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Is Canada ready to lift mask mandates? Experts weigh in

Editor’s Note: This story was originally published in March 2022 after after masking requirements were lifted across much of the country  – including gyms, restaurants, and grocery stores. We have republished this piece in light of the recent easing of masking policies in high-risk settings.

Most remaining mask mandates in Ontario expire on June 11, including on public transit and for those visiting hospitals. Health-care workers will also no longer be required to wear masks but will instead be given guidelines for different circumstances under which to mask. Provincial mask mandates will remain in effect for long-term care homes.

This recent announcement has not been without controversy. A number of hospitals have stated that they will continue to enforce masking despite the change in provincial health policy. With official testing records accounting for only an unknown portion of estimated infections, many of the debates around masking highlighted in March following the easing of public health restrictions are yet again bubbling to the surface.

This week, Ontario and Nova Scotia joined most Canadian provinces in lifting mask mandates for a slough of public settings including retail, gyms and restaurants. Quebec and P.E.I. are expected to follow suit in April. And while restrictions vary province to province, most have lifted mask mandates in schools or expect to once the March break ends, leaving many to wonder if the move has come too soon.

We asked a pool of experts if they think the time is right to lift mask mandates in Canada or if we’re moving too fast. This is what they had to say.

Lynora Saxinger

Infectious diseases specialist with the University of Alberta

“It’s a really difficult and polarizing space right now. The best available evidence does support masking as an important part of a bundle of protections, but the best available evidence isn’t high level enough to tell us how much protection masking adds right now, or what to expect if we take it away at this point of the game. One of the other problems that we have is that most of the supportive studies are theoretical, lab based or observational. Observational data on masking can be very different between places, at different times, with different variants and different background immunization. So it’s a very complex situation to try to analyze.

With that, I really don’t understand the rationale behind rushing to drop (mask mandates) when most everyone has adapted well to using them at this point. I think that there’s a risk in saying “we don’t need to do that anymore” too early while things are so uncertain, with possible increases in transmission and also risk of sending a message that (the pandemic) isn’t a big deal anymore. That is premature. I think there is additional value to taking things more slowly, assessing what happens with each reduction in measures, and really keeping an eye on the changes that could be coming because it really can be harder to put the genie back in the bottle.”

Kashif Pirzada

Emergency physician in Toronto and faculty member at the University of Toronto

“There’s still a large, vulnerable population that includes unvaccinated children, like children under 5 who are not eligible, elderly people, immunocompromised people, people with transplants and people with comorbidities. That’s a huge portion of the population – 30 to 40 per cent. All of these people are left vulnerable in any indoor space where the virus can circulate freely in the air. Masks as a personal responsibility is a good thing but it’s unrealistic. One infected person in an enclosed room with poor ventilation will infect every single other person. We’ve seen it time and time again. You have people vulnerable going into grocery stores, schools, pharmacies, hospitals – all places they can’t realistically avoid. These are places they have to go, and then there’s really no protection for them if you remove mandates like this.”

‘Masks as a personal responsibility is a good thing but it’s unrealistic.’

Andrew Morris

Professor of infectious diseases at Sinai Health, University Health Network and the University of Toronto, and member of the COVID-19 Science Advisory Table

“No. I don’t think it’s time. One reason is that I’m unconvinced that we’re at the end of the pandemic in Canada. We actually have – in most jurisdictions across the country – a fair amount of transmitting infection with fairly high numbers. We also continue to have a reasonably vulnerable population. The most benign yet reasonably effective intervention apart from vaccination that is actionable are masks. I think we should get rid of (the mandate) when the numbers are low, but we don’t really have much assurance that the numbers are low, nor that cases aren’t going to rebound. What we’re seeing in Europe right now and wastewater testing in the U.S. all point to a likely resurgence of cases. I would wait at least a few more weeks before we drop them. If we had really fantastic air ventilation and filtration in shared spaces across the country, we probably wouldn’t need to have mask mandates. But until we have, we’re likely going to need these mandates. It still amazes me how polarizing and political masking has been.”

