Early this year, sociologist Zeynep Tufekci, who initially called for universal mask wearing in March 2020, wrote about the need for the public to upgrade to better quality masks. Yet, 19 months into the pandemic, we still do not have a national strategy to supply Canadians with high-grade protection, nor do we have public messaging to encourage better mask use.
Worse, students and high-risk workers (e.g., health-care staff, teachers and warehouse workers) still face barriers to accessing this essential equipment while having to spend time in settings that present some of the highest levels of exposure to the virus. In early September, and right before the start of the school year, two articles were published in The Toronto Star posing the question of whether or not we need to upgrade our masks.
Unfortunately, some answers to this question in the articles were outdated. Some respondents argued that, even with the onslaught of the Delta-driven fourth wave, cloth masks or surgical/procedure masks alone would offer sufficient protection and prevention of spread. Concerns were also raised about insufficient stock of higher-grade protection such as the respirator masks that can filter 95 per cent of non-oil airborne particles. (N95 masks are examples of such respirators).
We agree that any face covering is better than none and that masks young children will actually keep on their faces are the minimum that should be achieved. Still, the aim must be to encourage all Canadians to wear masks that fit their faces more closely than cloth or surgical/procedure masks alone often do, and to choose materials that filter better than cloth.
Why? SARS-CoV-2, the virus that causes COVID-19, is airborne. That is the evidence from a now voluminous amount of both peer-reviewed and pre-print publications. The research demonstrating this has exceeded the standards that demonstrate the airborne transmission mode for other pathogens such as the virus that causes measles. Airborne pathogens require high-quality masks and respirators that fit our faces well and that filter out airborne particles better than cloth masks.
Without approval yet for vaccination of children under the age of 12, it is even more critical that children in this age group wear as high quality a mask as consistently as possible. At the time of writing, school re-opening has led to a total of 2,430 school-related cases of COVID-19 in Ontario. This spread impacts students, staff and the communities in which schools are located.
When the pandemic began, and personal protective equipment (PPE) shortages were a very pressing concern for our health-care workforce in particular, Canadian PPE manufacturers rose to the challenge and expanded their production lines to make disposable or reusable respirators. According to the Canadian Association of PPE Manufacturers (CAPPEM), Canadian stock of higher-grade masks in Canada is now plentiful and CAPPEM members can expand production as needed. These devices must be distributed effectively to all Canadians to help battle the fourth wave, especially to those in high-risk settings.
Nineteen months into the pandemic, we still don’t have a strategy to supply Canadians with high-grade protection.
High-grade masks, particularly for individuals in high-risk settings, should be government-funded and distributed appropriately through these settings. Outfitting Canadians outside of these settings may require more creative approaches, but there are options. In Austria, for example, supermarkets were involved in the distribution of FFP2s (Europe’s approximately N95-equivalent masks) for a period of time free of charge to customers. Another approach could be to distribute higher-grade masks via mail, community centres, libraries and through other public services. While subsidizing higher-grade masks to Canadians presents an initial cost, this investment is well worth the long-term economic and health protections it provides.
Options for better masking include wearing American Society for Testing Materials-graded procedure or surgical masks with a mask fitter over top to improve the fit of the mask (there is also a DIY for mask fitters courtesy of the University of Wisconsin), disposable respirator masks with either ear loops or with two head straps for a tighter fit, and elastomerics – reusable respirator masks with replaceable filters. These higher-quality masks are now available in a variety of sizes, ensuring most people can benefit from better fit and filter.
While schools are one focus, we all should be upgrading to masks that can fit and filter well. This key strategy must be introduced widely and encouraged, along with ones such as daily rapid antigen testing (which can check if you are acutely infectious or not). The public needs this information in clear language, as do employers who legally must protect their employees’ health.
Other critical protections in the layered approach include tracing and isolation, indoor air ventilation and filtration, hand hygiene and, of course, vaccination to all eligible to further reduce transmission as well as the risk of severe outcomes such as hospitalization or death.
No one strategy is sufficient; we will save lives by combining them and aiming for better.