Opinion

The end of public health in Ontario

Make no mistake my friends, as Premier Doug Ford often says, public health is coming to an end in Ontario. As the sixth – and largely preventable – wave (perhaps more appropriate, tsunami) of COVID-19 washes over the province, there is a notable absence: public health.

Recently this has manifested in several ways: the absence of Ontario’s top doctor, Kieran Moore; the inaction by local medical officers of health (MOHs); the pre-emptive lifting of protective measures, such as mask mandates, without scientific justification; the failure to do basic surveillance, like testing; among many other examples.

But public health is more than just absent. It’s coming to an end.

This process began prior to the pandemic when Premier Ford announced the “modernization” of public health on April 11, 2019. Modernization is double-speak for dismantling public services. The decision to modernize entailed cutting public health spending by $200 million (a 27 per cent budget cut) and reducing public health units from 35 to 10. This latter point may be a primary reason why MOHs are so reluctant to stick their necks out to use their all-important statutory authority to protect the public – the executioner stands waiting, and MOHs know it.

Premier Ford was urged to pause his modernization plans by many, including Ontario’s Association of Local Public Health Agencies, until the COVID-19 emergency is declared over.

Low and behold, the COVID-19 pandemic is over! This pesky sixth wave, with wastewater signals already reaching new heights in some health units and certain to exceed the highest signals recorded provincially, is just a little spike!

If anything, the pandemic has provided great cover for the broader goal to undermine all public institutions, including health care, public education and higher education. Allow these institutions to falter, if not fail, under the weight of the pandemic and the public may just welcome plans to dismantle democratic decision-making in Ontario.

But public health isn’t coming to an end simply because Ford is following through with his plans – his agenda may be rejected outright by voting out the government in June. Public health is coming to an end because of those charged with protecting public health – the Chief Medical Officer of Health (CMOH), boards of health and MOHs. They have a duty to protect the public’s health and, frankly, they have failed. The cruel irony is that if MOHs simply worked together, collectively they just might be able to protect the public’s health. Instead, despite calls from the public, scholars, media, elected officials, MOHs appear to be standing on the sidelines.

But public health is more than just absent. It’s coming to an end.

The most damning representation of this failure – and, sadly, there are many – is the recent passivity of Ontario’s MOHs as the Ford government dropped Ontario’s last line of defense against COVID-19 by removing the provinicial mask mandate. In response, not a single health unit acted to reinstate making policies to protect the public – although Middlesex London Health Unit made sure to protect itself, as you must mask in their facilities. While many units continue to strongly encourage people to wear masks, this is as compelling as telling someone who is intoxicated that they shouldn’t drive. Incidentally, drunk driving only resulted in 155 deaths nationally in 2019 while there were more than 480 COVID deaths in Ontario in March alone.

Section 22 of the Health Promotion and Protection Act (HPPA) clearly grants MOHs the authority to enact measures to prevent the spread of infectious diseases. So why haven’t they used this power to require masking in public settings?

Recently, Bruce Arthur of the Toronto Star proffered several explanations. Perhaps most damning is that not all MOHs agree masking is necessary. Most infamous would be the acting MOH in Haldimand-Norfolk, Matt Strauss, who very publicly vocalized his opposition to cloth masks. However, he noted, “I will wear a high-quality clinical face covering when I interact with high-risk individuals in high-risk settings.” Given the prevalence of COVID-19 transmission and the inability to identify who is a risk, that would mean wearing a mask, well, everywhere. Note that Strauss can’t even call it a mask – which should, at a minimum, signal the seriousness his assessment should be given.

It’s not entirely Strauss’s fault – after all, he does not have any relevant public health training to inform his assessment. In fact, he cannot be appointed as the full-time MOH in Haldimand-Norfolk as he does not meet the eligibility requirements. Strauss was a controversial appointment as acting MOH, undoubtedly intended to be the countermeasure to the former MOH, Shanker Nesathurai, who ruffled the feathers of local farmers by, rightfully, using his section 22 powers to protect migrant farm workers. More on this later.

While masking has come under some scrutiny, and some (including Strauss) wrongly suggest there is insufficient evidence about the benefits of masks, the reality is that they are a valuable and effective tool. The science continues to support this again and again and again. They may not be sufficient – a host of common sense initiatives are required, such as improving ventilation and they work best when commonly adopted and of high quality – but they can play an important role.

Another reason MOHs might be reluctant to use their section 22 powers is that they are following the lead of CMOH Moore, who inexplicably – and, frankly, inexcusably and unforgivably – abandoned the basic tenets of public health. In telling Ontarians to do individual assessments, Moore abandoned public health’s foundation of collective action, never mind that it’s impossible for individuals to do a meaningful risk assessment without adequate surveillance (the backbone of public health). Moore, shockingly, stated in response to the lifting of mask mandates, “You have to recognize you can’t mandate masking forever, that it has to be eventually an individual choice based on an individual’s risk assessment.”

Putting aside for the moment that nobody is advocating for masking forever (which, incidentally, some people may be forced to do to ensure their own protection), public health protections, particularly for limiting the spread of contagious diseases, require collective action and collective responsibility.

MOHs may also have concerns about enforcing section 22 orders – but that is an issue difficult to discuss without first having an order to consider. It would seem there is a misconception that a section 22 order would need to be exhaustive. While that may be advisable, it is not necessary. Section 22 does not necessarily need to be applied across the board. Indeed, very targeted and deliberate orders may do much to reduce the spread of infection.

Public health protections require collective action and collective responsibility.

Consider the all-important need to protect children in schools. An MOH could use section 22(5)(5.02) to order a class of persons – say, children and staff in public schools – to require masking. Such an order would comport with the existing duties of school principals under the Education Act to give “assiduous attention to the health and comfort of pupils,” which includes “ventilation of the school” (s. 265(1)(j)). Moreover, principals can refuse to admit into a school “any person who the principal believes is infected with or exposed to communicable disease requiring an order under section 22” (s. 265(1)(l), emphasis added). Given that everyone is presently being exposed to a communicable disease, and that without proper testing it is impossible to know who has been exposed or when, a creative section 22 order could be drafted to make admission to schools contingent on wearing a mask. Moreover, principals under section 265(1)(m) have the right to refuse to admit any person to the school who “would in the principal’s judgment be detrimental to the physical or mental well-being of the pupils.” Enforcement here would lie with principals, not boards of health or MOHs.

Similar creative solutions are possible for other settings, particularly where people are likely to be exposed. A section 22 order could be made for retailers who wish to remain open to require masking on their premises. Retail spaces are not public – and conditions for entry are not new: no shoes, no shirt, no service.

For some reason, there seems to be widespread misconceptions about what section 22 can apply to. As Arthur notes, “section 22 needs to meet an immediate threat within your health unit, but it’s harder to defend if your PHU is highly vaccinated.” It is not clear where this mistake originates – but it’s a mistake. To invoke an order under section 22, an MOH is only required, on “reasonable and probable grounds,” to demonstrate that a communicable disease may exist in the health unit; that the disease presents a risk to the health of persons; and that the requirements imposed under the order decrease the risk. That’s it.