Stefan Baral

Population health and family physician providing clinical care in homeless shelters in Toronto

I’m very supportive of the lifting of mask mandates. As a top level piece, I believe that wearing an N95 or a K95 is effective. But I also think the evidence is increasingly clear that the use of the majority of masks that are used by folks day to day – and the way that they use them – is of limited utility. And it’s true that it’s not a huge burden to wear a mask. But it still burns a lot of (the public’s) energy, and I think it’ll actually be easier to engage with the public on higher yield interventions if we can get rid of the ones that we understand to be lower yield at this point.

I also think that people feel more comfortable being out and about (when they’re sick) when using masks. But a cloth mask versus a big sneeze is not very effective. It’d be better if we created systems, strategies and interventions to help people stay home, isolate and not have to go to work when they’re sick – and to engage in those things in good faith. I think that requires energy and resources on the system’s behalf. That’s where I’d like to invest my time and energy from a public health perspective.”

‘It’d be better if we created systems, strategies and interventions to help people stay home and not have to go to work when they’re sick.’

Marianne Levitsky

Occupational hygienist with ECOH, adjunct lecturer at the Dalla Lana School of Public Health and board member of Workplace Health Without Borders

I’m in the camp that says that in order to be cautious, we should continue to have mask mandates. If you look at the history of this pandemic, it’s wave after wave because they tend to remove most restrictions all at once and then case counts go back up. A much more prudent way of operating would be to lift one restriction at a time, evaluate, and then decide what to do next.

Especially now when the rates are still very high. In Ontario, they stopped doing PCR testing for everybody when Omicron hit, so the actual infection rates are estimated to be 10 times what’s been shown by PCR tests. The Ontario Science Table has estimated that we’re getting about 15,000 to 20,000 cases per day. That is much higher than it was when the mask mandates were first put in place. We also know that the Omicron BA2 variant is increasing, and it’s even more contagious than the original.

Since we now have a wider availability of very good masks, like N95 respirators, we should take advantage of that and use them. If we’re indoors where there are a lot of people whose status we don’t know – whether they’re infected, whether they’re vaccinated, when we don’t know what the ventilation is like – it’s wise to wear a good mask. It just seems like an especially bad time to lift the mask mandates.”

Kevin Hedges

Board member and former president of Workplace Health Without Borders

There’s different strategies for controlling the risk. Canada has been following what we call the mitigation strategy, which means the curve doesn’t completely flatten before restrictions are removed. There’s a big risk in doing that. At the moment, Canada’s is kind of a yo-yo process. The curve never gets down to the bottom again when the restrictions are removed. Obviously when we remove restrictions while cases are going down, it’s going to go up again. That’s a no-brainer. We’re seeing an increase in infections overseas including Denmark, Hong Kong and even now in China. Canada will most likely follow but we still don’t know yet. Nevertheless, this is not the right time to drop the mask mandate.

If anything, I think people should be wearing better, well-fitted masks that form a better face seal, not lifting the mandate. It took us so long to acknowledge aerosol transmission in Canada. Even now, some people haven’t fully acknowledged that SARS-Cov-2 is airborne and you can breathe it in, and that’s been a really big problem. These very small inhalable particles containing the virus float around like smoke, meaning airborne precautions are very important.

I think the public should be better educated about the proper types of face masks. We need a selection of masks that people can choose that comfortably fits the face shape and size of each person and has a proper seal – and we need to shift away from the blue surgical masks. A blue or surgical mask might stop really large projectile droplets, but many of the really small particles will go straight through or go through the gaps around the face. We should encourage people to wear respirators (which are fit for purpose), like N95 and KN95 masks. If we go that way, I think we’ll see fewer infections.”

The comments section is closed.

