Researchers and advocates are concerned that public health guidance enabling asymptomatic workers who test positive for COVID-19 to continue working could further put migrant workers' health and safety at risk. But the province's chief medical officer of health says the policy was made "out of respect" for workers.
As part of an announcement earlier this week that Windsor-Essex County, with the exception of Kingsville and Leamington, would be allowed to reopen on June 25, Premier Doug Ford outlined his government's plan to tackle outbreaks on farms and through the region.
Several farming communities in the province have struggled with increasing numbers of workers, including hundreds of migrant workers, testing positive for COVID-19. On June 23, the Windsor-Essex County Health Unit reported 32 new cases of COVID-19, 30 of which were among farm workers. Three migrant workers have died in the region. The COVID-19 pandemic has put migrant workers' living and working conditions in the spotlight, with advocates calling for reforms and more rights for these workers.
The government's plan included increasing "proactive testing" of farm workers through mobile testing units, and a press release said Chief Medical Officer of Health Dr. David Williams would be issuing "new public health guidance allowing positive asymptomatic workers to continue working as long as they follow the public health measures in their workplace."
At a recent press conference, Williams explained that when the province started to test asymptomatic people, guidance to employers in some settings on what to do if an asymptomatic worker tested positive included having them work at home or in their cubicle if they wore a mask and stayed away from other employees until they could get retested.
He said when officials were testing on farms they encountered a situation where 28 asymptomatic workers tested positive.
"Then we we’re asked how do you interpret this...and how do you do that in a cluster setting?" Williams said. "We wanted to modify our previous guidelines to say in this situation can you cluster that group, can you keep them away from the rest of the group until we retest and monitor?
"So we put out a cluster method, where you could take those individuals who are asymptomatic and are still test-positive and ask them to work separately from the rest, because they're mostly on farms, they're out in large acreage," he said, adding that workers would need to wear face masks and that they would need to eat and sleep separately from the rest of the workforce.
"We would monitor them. We would retest them within 48 hours, and if any develop signs or symptoms, you would have to deal with them as possible cases. If they turned negative, they could resume their duties and go back and work with the workforce, the same as the rest," said Williams.
A guidance document dated June 25 contains a section for non-health-care workers and says "work self-isolation" shouldn't be used for symptomatic workers and "should only be applied when there is adequate ability to maintain physical distancing, apply control measures, and is at the discretion of the (public health unit)."
The document describes "work self-isolation" as a person continuing to self-isolate outside of work for two weeks from the day they develop symptoms or from the day they were tested if positive and asymptomatic. At work it means wearing a face covering, staying more than two metres apart and practicing hand hygiene.
Some factors to consider when determining if employees can continue working after testing positive include whether the work is mostly outdoors such as for traffic police or park rangers or if it's indoors, but with little interaction with others such as for a night security guard. Other considerations listed in the document are whether workers can self-isolate when travelling to work and the risk of transmission in the community.
The document, which includes a chart on how to handle different test results, also states that "cohorting of workers who are returning to work on work self-isolation should group together those who are returning after a positive result and now asymptomatic (for more than) 72 hours."
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Syed Hussan, executive director of an advocacy group called "Migrant Workers Alliance for Change, called the guidance "a death warrant."
"This directly puts migrant workers’ lives at risk, it says to migrant workers that you keep getting sicker, you keep infecting other people, you keep dying, but you have to keep working."
While the government has noted that this isn't a directive, but rather guidance, Hussan said "it’s a green light in principle to increase exploitation."
"We already know that migrant workers’ housing and working conditions are such that infection rates are growing enormously," said Hussan, referring to bunkhouses where several workers live together in close quarters. He said physical distancing is very challenging on farms.
"Would you put your father in this position? Would you let a sibling, would you let a child of yours who had COVID-19...work in the fields with other people or would you let yourself go work in a field with another person who had COVID-19? If you wouldn’t, why is it allowed for these people?" he said.
Kerry Bowman, a bioethicist at the University of Toronto, said while the government's June 24 announcement was "a big improvement," the fact that migrant workers are "completely reliant on the farms and linked to the farms, that has to be decoupled at some point for them to work more safely."