COVID-19 clearly presents a risk to health through infection and the potential for long COVID. That risk is shared by the unvaccinated and vaccinated alike, although vaccination greatly reduces the risk to health and risks of long COVID. That’s not much solace for the many unprotected or inadequately protected individuals – currently, only one health unit in Ontario has a vaccination rate of more than 70 per cent for those 18+ when taking into account the necessary third dose (Leeds, Grenville and Lanark District).

Perhaps a bigger concern of MOHs is the potential legal challenges they may face should they enact section 22 orders. Such challenges come with significant and unanticipated costs – and not just financially, but also to members of the units. This is not an insignificant concern, but the likelihood of these challenges succeeding is small given that the courts have thus far upheld most COVID-19 policies. Moreover, if section 22 orders were directed against a class of persons, rather than against individuals, they would not require numerous trials. One decision will be sufficient. And while faith in many things has been shaken these past two years, the courts in Canada tend to be deferential to public health. This was the approach of Justice Pomerance in Ontario v Trinity Bible Chapel,  noting, “greater deference is owed where public officials are dealing with a complex social problem, balancing the interests of competing groups, or seeking to protect a vulnerable segment of the population” (at para 125).

Nevertheless, weary and resource-strapped health units have suggested to me that there is concern in health units about losing influence and upsetting or ostracizing a weary public. But this is not a compelling reason. The public often needs to be persuaded to act proactively to protect its health. Should impaired driving laws be relaxed if the public grows tired of drinking responsibly? Moreover, the past two years demonstrated that most Ontarians are willing to abide by requirements. Ontario’s Environmental Protection Act prohibits littering (s. 86), but I have not once heard about removing this provision due to lax enforcement or public buy-in. To be sure, some individuals will not comply (indeed, many did refuse to comply with the provincial mask mandate), but health policy should not cater to those who will always be unwilling. Besides, if someone believes TikTok or YouTube (or Strauss) about the harms of masking, it is doubtful the health units wield meaning influence anyhow.

Arthur also notes that MOHs may be reluctant to speak out against the province’s messaging. But this also is not a defensible position. MOHs are not charged with protecting the health of people residing in the entire province, but those within their health unit. Their assessments are localized, so a province-wide assessment isn’t relevant in determining how to address a threat within their unit. Indeed, consideration of the broader context would render local health units moot (something Ford aspires to achieve). Given that COVID-19 currently is a threat to the health of residents in most, if not all, health units in Ontario, most MOHs would be justified in enacting section 22 orders to require masking. In so doing, they would undermine the clearly fallacious narrative the government is pushing about COVID-19. Just because the provincial government has abandoned efforts to protect the public – making any local efforts potentially less effective – doesn’t mean that MOHs should follow suit.

We need bold action from MOHs. If not now, when?

There may be some concern by MOHs that CMOH Moore may override their decisions. But it is not clear that the HPPA grants this authority. While section 77.1(2) does bestow upon the CMOH the powers of the board of health and those of the MOH, that power is circumscribed by section 77.1(1): “If the [CMOH] is of the opinion that a situation exists anywhere in Ontario that constitutes or may constitute a risk to the health of any persons, he or she may investigate the situation and take such actions as he or she considers appropriate to prevent, eliminate or decrease the risk”. In other words, the CMOH can exercise this power in a limited fashion – indeed, section 77.1 is titled “Chief Medical Officer of Health may act where risk to health.” It does not authorize the CMOH to override an MOH’s actions to prevent, eliminate or decrease risks.

To be sure, there is some ambiguity around the use of section 22 given that it is not a frequently used power and has been subject to little judicial consideration. However, Schuyler Farms Ltd. V Dr. Nesathurai, a recent decision by the Superior Court of Justice provides some useful insight. In Schuyler, the court was assessing a section 22 order by Nesathurai, then MOH of Haldimand-Norfolk, that required migrant farm workers to isolate for 14 days before being permitted to work. In upholding the order, Justices Sachs, Backhouse and Favreau noted that section 22 “set out a non-exhaustive list of specific orders,” including “requiring a person to conduct himself or herself in such a manner as not to expose another person to infection” (para 9). This seems particularly relevant for any section 22 orders requiring masking.

A critical part of this judgment was the judicial notice of the importance of the precautionary principle when determining the need for a section 22 order:

The precautionary approach embodies the principle that reasonable action to reduce risk should not await scientific certainty or proof. It is and should be at the core of public health practice when dealing with a new disease such as COVID-19. Underlying the HPPA and particularly the s. 22 thereof is a focus on preventing public health problems, rather than dealing with them after the fact. (para 108)

The precautionary principle should guide public health decisions – a point that many others have made. Importantly, the court recognized that perfect evidence is not necessary – sorry Strauss, no randomized control trials required – given the importance of prevention.

In short, I have yet to be convinced that there are compelling reasons why a section 22 order cannot be issued. The mandate of MOHs is not to curry favour from a government seeking re-election, but to protect the health of residents in their health unit.

Masks are one of the best examples of a simple and yet effective protective public health policy. They minimize exposure to infection, and thereby reduce transmission of what is clearly a virus that, despite hopeful thinking, continues to wreak havoc. Until we have more robust protections in place – which will require far more difficult changes in society, including addressing ventilation, ensuring global vaccine equity and increasing vaccination rates – masks are a simple but effective solution. Masks are to COVID what condoms are to sexually transmitted infections. Maybe nobody wants to wear one, but they are quite effective when used properly.

The public often needs to persuade the public to make healthier decisions – I have spent most of my career working on policies that aim to make the healthy choice the easy choice. Besides, public health has had much training in how to frame measures enacted to protect the public’s health. Consider smoking bylaws – arguments levied against COVID protections, from rights to freedom to economics, were once levied against restrictions on smoking indoors. Thankfully, smoking bylaws have been normalized. Can you imagine going to a restaurant or workplace where smoking was permitted?

The failure to use section 22 powers to require masking amid the most devastating public health crisis in the last 100 years for me, sadly, signals the end of public health in Ontario. This is not an inevitable consequence, but rather a result of the inaction of those vested with the power to protect public health.

Undoubtedly, the fear of Ford’s modernization agenda remains front of mind, and MOHs are thus wary of what the government may do if they “step out of line.” In this respect, they may be playing a long game, trying to curry future favour, perhaps less budgetary cuts or surviving the “hunger games” and emerging as one of the 10 lucky MOHs to survive amalgamations.

But that is precisely why public health is coming to an end in Ontario. Now is the time for concerted action; when we need bold action from MOHs. If not now, when? The next “mild” wave that brings about hundreds or thousands of deaths? Or the next pandemic that might be more deadly?

In attempting to receive scraps from the table of a Premier who does not prioritize the health of Ontarians, MOHs seem reluctant to act for fear of political consequences. But the gutting of public health is already happening – and will continue to happen. Indeed, I can imagine Ford pointing to the inaction of MOHs as a further justification for cutting budgets, restructuring public health and removing the pesky powers that he cannot control.

The purpose of the HPPA is clear: to protect and promote the health of Ontarians. MOHs need to be courageous and not cower before a government that has ignored the science and decided to put us all at risk. Masks are not going to end the pandemic, but they will protect people. That’s the job of public health.

If Ford’s government is re-elected in June, public health will undoubtedly be further decimated. This may be the last chance for MOHs to use their statutory powers; to fulfill their mandate to protect the health of the public.

Failure to act will be how public health will end: not with a bang, but with a whimper.