10 Comments
  • Doctor Squirrel says:

    My concern is this

    Climate Change accelerate mutations.
    Large portion of earth stayed unvaccinated, which exacerbate the speed at which variants will appear

    I do agree with Bill Gates that a deadly “plague level” variant could appear

    I’m especially concerned some of the newest variants
    are more dangerous to kids

    This means the irresponsible unmasked asymptomatic Covid-carrier person
    can end up killing kids without having a clue about it

    I think most peoples don’t understand you need ALL measures

    mask
    distance
    vaccine
    limited circle of contacts

    the vaccine doesn’t prevent you from being a carrier

    With the situation in China,
    all it takes is a few Chinese somehow making it to Canada
    to destroy all our efforts to contain the virus

    And the same is true for any country that still have a bad situation

    No travel ban is ever 100% effective

    The mask should stay up until the situation is globaly stable on earth

    I’m also alarmed that 66% of covid death were in the indigenous population

    We need to treat them better

    Canada need to step up, reform the RCMP and reform the health care given to natives

    I mean RCMP main job shouldn’t be hunting down activists and native and protect the oil industry

    It should be hunting down Russian spies, traffickers,, hackers, and other nightmares

  • colin fletcher says:

    The mask mandates as well as the most of the vaccine mandates should have always been up to the individual’s right to choose. Not coercion. That is called democracy. Do LESS people die in China from covid?? I don’t know. And I really don’t care. We can not continue to violate people’s individual rights just because people are scared of a virus. I do agree that in certain work environments, such as in long term residential homes. Mask and vaccine mandates may be justified. That can be covered understandings of necessity to commit to a safe work place. But we can’t dictate what people do or don’t do in a private business establishment. Such as a gym or restaurant. Democracy is kind of important. More important than claims to public health. People fought and died to establish Canada as a democratic nation.

    If we want to claim to be a democratic society, we can’t force people to put something over their mouths, if they don’t choose to do so. A centralized government can not dictate what the population does or doesn’t do. Not if it continues to violate the Charter of Rights. We have a Charter of Rights for a reason. I think Mr. Trudeau needs to read it. Public health is not a trump card that gives allowance for government to create a dictatorship. Prohibition never worked for the exact same reason.

    It is extremely similiar to the abortion issue. And its a no-brainer. We all have the right to pro-choice. Once we dictate what people can and can’t do with something as fundamental as breathing. Then we have lost perspective.

    • Doctor Squirrel says:

      There never was a “right to choose” in emergency situation.
      there are mitigation rules, you are expected to follow them.

      Be glad you’re not in Napoli during the plague, locked by force inside the city.
      That’s what happen when a pandemic reach hell level.

      It seems too many peoples think the black death was a myth.
      It’s very real, and with the permafrost melting, unknown bacteria will emerge.
      Covid 19 is just the first wave.

      Judging by the population reaction, especially the shameful protests in Ottawa, I would say peoples are too uneducated to face a real code red.

      Don’t compare Canada to China.

      China had peoples die from their containment measures.
      What they did was worst than Renaissance Napoli.

      They literally shutter building doors and windows.
      That’s brain dead.

      It’s also China’s negligence in their “live” food market that played a big role in the emergence of Covid.

      The “Charter of Rights” isn’t a charter of idiocy.

      I’m a human right activist.
      I should know.

      It’s there to protect your normal freedom,
      not to allow you to do whatever you want.

      There is a thing called democracy (voting to select representative leaders)
      But this ain’t perfect. (see the Trump event in the US, a wannabe dictator)

      there is a better thing called Utopia.
      To reach that you need at least 50% of the population to care about each other
      and at some point you need to move past money,
      toward “Utopian Capitalism”
      as effective as Capitalism,
      but in theory, it would have no rent seeking, no damage to nature,
      and make sure everyone got a solid safety net.

