To mask or not to mask. The sequel

Kieran Moore is a Canadian physician and public servant who serves as the current Chief Medical Officer of Health of Ontario. Healthy Debate photo

by Maddi Dellplain, Healthy Debate November 22, 2022

Canada’s provincial medical officers of health are resisting calls for mask mandates despite pediatric hospitals facing a surge of hospitalizations from respiratory syncytial virus (RSV), COVID-19 and influenza.

In B.C., Bonnie Henry says there is no need for “that heavy hand of a mandate… because we have many other tools and a high level of protection.” Instead, Henry has encouraged mask use in settings such as public transit, in crowds and when sick.

In Ontario, Kieran Moore has “strongly recommended” the use of masks in all indoor public settings, despite hospitals at overcapacity and limiting services. Moore recently was widely mocked for going maskless at a public event shortly after making his recommendation.

At the time of publication, no provincial or territorial chief medical officer has opted to reinstate mask mandates in indoor public settings. Critics of mandates have highlighted that masking may be less effective given that we are dealing with several viruses, rather than just COVID-19. “We have a spicy cocktail for the next couple of weeks, if not the next couple of months,” says Luc Boileau, Quebec’s director of public health. “Living with the virus is now living with the viruses – it’s not just the one.” Others have pointed to the difficulty in ensuring proper masking among some of those most impacted – in this case, among young children in schools and daycares.

But proponents have emphasized that masking works to reduce transmission and recommendations alone are not enough to reduce the pressure on hospitals.

Healthy Debate spoke with experts in March about whether it was time to lift mask mandates. We checked back in to see what they think of the issue now, eight months later, as we face down a “tripledemic” heading into the holidays.

The question remains: Should we return to mandatory masking in indoor spaces?

Marianne Levitsky – Adjunct lecturer at the Dalla Lana School of Public Health, board member of Workplace Health Without Borders and occupational hygienist with ECOH
Kieran Moore made a very good case for widespread masking now – but then stopped short of mandating it. The stories we are hearing from Ontario’s hospitals are heartbreaking, not only because we feel for the sick kids and their parents, but also because of the overloaded health-care staff. So much of the messaging on masks has been geared toward personal risk assessment, saying in effect “Wear a mask if you feel like you are at risk.” This is the wrong message, as the current situation makes clear. It’s not just a matter of protecting ourselves and the individuals we come in contact with. We need to mask because we need to protect others, especially children, by controlling community transmission of COVID-19, RSV and other airborne diseases.
Masks are not 100 per cent effective in preventing transmission. Some, like N95-equivalents, are more effective than others. But even modest reductions in transmission can make a big difference on a population level.
It would be great if we all adhered to non-mandatory recommendations like Kieran Moore’s. But it is clear from polling and experience that people do not get the message about the urgency of masking unless it is mandatory. A mandate needs to be combined with good public messaging and education on why we need masking and how to do it effectively. We need to see masking not as a restriction and imposition, but as something we do because we are members of a caring society concerned about the health of children, our health-care system and our communities.
Stefan Baral – population health and family physician providing clinical care in homeless shelters in Toronto
Mandating an intervention without properly resourcing access to that intervention is extremely problematic to me. We are requiring that the highest risk folks still go to work and are subjected to a high risk of exposure. People will use whatever masks they can but these are generally low-quality cloth masks that are functionally useless.
To me, mask mandates without an effective program to support them are the ultimate abdication of responsibility on the part of the government rather than the assumption of it. While I believe masking should remain a choice, I believe a more impactful program to increase access and uptake among those who want to wear masks would be implementing a surgical mask/N95 program where people can pick these masks up for free, or in some way that’s responsive to income level.
There could be some sort of mask benefit through Ontario Works, the Ontario Disability Support Program or Trillium. It would make more sense to institute occupational health supports where there are tax breaks or incentives to provide high-quality masks to employees that want to use them on site. There are so many ways we could help people who want to wear masks access the resources they need to keep themselves safe.
It is nearly 2023. We need to transcend the increasingly arbitrary mandates where the lowest-risk folks have the highest-quality masks, and the highest-risk folks have whatever they can afford.

Mask mandates without an effective program to support them are the ultimate abdication of responsibility on the part of the government.

Karif Pirzada – emergency physician in Toronto and faculty member at the University of Toronto
Given the unprecedented, unpredicted demand on the pediatric health system, something needs to be done. At least mask mandates in schools and maybe transit. The health system can’t really stand the stress as it is right now.
We’re not sure the causes of why there’s a pediatric surge. There’s one theory that maybe kids weren’t exposed to the usual pathogens and now they’re having it all at once. The second theory is that maybe there’s some immune dysfunction related to widespread COVID infection in the last year. Either way, the answers will not be clear for quite some time. But currently, there is an urgent need to decompress the acute-care system for kids right now.
Critics of these kinds of mandates point to the “forever nature” of this, that it’s going to be a permanent imposition on liberty. But we removed these mandates and the system was completely destroyed so that’s proof that whatever measures we put in now may only be needed just for this acute crunch and can be removed later. It’s a common-sense protection to save our system. It isn’t some kind of imposition on liberties.
Kevin Hedges – board member and former president of Workplace Health Without Borders
Apart from being professionally employed with the Occupational Health Clinics for Ontario Workers (OHCOW), I also do volunteer work with the Canadian Aerosol Transmission Coalition (CATC).
My concerns about strongly recommending masking indoors is that it does not go far enough. I worked as a regulator in Queensland Australia Mining and if miners were exposed to a hazard underground – for example, lead – then filtering facepiece respirators were required.
Looking around today in the Natural History Museum in Gatineau, I would say 5 to 10 per cent of the occupants were wearing an array of face coverings. We weren’t told to put a mask on at the entrance. I see that the infections and hospitalization are increasing, especially among children, so there is clearly a disconnect. N95s, CAN99s and NIOSH approved respirators are easily accessible and can be ordered easily online. But going a step further, why isn’t the government making N95 masks or better freely available to the public? We should be providing them at the entrance to stores, hospitals and other public indoor places.
Masks, preferably N95s or better, should be required, not optional, in any indoor congregate setting outside of a person’s home.
Maddi Dellplain, Digital Editor and Staff Writer
Maddi Dellplain is a B.C.-based journalist specializing in health reporting. Maddi works across multiple mediums with an emphasis on long-form features and audio-based storytelling. Her work has appeared in The Tyee, Megaphone Magazine, and more. Twitter

Source Healthy Debate


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Life after COVID: Solutions for our health-care system Healthy Debate

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