 

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73 Comments
  • Gabriel says:

    “Ontario reports 1432 COVID-19 hospitalizations, no new deaths“

    https://www.cbc.ca/amp/1.6438049

    Well this is awkward.

  • Kathleen Kilburn says:

    And now the move to expand prescribing powers to pharmacists.

    I don’t have a problem with the concept.

    What I have a problem with is that pharmacies are businesses. And they charge fees for services. Including, already, dispensing fees.

    So how is this not just another slip of the thin edge of the wedge by that troll Ford to expand private health care in the province?

  • Isabella Brawn says:

    Reelect Ford and we get American style health care. God help us! Vote NDP

  • Sara T MD says:

    Thank you Jacob for sharing a comprehensive and thoughtful message that currently applies to most provinces in Canada. It would seem the vocal contrarians are posting many comments, some in not a “healthy debate” way. Your replies to such are brilliant.

    I especially appreciate your analogy with condoms in your article: “Masks are to COVID what condoms are to sexually transmitted infections. Maybe nobody wants to wear one, but they are quite effective when used properly.” Couldn’t agree more! We need your voice and advocacy. Thank you and stay safe.

  • Harold Pupko M.D. says:

    Public health agencies have been failing us for years.
    Case in point: the vitamin D deficiency/insufficiency epidemic.
    Has any public health authority ever actively campaigned to inform the public that everyone should be taking vitamin D supplements?
    This is basic science. We live in Canada. We cannot produce sufficient vitamin D to sustain a healthy population by natural means, especially when we employ the public health advice to avoid excess sun exposure to prevent skin cancers.
    Prior to its discontinuation in 2010, I used to routinely order vitamin D levels on my patients to assess how much vitamin D to recommend, as the majority were found to have insufficient/deficient levels. The Health Canada recommendations for supplementation would often be insufficient to bring people into the healthy zone. Health Canada’s advice was already failing Canadians in 2010 (and still is).
    The economic and health savings should be reason alone for public health authorities advocate that all adults take at least 2000 IU/day of vitamin D.
    https://www.sciencedaily.com/releases/2021/02/210210133333.htm .
    Could a policy of universal normalization of vitamin D supplementation have lessened the burden of the COVID pandemic? Possibly. Some have suggested that the epidemic of low vitamin D levels contributed to the COVID pandemic, creating a syndemic.
    COVID issues aside, a simple recommendation such as vitamin D supplementation from our public health agencies could still make a huge difference in impacting the overall health of our population. These agencies help to make themselves seem irrelevant by not helping us to help ourselves.
    We have seen a two year erosion in the public’s trust of public health as an institution. If the axiom that “public health moves at the speed of trust,” then public health is in a state of suspended animation that makes it vulnerable to the April 2019 mentality that allowed for government to suggest imposing “modernization.”
    As a physician who is supposed to follow the COVID script of supporting all public health recommendations as a good team player, I find it harder and harder to do so, as my sense of moral injury deepens.
    Maybe public health needs to be reinvented.

  • Steve Roedde says:

    Typically, we start with disagreements on policy decisions. The author appears to land in the extreme “the sky is still falling, mask everyone, (inside and out), restrict all possible behaviour crowd. As I have stated before, the best possible effect of masks is a 12% RRR of infection (not hospitalization), demonstrated in one of two RCT’s done in the pre-Omicron environment. The second RCT showed no benefit. That is data, that is science. The author has nothing better than that to support his beliefs. Period.
    Next, the author conflates cases with adverse outcomes… more than 75% of hospital cases are “with”, not “because” of COVID, and the percentage in ICU’s “with”, COVID is rising steadily.
    In most other regions with high vaccination/natural immunity rates, the bump in cases was followed by an extremely modest increase in adverse outcomes.
    Further, we now have many effective therapies with which to treat those (diminishing) number of Ontarian’s who have not yet had COVID. We will all be exposed, nearly all of us will be infected. That’s reality.
    As always, policy-makers take the data at hand and apply values, which include emotional responses, other risk benefit outcomes, as well as financial and opportunity costs.
    As an example, we know that elevated crossings can decrease auto-train crashes to zero (the extreme “precautionary principle” advocated by the author). However, construction of these on every road-rail crossing in the country is neither affordable nor practical. The opportunity costs are overwhelming. Policy choices reflect this.
    The author, instead of arguing a position based on scientific data (as I did on the issue of mask efficacy), resorts to ad hominem attacks on those who make policy decisions that do not align with his own.
    There is lots of valid criticism that can be heaped on the Ford government regarding public health organization and funding, but when it comes to Public Health leadership, Moore is skilled, knowledgeable, credible, tough and pragmatic. However, the author assumes that different decisions “must” be due to weakness, stupidity or political interference. Sorry, try again,

    As a final note, “Healthy Debate” is clearly and unequivocally an ideological and political silo. The writers are all of one hive-mind and seem (in my opinion), incapable of incorporating new data, new realities, and updating their predictive models.
    Disappointing.

  • Chris Bonnett says:

    This is a brilliant, deep article and I commend Dr Shelley for his constructive and appropriately blunt responses to a lexicon of today’s favourite buzzwords and a deluge of unsubstantiated opinion. Obviously the word is now out and Dr Shelley has attracted a whole new audience to Healthy Debate.

    The only point I can add is that individual and collective responsibility are not opposed. It is not either/or, not a zero-sum game, and neither channel is sufficient on its own to create and sustain health. It’s time to reconcile because the whole is surely greater than the sum of these two positions.

  • dean says:

    Authoritarians imposed masks and lockdowns while providing no independently researched data to support the efficacy of those measures against the harm caused to society, economically and in terms of mental health .
    Alternative treatments to the Big Pharma gene therapies (on who’s behalf the CDC changed definition of the word “vaccine”) are suppressed as “harmful” or “disinformation” through Leftist social media cancel culture .
    corporate fascism from the elites and socialist dictatorship over the public.

  • Joe says:

    Hide in your basement. Or better yet, move to Cuba.

  • Frank Brommecker says:

    A small group of extremely vocal people are negatively affecting public health. If we responded the same way to smokers we’d still have smoking allowed in enclosed public spaces. And what about speed limits? Doesn’t that limit people’s “right” to drive their preferred speed? I don’t understand why asking people to wear masks for everyone’s safety is so different and sensitive a topic. We’re just talking about the common good.

    • Dave says:

      “Asking people to wear masks” as you put it, is a laudable position. This connotes personal responsibility and choice. I think we should be asking people to take the mitigation of COVID transmission by mask wearing seriously, but to ultimately decide for themselves in most public environments and keep mandates for the most controllable, temporally isolatable environments containing individuals at greatest risk of severe COVID outcomes such as long term care homes, hospitals, etc. This article, on the other hand, is advocating for legal strategies to enforce broad spectrum public health authoritarianism. As in invoking law so that “All children must wear masks in schools at all times” or they are subject to penalties (fines for parents? Expulsion from school?).

      What’s the difference? I suppose it mostly boils down to 2 issues. 1) How well do masks work in non-temporally isolatable, relatively uncontrolled environments and 2) How comfortable one is in having authorities limit freedoms (rather than letting individuals take responsibility).