      Think “birth of Egypt” due to the Nile excess food, but apply that to everyone,
      making sure they all reach their best potential and can contribute something unique

      (If you didn’t know, that was the birth of civilization and science,
      the excess food was used to create the “priest caste”
      and they mostly focused on things like astronomy, cycles of seasons, agriculture, medicine, etc
      in other words those priests were really scientists)

      Because at the end of the day,
      it’s what you leave after you’re gone that matter.
      and if we can turn everyone into Mozart, Einstein and other genius,
      then the world would be better off.

      Less Mistakes.
      More accomplishment

      But don’t listen to me, I’m just a squirrel

  • Don Taylor says:

    A thoughtful perspective on the pros and cons. I, a vaxxed and boostered retiree, will continue to wear a mask when I am in confined public spaces, such as grocery stores, medical clinic waiting rooms and in other venues where doing so makes others more comfortable with my presence. As for those who insist that masking by the public in public has always been a wastage of time, resources and/or energy, please explain why influenza rates have dropped so dramatically during the pandemic.

  • curtis collins says:

    masks need to go and should never have been mandated. only the sick should wear masks… they were studied by the university of waterloo and were found to be only 10% effective. follow the science?

    • Doctor Squirrel says:

      you learn to buy a pair of glasses

      https://uwaterloo.ca/news/media/study-supports-widespread-use-better-masks-curb-covid-19

      It is true however that low quality masks, or poor usage don’t help.
      I’ve seen peoples wearing the mask without covering the nose. ineffective.

      also peoples think masks are bullet proof.
      You still need distance and a vaccine.

      THE SICK SHOULD STAY AT HOME

      The particles can reach 4 meters when they cough, even if wearing a mask
      There was a fancy test with colored gas in the usa, a fancy high tek test.
      It was fun to watch that video and see how complicated air flow is.

      That’s why they installed ventilators everywhere to pump the air up and throw it out
      It reduce risks

  • Steve Roedde says:

    A disappointing piece. The usual Healthy Debate skewed author selection applied.

    Masks are a medical intervention. As such, randomized trials are the appropriate study design to demonstrate efficacy. More than two years in to this pandemic, only two have been conducted. One negative, the other, in Bangladesh, demonstrated a small (12%) relative risk reduction). Because of the utter failure of the big grant agencies to fund this important work we still don’t really know….
    Most of the opinions of your “experts”, are just that, opinions. There is evidence, which is then used by applying individual values (which includes emotions such as anxiety) to make decisions in the real world.
    Few of your guests mention the costs… because that too has been largely unstudied. The costs are financial, impacting the poor more than the wealthy, environmental (millions of tons of waste as well as energy inputs to make them), educational (an unknown number of kids with impaired speech and emotional awareness), as well as many others.
    We have effective vaccines. Those who wanted them have obtained them, Those with metabolic syndrome have had more than two years to address this individual risk factor. We will all get, or be exposed toCOVID 19. Those who believe otherwise are, frankly, delusional.

    I get the impression that the big issue has become a collective anxiety disorder, fuelled by a fear of contagion that has deep evolutionary roots and magnified by both governments and some in the health profession. Add in the constantly reinforcing tribal signalling involved when one wears a mask, and some seem incapable of discarding something that has little if any current utility.

    If you are anxious, feel free to wear a mask, if you are sick you can consider wearing one, if you are vulnerable because of obesity, age or immune compromise, you can also choose to. If you interact with vulnerable individuals, you can also “mask up”.

    This was once a relatively free society where we had the right to make individual choices about out risks.
    However, the widespread continuation of these mandates will do nothing except further the divisions that have fractured our society and further enable virtue signalling petty tyrants.

    This coming from a triple vaccinated, immune suppressed, older, retired physician who also has opinions… and has discarded his mask… except where forced to wear one through rules imposed by the powerful.

    Enough!

