
Nikisha Khare, MPH, medical student
Gillian Spiegle MD FRCPC
Alexandra Florescu, MD PhD Candidate
Michael Tylee MD FRCPC
Jennifer Teichman, MD, MSc
Adam Kaufman MD CCFP (EM)
Anson Dong, MD, MBA
Gurbani Sandhu MD
Prabal Rana MD
Kaaren Heasman
Leigh Minuk, MD 
Lise Bondy MD, FRCPC
Matthew Muller, MD, PHD, FRCPC
Kevin Gough, MD FRCPC MEd
Ian Casson, MD, FCFP
Sharon Gazeley MD FCFP
Rishad Khan, MD
Geoff Hartin MD
Michael Beyaert, MD
Rabea Parpia, MD
Kara Grace Hounsell, MD
Kelly Leslie MD 
Brittany Chow, MD
Rigya Arya MD
Finola D'souza, MD
Thomas Dashwood, MD
Joshua Wales MD CCFP(PC)
Céline Allen MD
Sean McIntosh, MD
Charlotte Hunter MD CCFP
Justin Huang, MD
Stacy Deniz MD FRCPC
Silvia Odorcic MD FRCSC
Jeremy Cygler, MDCM