Windsor medical officer won’t let migrant farm workers with asymptomatic COVID-19 back to work

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The county at the epicentre of Canada’s largest COVID-19 outbreak among migrant workers is not broadly implementing a controversial guidance that allows workers who are asymptomatic to return to their jobs.

Wajid Ahmed, Medical Officer of Health for the Windsor-Essex County Health Unit, said he is not currently allowing workers who have tested positive for the disease to return to work.

“The farm that we are dealing with – none of them are allowed to go back to work. They’re all self-isolating,” he said in an interview. “There are risks, if these guidelines are used in a very blanket way to allow these workers to go back to work. So we feel that we do have the responsibility to review each of these situations carefully.”

The guidance, introduced last week by the Ontario government, has sparked an outcry among migrant rights groups and in the medical community. More than 220 health care professionals have signed an open letter to Ontario’s Chief Medical Officer of Health, calling on him to reverse the policy that allows asymptomatic workers to keep working, under certain conditions. This measure poses “a specific and demonstrated public-health risk to migrant agricultural workers and the communities in which they live,” the letter says.

Ontario has more than 940 confirmed cases of COVID-19 among migrant farm workers, with more than half in the Windsor area, according to a Globe and Mail count. Health officials have emphasized that the workers arrived healthy and contracted the coronavirus that causes COVID-19 locally. Three men from Mexico – Bonifacio Eugenio Romero, 31, Rogelio Munoz Santos, 24, and Juan Lopez Chaparro, 55 – have died.

One farm in the Windsor area has had at least 183 workers test positive, after on-site mass testing ramped up in recent days. The local public-health unit has not identified the farm.

Dr. Ahmed indicated he will apply the new guidance to some specific cases, when the risk of transmission is low, rather than as a broad approach for larger cohorts of workers.

“Even before we initiate any investigation, the general recommendation is if anyone who has tested positive, they need to self-isolate until we figure out what’s going on, or if there’s any reason for us to be concerned,” Dr. Ahmed said.

The guidance “does give us a little bit more flexibility to think it through and make some exceptions. But those exceptions have to be rare exceptions that cannot be a default to say that people can go back to work.”

Premier Doug Ford was asked about Dr. Ahmed’s stance. “That’s the choice of Dr. Ahmed, he’s been doing a good job,” he said at a press conference Tuesday. Regarding the farm with the large outbreak, “that’s going to be his decision; in other situations, he might be a little more flexible.”

Canada’s top public-health official, Theresa Tam, said last week she is evaluating Ontario’s new guidelines on asymptomatic workers who test positive. The guidance is also at odds with federal government messaging that those who test positive for the virus should not work.

Many health experts are decrying the strategy as dangerous and discriminatory against migrant workers, who often don’t feel empowered to assert their labour rights because their status in the country is tied to their status with a particular employer.

The open letter to Ontario Chief Medical Officer of Health David Williams – signed by physicians, nurses, epidemiologists, social workers, researchers and pharmacists – says the measure he introduced “cannot be safely followed or consistently applied, and does little to address the root causes of these outbreaks,” such as poor working and living conditions.

The guidance was “surprising to see in print, because it was so inconsistent with our understanding of best practices,” said Shail Rawal, a Toronto physician who is a signatory and one of the letter’s authors, adding that the communication around this policy has been “confusing.”

Given that evidence shows that people who are positive and asymptomatic can still transmit the virus, “there are questions as to whether it was grounded in public-health principles or economic considerations,” she said.

The letter notes that many workers cannot adhere to recommended public-health measures, given a lack of access to personal protective equipment and that physical distancing is difficult in the fields, greenhouses and bunkhouses. It says the guidance fails to ensure that employers directly address the conditions that exacerbate the spread of COVID-19.

It asks Dr. Williams to revoke the measure, and adopt other policies that would better protect workers, such as paid sick leave and protection from employer retaliation for missed work.

Others are also calling for a reversal of the policy. Adrianna Tetley, chief executive officer of the Alliance for Healthier Communities, sent a letter this week to Dr. Williams and the provincial ministers of labour and health, noting that “no other group is expected to work if they test positive” for the virus.

“While maintaining food supply is important, we can’t do it at the expense of migrant workers’ rights and safety,” she said.

Advocates and health experts have warned federal and provincial governments for months that cramped living conditions and precarious work status put farm workers at heightened health risks during the pandemic.

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