      For the first, we have been pushed a narrative that masks (and vaccines for that matter – which do work but no longer anywhere near as well in preventing transmission as initially promised) simply work no matter what. However, I believe the truth is more nuanced: A) Masks that are designed to prevent transmission of viral particulates (i.e., N95) definitely work in controlled environments where they are used properly (basically properly fitted and not touched for the duration of their use). B) People that are more likely to self-select toward mask wearing are also more cautious, relatively limiting their exposures and exhibiting fewer COVID outcomes when compared to individuals who do not self-select to mask. Clinical studies in the context of “A” and observational studies in the context of “B” have been presented to support the narrative that “MASKS PREVENT COVID”. Which is only partly true. They are efficacious in preventing COVID transmission (i.e., when used in specific controlled environments) but not necessarily EFFECTIVE (i.e., they don’t work, or work well, in many real world environments) in many general public applications.

      The upshot is that when you enforce laws based on the “MASKS PREVEN COVID” narrative, you risk ending up mandating, for example, 5-year old school children to cover their face for up to 6 hours a day. I don’t know about you, but if you’ve ever watched a masked 5-year old for more than a few minutes, the masks definitely are not, on average, used as intended for any substantial length of time, seriously undermining effectiveness. And then most children in these environments, nor their teachers, etc, wear properly fitted N95-grade masks – far from it… Then there is the potential harms of masking young children all day long in their primary social environments. “We do not know the long term effects of long-haul COVID”? What about the potential long-term effects on social development? Why is it OK to ignore the latter and treat the former as the only important concern?

      As such, I implore the consideration of taking mask wearing seriously in the prevention of COVID-caused disease burden. Again, in some temporality isolated environments, it sure seems like the responsible thing to do. However, when we get so comfortable with mandates that 5-year olds end up being forced to wear plausibly ineffective face coverings all day long in school (as they currently are in parts of Canada), goodness knows until when, are we really better off with more masking laws?

    • Elizabeth Rankin says:

      Well-articulated summation!!!

  • David says:

    Did masks and lockdowns stop waves 1 – 5?

    • Jacob Shelley says:

      Hi David,

      Did anyone suggest they did? Did they reduce the impact of the waves 1-5? Yes.

      Usually, in car accident, the question isn’t “did the seatbelt stop the car accident?” Minimizing harm, reducing spread, limiting impact – all worthy objectives.
      Best,
      ja.

  • Kyle says:

    There are studies and drs. Speaking out about the possibility that all these vaccinations in short amount of time are stressing the immune system. Masks also limit ones exposure to the microbiome in the environment. This inturn could lead people to have weaker immune systems even towards other illnesses. What the public wants is irrelevant when major media outlets have run wrong information biased towards one narrative. People are at there weakest at a time when mental illness is on the rise. Our whole approach to the pandemic was inappropriate. From firing health care workers and creating a shortage, and burn out. You can’t control this virus with simply vaccinating people. It is pointless and many drs have spoken out against this. Again north america is moving away from unbiased science and debate to medical tyranny and pursuit of money. People need to be eating right, excercising and staying positive. Our health care system has failed us in so many ways and it’s partly to do with incompetent government wasting money, and focusing on one solution vaccination. We have stopped nothing and we still don’t know the damage wrought by the people injured from the vaccines. Children have been proven to be very safe against covid from studies in Europe. This hysteria over protecting kids is causing undue panic. There is a reason no one trusts media or medical community and it is because both have strayed so far from there original purpose.

    • S. Brant says:

      Yikes. You weaken your argument considerably with simple spelling and grammar errors.

      • Guy Giannini says:

        Please don’t do that. Many people have trouble with our language and the tools we use to communicate. By challenging their use of grammar and spelling you challenge their right to join the conversation. Please listen to what is being said…not how it is being said!

  • Ben says:

    Still 0 ICU cases for weeks. Your point is invaluable.

  • Bruno Savage says:

    Government controlled healthcare is untenable, inevitably destined to collapse. The sooner Canadians recognize this fact, the better. You cannot have GOVERNMENT between patient, and caregiver…it is a recipe for disaster. Ontario’s system is absolutely wasteful, and highly ineffective, if it were not for the vocation if the caregiver, it would have collapsed long ago, bureaucrats will ALWAYS deteriorate it.

    • Jacob Shelley says:

      Hi Bruno,

      I’m going to wager a guess: you’ve never actually studied health care systems.

      Would be more persuasive if you provided some evidence and justification for your claims.
      Best,
      ja.

  • Steve says:

    Anyone with gr.9 biology knows that masks offer no defense against pathogens. You walk through a cloud of covid your gona breathe it in. Not to mention a mask takes 450 years to biodegrade. This is the new flu ladies and gentlemen. Get used to it, it’s not going anywhere.

    • Jacob Shelley says:

      Hey Steve, some folks that studied biology beyond grade nine disagree with you. If your assessment is based purely on what you learned in grade nine, might be best to listen to those that continued to study biology and have a comprehension level deeper than that of a 14-year-old.

      Best,
      ja.

      • Kyle says:

        Might want to come back with some info before you toot your own horn.

      • Jacob Shelley says:

        Hey Kyle,

        First, that’s not how arguments work – my job is not to prove an unsubstantiated claim wrong.

        Second, my piece has several links to papers by those with more than grade 9 biology.

        Third, my doctorate and four other degrees have helped me learn now to construct proper arguments. Toot toot!

        ja.

      • Steve Roedde MD CCFF (EM) (retired) says:

        35% of whom are there because they tested positive… but it’s not the reason for admission. The graphs of ICU admissions have been declining steadily for the last 90 days… not time to panic and once again introduce marginally effective measures like masks (12% RRR of CASES in one of the 2 RCT’s done (the other showed no benefit at all). These two RCT’s were done in the pre-Omicron environment when vaccination rates were essentially zero. Almost certainly the effect is much much smaller now in absolute terms. That is simply the best and strongest data available. Being reasonably well done RCT’s, they trump all observational studies… which because of confounding variables are inferior. Pretending there is proof of masks beyond this is both intellectually dishonest and manipulative.

  • Ron Hartling says:

    I totally agree with Dr. Shelly’s perspective. The correlation between Premiers’ invariably foot-dragging imposition of public health measures and their consistently premature lifting of those measures with the intensity of each successive COVID wave in their respective provinces constitutes ample evidence that the politicization of public heath decision-making has cost literally tens of thousands of Canada’s nearly 40,000 COVID deaths to date. Canada’s democracy has degraded to the point that most of those decisions are taken not by elected ministers but by the unelected/unaccountable political staff in the Premiers’ offices who now control most of the levers of power. Those “advisors”/courtiers have zero public health expertise and their overriding consideration on every decision is whether or not it will enhance “their guy’s” re-election chances. When during this entire pandemic have voters ever been informed of the trade-offs in lives versus “freedom” entailed by public health decisions or been given the opportunity to express their wishes?

  • Tara Kainer says:

    Absolutely, the job of public health is to protect the health of the public and not cower in fear before an immoral premier who is willing to sentence Ontario citizens to sickness and death through bad policy in order to win an election. Where is the courage of Kieran Moore and all of the MOHs in Ontario to do their jobs? For shame.