    • James Dickinson says:

      Steve, Colin and Curtis seem to forget that we live in a society, where we each give up some of our freedoms to live amicably alongside one another. As a society, we need to look after one another when individuals cannot, for example we pay for the medical care that sick people need. Masking is not a perfect solution, but it reduces the risk of our taking in aerosols that may be infectious, but also of our putting out droplets and aerosols that can infect others, since we may be infectious before we feel ill. Even a small reduction in the probabilties is helpful. The argument for randomised controlled trials is ridiculous. It is an argument for perfection. Trials are really difficult to run, especially in the current circumstances, since getting large numbers to consent to randomisation would be impossible. So we have to make the best decisions we can on admittedly imperfect information, and err on the side of caution. And anything to reduce the stress on hospital and ICU workers is worth doing, let alone the harms caused to people who get infected unnecessarily. .

      • Steve Roedde says:

        James Dickenson. Your assertion that doing RCT’s for masks is “ridiculous”, demonstrates profound ignorance of experimental designs for medical interventions as well as what is possible (and required). As I said, two HAVE been done demonstrating uncertain benefit. Arguably one of the most important societal actions of potential benefit during this pandemic. Early in the pandemic it was indeed reasonable to make the “best decisions we can on admittedly imperfect information”. Two and a half years in…a complete and utter failure of the health leadership and funding agencies of the world means we are not much further ahead.
        I assume you also believe that this should be mandated because RCT’s are difficult and expensive? It WILL be harder to do RCT’s now, as cases are lower. Yes, they are “difficult to run”… so is forcing everyone on the planet to wear masks! Yes they are expensive…so is billions of dollars of petrochemical-containing masks and all of the other costs I discussed in my post.
        The problem has been that much of COVID policy (worldwide) is driven by belief (and frankly, ideology) rather than evidence. This is not new. Surgeons who “know” that knee debridement works for OA, angioplasty reduces symptoms for angina more than medical therapy (with specific criteria). They too felt that withholding therapy on these “obviously effective” interventions was unethical. The list of debunked beliefs in medicine is endless. On a related note, many well-intentioned physicians believe that ivermectin is effective in COVID 19 and cite (mostly) observational data… Stop and ponder this for a minute. This is in fact, what you are suggesting should be the standard of evidence that is required for medical interventions, including masks.

        You make assertions based (mostly) on belief… Speaking of belief… what things will need to be in place before you feel forcing people to mask up can be stopped… or will you (and desire to force others to) wear one forever? Sorry, the “precautionary principle” was appropriate 2 1/2 years ago… now… not a chance.
        The guilt trips about “protecting others” by wearing masks is also based on (mostly) unfounded belief. I’m not buying it. I spent my career teaching EBM and the current state of knowledge is just not good enough.
        It is incumbent on those who are continuing to push restrictions on individual choice that need to either provide credible evidence or (as one of the people in the article obliquely stated) acknowledge that they have, essentially, unfounded beliefs and opinions.
        Of course this reply is also just another informed opinion… but I’m old, and have seen more entrenched medical beliefs debunked than I want to admit. Enforced community wide mask-wearing for viral infections may, or may not, be another one.

    • Doctor Squirrel says:

      NOTE:
      I’m NOT a Medical Doctor
      I am a scientist.

      Let me take your claim of being a retired doctor
      with a grain of salt

      Endless flood of studies out there, you should visit Research Gate some day.
      Lol, they even modelled air flow mechanics.

      Masks are not magical, there is a distance element.
      If you pack an elevator with masked peoples, the masks won’t help.

      Mask + asymptomatic + 2 meter distance + proper ventilation = decent result

      4 meter distance should yield 100% protection

      [Few of your guests mention the costs… because that too has been largely unstudied. ]
      about 1$ per mask
      the virus survive 3 day on a dry surface
      if you put your mask in a contained place
      it should be reusable 7 days latter

      don’t do that if the mask was used to visit an hospital

      but if it’s used to walk outside, it’s fine

      now for the grocery store
      I use a construction mask
      (I alternate two of those since the start of the pandemic)

      for casual walk, I use the ordinary 1$ ones and reuse them on a weekly basis
      I got one box, still not finished

Authors

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.

maddi@healthydebate.ca
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