He said when it comes to asymptomatic positive people working, "if people want to work, they should, but they should be compensated if they simply don’t feel safe with that."
"There’s also a difference between what the policy is and what their fear is of what their employer will do," said Bowman. "One of the things that worries me is there’s a lot of confusion about what it means to be asymptomatic and positive — is it a false positive, could they become symptomatic a few days later, and so I think that confusion could create some anxiety and I think the workers really should have a right to not work without financial loss if they are asymptomatic.
"To say that yes you’re positive, but you’re not sick, but you might get sick, but you could be infectious, but we don’t know, I find it confusing," he said.
Stephanie Mayell, a doctoral student at the University of Toronto and a member of the Migrant Worker Health Expert Working Group, said some workers feel there is a lack of clarity around the rationale for testing and what it means to be asymptomatic.
"My friends found this a little bit startling and frightening, this announcement," said Mayell, referring to migrant workers she knows. Even though the guidelines talk about cohorting workers, there are concerns that this would not only be challenging on a farm, but would also put "a lot of power in the employer’s hands again to operate as...a public health person," she said.
Janet McLaughlin, an associate professor with Wilfrid Laurier University's Faculty of Human and Social Sciences and a co-ordinator with the working group, said one of her concerns is that workers might feel "compelled to work even if they don’t feel a hundred percent, or they may feel pressured to suppress symptoms to keep working."
She said the group's research has found that migrant workers often feel like they have to work even when sick or injured because they don't want to disappoint their employers who their work permits are tied to, they rely on the income they get to support their families and they don't have permanent residency status.
"If they disappoint an employer, their fear is that they may not continue to be employed, either this year or in future years," said McLaughlin.
Mayell added that if workers were given the choice about whether or not to work, "even if they wanted to not work to preserve health and even if they were given income supports, that doesn’t protect them against reprisal."
"For it to be a truly free choice for workers, they would need to have guaranteed income support if they choose to self-isolate and not work while COVID positive, and also they would need to be guaranteed that choosing this would not jeopardize their job either this season or in the future," McLaughlin said.
It's also "unclear if working in strenuous conditions for long days, as is often the case in agriculture, could potentially compromise a worker's health," said McLaughlin. "Workers or employers wouldn't know if they are asymptomatic or pre-symptomatic or when debilitating and potentially serious symptoms may appear." Additionally, it's likely workers would experience much stress after receiving a positive result, especially given that three workers have already died, so there's also the mental health of workers to consider, she said.
McLaughlin said even if employers do try to keep negative and positive asymptomatic workers separate, there could still be a risk of transmission.
"It’s one thing to say just go and work by yourself in a field, but the minute you have any kind of interaction or touching of similar objects, you have the risk of transmission," McLaughlin said. "It’s easy enough to say they can be completely isolated at work, but is it realistic in all circumstances?
"It would be safer, in my opinion, to keep those workers fully isolated as many other employees are told to do in other industries when they get a positive test. They’re not told to come to work and just try and stay away from other workers, they’re told to stay home."
While the guidelines reference workers' experience with using personal protective equipment, McLaughlin questioned who would ensure this happens, adding that some workers have said they didn't receive such training or that it hasn't been in their language.
Williams countered the view from some advocates that the government's guidance shows disregard for migrant workers' health and safety.
"When we came with our policy around asymptotic workers, it was partly out of respect for those workers who had gone through all the quarantine period, had done everything they should have done, they depend on that income, they depend on the work, and in a sense they’re saying, 'I’m not sick, I didn’t do anything wrong, why can’t I continue working and if I take all the precautions I think I can do this,'" he said at a media briefing on June 25.
When migrant workers arrived in Ontario, they were put up places like hotels and motels to quarantine to ensure, said Williams, adding that some domestic workers hired on farms "brought those infections in and spread it."
"It wasn’t the migrant workers who brought the infection in, so therefore our steps to do this is to honour that and to make sure we respect them as employees and to make sure that they are covered as well if there is some need if they do get symptomatic," he said, pointing to Premier Ford's reference that workers would be eligible for Workplace Safety and Insurance Board benefits, and possibly the Canada Emergency Response Benefit.

Advocates worry guidance enabling asymptomatic people to work poses risk to migrant farm workers

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