  • Dave says:

    Matt Strauss likely has it right RE public masking. Make sure we use highly effective versions (n95) in temporaly isolatable situations where we are most likely to encounter vulnerable individuals. For those out in public for long stretches, relying on more comfortable cloth masks, fatigue sets in, meaning you don’t even end up wearing those properly. Nowhere is this more likely than for children in schools. And then are they really better than no face covering? We certainly have no evidence that they are. And children themselves are at practically null risk, especially from omicron, so is it really a fair ask for them ?

    This article is a fairly sensational, anxiety driving scree. The fact is, this wave of CVD was the least avoidable due to increased transmissability of BA2. Very fortunately, it is not, so far, looking as if it will lead to more deaths and hospital caseload than previous waves. And the upside, optimistically, is bolstered immunity to subsequent strains from such high infection rates. Let’s all try to keep calm, carry on, and be grateful that omicron is as mild as it is.

    • Jacob Shelley says:

      Hi Dave,
      My first response didn’t seem to get posted, so if this is a duplicate when it shows up, apologies.

      Strauss is right about cloth masks insofar as they are less effective than better quality masks – but that’s really not the point of his op-ed. He argues against masks, which the science doesn’t support. Indeed, he says he’d wear one in high risk settings – and given current levels of community transmission, that’s everywhere.

      Yes, fatigue is setting in. I also get tired of wearing my seat belt and waiting for chicken to cook! We do have evidence (some linked in the article, but there is much more) that masks in schools are better than no masks. The current condition of schools – with schools shutting down, teachers absent, etc – also demonstrates the importance of masks. Yes, the current variant would drive increase transmission – but that would be an argument for masking, not against. Strange to argue, “this is more transmissible, so let’s forego the measures that help reduce transmission.” Masks will not, alone, solve this – but they are an important piece.

      And yes, kids are at risk. Tell the parents of the children that have died that the risk is null. COVID has become a major concern for paediatric populations, and is among the leading causes of natural death now. Moreover, COVID does more than present risk of death – there are significant concerns of long COVID even in mild cases. 1 in 4 Ontarians presently dealing with post-COVID symptoms. Some of these are very dangerous – indeed, some of the outcry against vaccines for heart issues are dwarfed by the potential cardiac implications of a COVID infection.

      Beyond the very real risk to children themselves, they can spread COVID to others – including their loved ones who may be unvaccinated or unable to vaccinated.

      Hospitalizations and deaths are but one measure. They are also going up, leading to more cancelled procedures, burnout, demoralization, etc.

      In short, masks seem like a pretty easy tradeoff.
      Thanks for engaging.
      ja.

      • Dave says:

        One could make the argument (to which I subscribe) that the community is not currently “high risk” for most. Those that are vaccinated and/or have had omicron recently (which is many, possibly the majority – or soon to be), are not old and frail or have certain chronic conditions, or are not extremely unhealthy, are not at material risk of severe COVID outcomes.

        Sure, children can spread COVID – like anyone else (though on average probably less so due to lower viral shedding per case duration). The relevant question is why we are subjecting them to a cloth face covering mandate (as we still are in some provinces and as you are advocating for here) when as far as we know – weak analogy from observational masking studies with compromised internal or external validity aside – they probably don’t do much in school environments (again, where children are expected to wear them for hours on end). (Note: the bulk of the evidence you’ve linked in your article are either compromised observational designs of public masking (where it is nearly impossible to effectively control for confounding – basically the distribution of how vigilantly and effectively people mask in the groups compared), or evaluations of masking in a controlled environment such as in a clinic – where they DO work. There are other studies that show a null effect of masking in public environments such as schools – some even of experimental design – but these are less prominent, perhaps a result of a COVID-message exacerbated publication bias). “But what if it saves one life?”. “What if one more child gets to spend the next holiday with a beloved grandparent?”. Poignant emotional appeals aside, what if if it doesn’t – or only saves a small handful, and a lot of children grow up with compromised social development and a general unwillingness to trust that public health has THEIR best interests in mind.

        Hospitalizations and deaths are going up. But marginally so far. Nothing like the Omicron wave at the beginning of the year, which was in turn a reprieve from the prior Delta wave. Should we not be grateful of the opportunity to focus on moving forward in a potentially post pandemic era. Not clamoring for perpetual authoritarian restrictions. Where does it end?

        You know who is on board with the sentiment of your article? Who also thought this wave was preventable? Who also thinks public health powers should be rachetted up? China. Ask the people of Shanghai, currently trapped in the their domiciles, literally deprived of food and essentials, having their pets dragged out and exterminated…, whether they agree with unlimited authoritarianism in the face of COVID. But we wouldn’t got that far, you say? Well where precisely due you propose the line is between what you are advocating for and what Chinese officials are currently enforcing?

        With all due respect, perspectives on real-life risks as an immutable part of mortal humanity (that includes engaging in the physical world, as it always has, and hopefully always will) has been warped in the COVID era. People have always gotten sick. Now we are learning about the potential of “long-haul” flue syndromes that have flown under the radar thanks to COVID… Orders of magnitude more children die in automobile accidents, drown in pools, or everyday injury, etc – there are plenty of examples – than from COVID, yet no one is seriously contemplating banning children from automobiles, or from playing outside. The fact of the matter is that humans sometimes get sick or injured and die prematurely… The number of children who have died from COVID in the USA, ages 0-18, is about 1100 (CDC website). Horrible and tragic, but no more so than the thousands of children that die from other causes.

        My two cents: We need to stop spending so much time and effort on ineffective lockdowns and mandates in the era of highly transmissible, mildly virulent COVID and refocus on bolstering our long-assailed and overburdened hospital system. First and foremost is increased funding of resources and incentives for front-line staffing and perhaps preparing emergency reserves of extra hospital acute care and ICU capacity. Like many had predicted, a pandemic such as COVID-19 has really bared the cracks in our health system. Yesterday was the time to shore them up so that Canadians no longer have to be oppressed by heavy handed, authoritarian public health flailing about in misguided, and often ineffective, attempts to compensate.

      • Jacob Shelley says:

        Dear Dave,

        What do you bring to your assessment? What are you relying on? I’m happy to discuss our differences, but I’d like to know what justifies your assessment of there not being a risk? I’ve identified some in my paper – so please share.

        Your opinions aren’t helped by suggesting masks puts us closer to China. Guess what: they also like clean water, safe food, sanitation, Last I checked, they wear pants in China too! Does that discredit the importance of wearing pants?

        As for COVID outcomes, you’ve ignored long COVID. If you only measure one type of harm, it’s easy to ignore the other types of harms.

        I’d encourage you to investigate the things we have done, collectively, to prevent drownings, injuries in accidents and other harms to children. Seems you’re misinformed on topics beyond COVID as well. Also, and very important, wearing a mask ins’t a lockdown. So maybe focus on the argument at hand rather than resorting to absurd arguments – that masks are lockdown and because China has a similar policy that it discredits the policy. Shows very shallow thinking about the issue – precisely why we need those with training in public health, like MOHs, to act!

        Thanks for engaging,
        ja.

  • Spenny says:

    Hey Jacob,

    Very beautifully written article. The links were a real treat, informative but not capturing the full story. I couldn’t quite finish it as my free time is limited but I have to say something. I think you are missed something crucial, the Ford government lifted the mask mandate under pressure from the voters. Public opinion seems to be against the mask mandate which is why strongly urging people is about as useful as telling them not to drink and drive. Odd choice for comparison by the way*. Personally I still wear a mask whenever possible as I work in the health industry. I feel pressured to drop the mask all the time, but I know the risks. Anyway, I just couldn’t grasp your point when it seems to me you are arguing about whether we should be eating more apples or oranges when really, we should be eating more vegetables.

    *Comparing the mask mandate which has been around for two years against drinking and driving which has been around for 80+ years. I mean, give it a generation or two to become popular. Everyone knows how incredibly stupid it is, and yet it persists. One day it will be eradicated, when cars are no longer needed.

    Cheers,

    Spenny

    • Jacob Shelley says:

      Hi Spenny,
      Thanks for your message. Ford is responding to SOME voters. A few weeks old, but consider this: “In fact, a total of 75 per cent of Ontarians and 73 per cent of Canadians said that they support wearing a mask in public indoor spaces” – see https://www.cp24.com/news/majority-of-ontarians-support-lifting-covid-restrictions-but-half-still-plan-to-wear-masks-in-public-poll-1.5819801.

      When the government undermines the importance of masks to the public, and signals through its offices the unimportance, it should be no surprise that the public buys-in. As I’m sure you know, most public health measures are contrary to what the public may want – don’t smoke, drink less, eat healthy, move more!

      As for the comparison with drunk driving, I think it’s entirely appropriate – it’s somebody else’s decision to act in a way they are comfortable with putting you at risk. Yes, it’s been around longer – and still requires enforcement and public education – suggesting that maybe the public needs to be told what to do some times. Moreover, we decry the deaths that arise from drunk driving, but seem passive about the deaths caused by COVID. COVID isn’t a choice – it is a result of the environment.

      I also compared it to other things – smoking bylaws, etc. I should have added something about seatbelts – they are not 100% effective, don’t save all lives, are mostly useless in day to day transit, but when needed, they do have a profound impact on reducing harms and deaths!

      Thanks for engaging!

  • Renny says:

    “Largely preventable sixth wave” What? Other countries and provinces are experiencing similar waves even with the mask mandate.

    People who are still terrified of covid can hide in their houses for 6-8 weeks until the wave is over.

    • Jacob Shelley says:

      Hi Renny,

      This is a site called “Healthy Debate” and I was hoping someone would push me on that.

      I agree, given the lax approach to this pandemic our government has taken that this wave was likely unavoidable. That said, we could have prevented it – but not by starting to take action in March. We’ve known for a long time how to stop the spread – vaccinations help, but we also need to increase ventilation, ensure people that are sick have sick days, that we test and trace to identify outbreaks, that we ensure people are able to isolate, along with other, more difficult but necessary steps, like ensuring global vaccine equity.

      The inevitability of this wave was due to the poor policy responses made to COVID-19 since the start of the pandemic. Being preventable doesn’t mean it would be easy to prevent or that we have the necessary policies in place to do that prevention – but the absence of the policies doesn’t mean it isn’t preventable.

      So, yes, largely preventable. We’ve just decided (on many levels) to “let ‘er rip” and hope for the best.

      I’m not terrified of COVID – and would prefer to not hide. I’d rather be able to go places and do things – good policies would allow that. Masks are one such policy.

      Best,
      ja.

  • Erica L Reid says:

    I was too tired to finish this article. I think it’s too long and could be more concise. I think the idea of public health coming to an end is just an idea at this point. An election is on the horizon and words said now are only that. Public health definately has a role to play but with Tam breathing down our neck nagging constantly I think some of us are worn down and need a good ol’ dose of figure it out yourself. Making individual choices may work out better in the end. We need time to compare. So let people enjoy breathing and if you want to triple mask – 100% go ahead. Sounds like a deal to me.

    • Jacob Shelley says:

      Dear Erica,
      Reading long articles can be no fun, but they serve a purpose – to give more detail assessment than what might otherwise be possible. Had you read to the end, you might realize that I argue public health is coming to an end because public health isn’t about individual risk assessment. Public health is what we do, collectively, to protect the health of the people. Collective action – like wearing masks, despite our individual risk (or lack thereof), during a pandemic – is what is required to protect everyone. You’ve suggested individual approaches to resolving a public problem; so you, too, are suggesting public health should come to an end.

      It is frustrating that this pandemic hasn’t come to an end yet, but just like you, individually, cannot figure out how to protect yourself from most public health threats – think clean water, pollution, sanitation, safe food, product regulation, safe medical supplies, etc – you’re also not able to prevent a pandemic on your own. We need to work together.

      We also can see how individual choice is working out – here and elsewhere. More people get sick. More suffer long term. More die. We can minimize that. Sounds like a good idea to me!

      Best,
      ja.

  • Erica L Reid says:

    Awesome comment. I second this.

  • Danuta says:

    Because so far we have survived against all odds of the ridiculous changing science that somehow managed to convince everyone that cloth masks lacking significant capability to filter pathogens somehow helped to mitigate the spread of covid and the fact that most people were contaminating their masks anyways through improper use including the “health experts “. How long would you like to continue this circus?

    • Jacob Shelley says:

      Hi Danuta,
      How long would I like to try to prevent people from dying prematurely or becoming chronically ill? I’ll keep trying – on many fronts – as I see that less as a circus and more as a good idea.

      As for masks, don’t fall into the trap set by the clowns – this isn’t about cloth masks. Nobody is advocating for cloth masks. The evidence (not the advice of clowns) actually supports masks – the higher the quality and the better the fit, the better – but, like many things, they are only part of the solution. They help mitigate the spread, but we need many things – vaccination, ventilation, sick days, etc – to really learn to live with COVID.

      Best,
      ja.

  • Pamela Ladouceur says:

    Our public health officials shouldn’t fear threats or repercussions when attempting to put in place mandates or guidelines to protect our health and well-being. And our political leaders shouldn’t put the health of the citizens ahead of their political interests and should not weigh mandates against losing votes. Unfortunately for Ontario Mr. Ford is looking ahead to an election and the thoughts of losing votes is more important then putting mandates back in place. So living with Corovid-19 is up to us now and the decisions we make will not only affect you but your neighbor and so on and so on and so on. So making the simple choice to wear a mask is a decision that may save you from getting sick and may save someone from dying. So why is it so hard to mask up.

  • Nathan says:

    Rather than enforcing mask or vaxx mandates why don’t you/we enforce healthy behaviors and living. By far those are the greatest determinants of public health initiatives. So far that messaging has been zero.

    Instead let’s teach and encourage people to take responsibility for their own health; rather than putting the onus on the general public.
    Sure, you’ll counter it’s out of empathy and consideration for the “compromised”, but we all see that argument for what it is; fear and hypocrisy.

    Let individuals make their own health decisions.
    Stop fear-mongering. Stop trying to play God

    • Michael Fraumeni says:

      Well said Nathan, precisely.

    • Jacob Shelley says:

      Hi Nathan,
      Great question. You’re right – we should promote healthy living. However, as you say that you then go on to suggest that people are responsible for their own health. This is just not true. You don’t test your water at home, or do inspections on your food, or regulate the contaminants released into your environment, or regulate the pollution that impacts your health, or do your own sanitation … among a host of other things.

      Besides, masks are kind of what allows people to manage their own health better. Not everyone can be vaccinated, and in order for those people to be safe, they need help. You say it’s about compromised, but you’re ignoring the very obvious fact that everyone under 5 can’t be vaccinated. They don’t have much of a choice. As for an argument about empathy being fear and hypocrisy, not quite following you here – but how is caring for others fear?

      You don’t make your own decisions on most things. You rely on society to keep you safe – even if you don’t realize it. Next time you take a sip of water, ask yourself if you understand how it gets to you clean. Then consider the fact that when that system broke in Walkerton, and a few people died, we changed our entire approach to regulating water to keep people safe.

      Public health is what we do, collectively, to keep one another safe. Despite your rhetoric, you’re simply mistaken that people have the ability, on their own, to control their own health entirely. Yes, many things have the patina of individual choice, but more is out of your control than you might realize. The narrative of take care of yourself doesn’t work very well during an airborne infectious disease outbreak either – which is why masks. Masks can help mitigate the impact of other’s actions, helping you stay safe. It’s not your fault if you have to go to work and somebody that is sick spreads a disease to you, is it?

      As for public health messaging on other healthy lifestyles and choices, there’s actually quite a bit. Happy to identify it for you – perhaps you’ve not been paying very close attention to all the messaging directed at you about how you can act to be healthier.

      Best,
      ja.

  • Michael Fraumeni says:

    From the article – “If Ford’s government is re-elected in June, public health will undoubtedly be further decimated.”
    Well, what’s the old saying if this happens, why not just throw in the towel. I must be sure to contact psychiatric help if the Ford government does get re-elected in June because it would seem, according to this article, there is no hope for public health and, as we all know, public health is an integral factor in any healthcare jurisdiction. Anyone have a list of psychiatrists taking on new patients? Thanks. Maybe I can be “diagnosed” with something like Prolonged Grief Disorder with how I ought to feel if the Ford government does happen to get re-elected, that should work for ongoing mental health care and treatment.

  • Donald Lesperance says:

    Thank goodness! The sooner the wings of unelected public officials are clipped, the better.

    Throughout the pandemic, they’ve given wrong advice and trampled fundamental rights while a deferential judiciary stood by. Facts that contradicted their preferred narrative of the moment were suppressed, as were voices of restraint and moderation.
    This is exactly the sort of hubris in public officials that brought us the horror of the residential school system, and it must never again be allowed to hold sway over policy.

  • Joe says:

    Healthy debate?! This is nothing but fear mongering..do you wanna live in a state of fear over a cold the rest of our lives? Have our mental health continue to decline even further then it already has these past 2 yrs?! I’m tripple vax’d and just got over covid…it was 2 days of a mild cold..I had flu’s take me out harder then this…enough is enough, it’s time to move on..the ones who want to sleep in their tripple masks, and spend their days hiding in their basement can continue to do so, while the rest of us with commonsense and logic enjoy our lives again.

  • Jacob Shelley says:

    Hey Ray,
    I do think masks work – not perfectly, and we need much more than masks, but they play a pretty clear role in helping preventing disease. As the Nature article I linked to notes, they’re not infallible, but they’re important (https://www.nature.com/articles/d41586-020-02801-8).

    The thing about human rights is that you can’t claim masks take away human rights when the purpose of masks is actually to protect human rights. Rights are always in tension – your right to do as you wish does not mean that you have the right to interfere with my rights. Imposing mask mandates does have an impact on human rights, but only very minimally, particularly when compared to the impact that the absence of masks may have on those who are vulnerable. I have worked for a long time in this area – indeed, much of public health requires weighing the rights of individuals against the rights of the community. What’s more, the courts have pretty consistently upheld COVID-19 protective policies, given that they aim to protect the public and minimally interfere with rights.
    Best,
    ja.

  • Travis says:

    This is literal disinformation. Healthy debate? What a joke.

    If you follow the link, there were only around 200 deaths in March, not 480 like this article claims… 95% of which were all in the age groups 60+

    Ending masks isn’t based in science? No, because for it to be based in science, we would all need to wear N95 masks because every health expert across the world has agreed cloth masks do literally nothing against the spread Omicron. Neither does the vaccine, by the way. So the mandates being gone now make zero difference. But that won’t stop people like the writer of this article from screaming about it.

    The CDC also came out with data recently acknowledging the risk of reinfection for natural immunity was virtually equal to that of vaccinated immunity during the Delta wave. So the “science” we had been following for the last year was literally proven wrong. You won’t hear that coming from “Healthy Debate” though. Nothing about this websites relates to health, or debate.

    • Jacob Shelley says:

      On the link (https://covid-19.ontario.ca/data/case-numbers-and-spread#Deaths_section) as of February 28, 2022 the total deaths were 11,951 and on March 31, 12,433.

      12,433-11,951 = 482.

      Just used the numbers Ontario provided. If there’s another source, please provide. I also don’t differentiate based on age as I find that problematic (just like I didn’t note that of the 155 impaired driving deaths, 88 were the drunk drivers – I see all deaths that are preventable as regretable).

      Agree that we should wear the best masks possible! :) Not screaming either – but thanks for reading and engaging. It makes the “debate” part more real! Easier to debate when you provide sources (e.g., CDC claim).

      Best,
      ja.

    • Jason Fenn says:

      Awesome reply

      • Jacob Shelley says:

        Thanks Jason – I can only assume you mean my reply, where I demonstrate how math works to come up with the figure of 480!

  • Jason says:

    Thank you Dr Shelley for sharing your perspective. It’s comprehensive and well presented. Sadly it’s become common for posts that appeal to reason to be commented upon by people with a small or contrary focus, or an axe to grind. Your credentials are clearly indicated at the bottom whereas none of your detractors have presented anything that gives them a shred of credibility.

    • Erica L Reid says:

      Right. Because fancy credentials mean that what he’s writing makes sense. I think you have just illustrated one of the major reasons we need a break from the drones of public health.

      • Jacob Shelley says:

        Hi Erica,

        I’m happy to compare notes. My fancy credentials just mean that I spent a lot of time researching and thinking about this topic. My paper above is about the law – the use of section 22 under HPPA – although it does touch on other topics. I do feel I am qualified to discuss the law and, more specifically, my expertise, writing, and experience in public health law specifically grant me a unique perspective on this topic.

        What is your background and what do you disagree with? If something doesn’t make sense, please let me know – this is published on a site, purposefully, that is geared towards discussion and debate.

        Or do you just not like what I’m saying?

        Fancy credentials don’t always mean people make sense or are correct, on that I agree. But simply objecting to listening to them because you don’t like that they have credentials (which may actually provide them with insight and perspective that those without credentials lack!) is not very persuasive.
        Best,
        ja.

  • Mike says:

    As you can obviously see, the reaction to your post is all negative. There is a reason for this. You are taking your “opinion “and making it fact, when in reality the facts are that masking the whole population does absolutely nothing but piss people off and rebel in some other way. Common sense dictates that we need to take responsibility for what we do on a daily basis. This does not mean masking the whole population and shutting down businesses. All that will do is cause more harm than good. Most people in hospitals did not go there because of covid, they went there for a completely different reason and were found to have it after being tested. We are going to have to learn to live a normal life because this will probably never fully leave. Does that mean that you want us to mask for the rest of our damn lives? Sounds like population control to me. Great idea, keep your madk on and let the rest of us live our lives in peace. If people choose to mask for whatever reason they have, then let them. Personal choice, get it. Listen to your libertard Prime Minister and get vaccinated, or does that not work in your eyes. Your post, in my opinion is there just to rile up the few that may possibly agree with your post. Personally, most normal level-headed people that I know laugh at so called experts as yourself. Not only that, I have to agree to your “healthy debate community guidelines” in order to post my comment. What does that have to say about you? Agree or be banished. Sounds quite Socialist to me.

    • Jacob Shelley says:

      Hey Mike,

      You’ve clearly never published anything – the norm for these types of sites are the angry, disgruntled folks writing. Indeed, I wrote for this site on Lyme disease years ago and they had to turn off comments!

      My opinion here is backed by my expertise – I was assessing arguments, and presented evidence and arguments to back that up. My doctorate in public health law and my extensive training, research, teaching, and experience in public health law allows me to make good judgments here. What’s informing your critique?

      Masking is a common sense approach, actually. If you can’t see the risk (it is floating in the air) and a mask minimizes the risk of being infected, and that infection carries not only the risk of getting sick, having longterm consequences, but also spreading that illness to others, wearing a mask is common sense, no?

      There are several other claims in your post that are not true – for example, your claims about hospitalizations. At a minimum, common sense would suggest you provide some reference to back this up rather than sharing your opinion and declaring it a fact – is that your problem with me? Interesting how you immediately proffer unsubstantiated opinion – and opinion I surmise is not backed by training or experience.

      Personal choice doesn’t work very well for public health – or for many things in society. “Personal choice about impaired driving, get it!” “Personal choice about defecating in the streets, get it!” We work together to ensure safety – from clean water, to safe food, to reducing pollution, to speed limits, to vaccines, to restrictions on risky behaviours that impact others. Personal choice is also restricted if people cannot engage in society because others do not care about transmitting a potentially lethal virus without regard for their welfare. Seems only some people get the right to make choice, and the rest must accept the risks that materialize.

      You can laugh at experts all you like, Mike, that doesn’t mean you understand anything. You might want to read about the Dunning-Kruger effect – it does provide for a good chuckle!

      As for this website having community standards, that is their prerogative and right. You also elected to comment and made a personal choice, no?

      Best,
      ja.

  • Kyle says:

    GTFO with this article. Those flimsy blue masks don’t do anything. And if you work with groups of kids like I do you know they’re just a host for germs and bacteria as kids drop them, chew on them and touch them constantly with no regard for what’s on their hands. A mask mandate is virtue signalling, nothing more.

    We know who this virus affects most. We know how to protect them. No need to carpet bomb the entire population with the same mandates when the majority aren’t at risk.

    • Neva kelly says:

      Agree thank you for speaking up against this absurd paper

    • Jacob Shelley says:

      Hi Kyle,

      Perhaps you’ve not heard of long COVID – the chronic impacts of a COVID infection that, in fact, impact everyone. If you’re unaware, I’d encourage you to look more into the potential negative impacts on everyone. While we are still learning about the full impacts, they cannot be dismissed without some callousness or disregard to how it does impact people – and there is potential for this to impact everyone.

      As for protecting those at risk, just so you know, masks are one of the ways that experts have identified we can do that effectively and easily. Mask hygiene can certainly be improved with kids, but they still help prevent the spread of germs – and we don’t often argue against other protective measures (say seat belts) because kids are fussy about them or don’t always use them right. We educate people.

      As for the flimsy blue masks – I agree, we should the highest quality, bet fit masks possible – but even the blue surgical ones do a much better job than nothing. Funny how that is – how some prevention is better than no prevention.

      The majority are at risk – just for different things. And I didn’t even bring up what people ignorantly think is fear mongering: that widespread transmission leads to new variants and these may evade vaccines … meaning we’d all be at risk again. Too bad facts and science always get in the way!
      Best,
      ja.

      • Renny says:

        Ahh, the old long covid narrative. You’d think after damn near everyone at this point having had covid, we’d be seeing a significant amount of people suffering from long covid.

        This isn’t the case.

      • Jacob Shelley says:

        Hi Renny,

        I can’t reply to your comment, so just responding here.

        Perhaps there’s an object permanence issue here – but just because you’ve not seen or heard about something doesn’t mean it doesn’t exist.

        Rather than identify the scientific literature that does exist about long COVID, I’ll share what our own government has shared: https://www.ontariohealth.ca/sites/ontariohealth/files/2021-12/PostCovidConditionsClinicalGuidance_EN.pdf.

        Specifically, this document notes: “Based on the available research, about one in four people diagnosed with COVID-19 experience symptoms beyond the acute illness (4 to 5 weeks after a positive test), and about one in ten experience significant symptoms 12 weeks beyond the acute illness. People who are not hospitalized and who have mild illness can also experience persistent symptoms and the post-COVID-19 condition. It is estimated that 57,000 to 78,000 Ontarians have had or are currently experiencing the post-COVID-19 condition.”

        Now you know.
        Best,
        ja.

  • William Gunn says:

    Fantastic article, a guide, and reprimand, for MOHs who have of late, been derelict in their duty. The duty to act responsibly and exercise their power to mandate masking in any public place and protect all citizens of Ontario from the inevitable consequences of not doing so.

    • Michael Fraumeni says:

      I completely disagree with the message of this article and well as what you seem to be implying. Now is the time to be proactive for citizens to understand the important role the MOHs of health have, what pressures they are under, and how best they can help citizens to become better, more informed and healthy citizens. I find this ridiculous from the article – “The failure to use section 22 powers to require masking amid the most devastating public health crisis in the last 100 years for me, sadly, signals the end of public health in Ontario.” These are highly trained medical doctors and the public needs to trust in their actions and what they are informing citizens to do or not to do. I have immense respect for Dr. Kieran Moore and all the local MOHs, they don’t deserve the slagging that articles like this and responses such as yours provide, albeit we all have a constitutional right to our opinions. They work long hours and are very intelligent, thoughtful people who have a very important role and are sincere in what they do for society.
      I am very saddened by the needless negativity pointed in their direction, it is simply uncalled for.
      Have a nice day.

      • Jacob Shelley says:

        Dear Michael,
        Perhaps pay attention to the *many* medically trained professionals and those, such as myself who work in public health, that note that there has been an abdication of responsibility of MOHs to protect the public.

        Your comment is interesting because you claim “now is the time to be proactive for citizens to understand the important role the MOH … have” – exactly the point of this article. MOHs have wrongly indicated they cannot act. They can.

        This isn’t needless negativity – this is a call to action, for MOHs to exercise their statutory authority to fulfill their duty to protect the public. As for sincerity, I’d encourage you to consider the Chief Medical Officer’s Health declaration that the peak of COVID was behind us – only to have it grow daily for a month, and he’s been absent. That’s not sincerity.

        Thanks for your comment.
        ja.

Authors

Jacob J. Shelley

Contributor

Dr. Jacob Shelley is an Associate Professor jointly appointed to the Faculty of Law and School of Health Studies, Faculty of Health Sciences, at Western University. He is also the Director of the Health Ethics, Law & Policy (HELP) Lab. He has a doctorate in law (SJD) from the University of Toronto and is an editor of Public Health Law & Policy in Canada.

 

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