COVID mask mandates may be coming back, but even experts are divided

‘They’re helpful in reducing infection, but far from perfect. For some people, the hassles of wearing a mask exceed the perceived benefits’

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Masks remind people of what they’ve been through, “and would sooner not experience again,” says clinical psychologist Steven Taylor., Which is one reason why governments and public health leaders may be understandably reluctant, he and others said, to bring mask mandates back, despite growing calls to do just that.

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Toronto’s public health board has requested the city’s top doctor “urgently explore” re-issuing mask mandates, beginning with schools. Ottawa’s children’s hospital, overrun by such an extraordinarily high surge in seasonal infections it’s had to open a second ICU, is pleading for residents to mask-up for the sake of their kids. Dr. Theresa Tam, Canada’s chief public health officer said Thursday that masks, as an added layer of protection, “might actually make a difference” in dampening the respiratory viral surge. At the University of Waterloo, masks are now required for lectures, seminars, tests, exams, and all other forms of “indoor academic instruction.”

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The bulk of the evidence suggests properly fitted masks help reduce the transmission of COVID-19, according to a large review of the available mask literature published last year.

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But masks have been a cultural flash point throughout the pandemic. Add in an approaching third winter of COVID and the “learning to live with it” messaging and it’s not clear just how much public buy-in exists for a fresh round of mandatory indoor masking.

Although the most recent surge of COVID appears to have plateaued, influenza cases are climbing, steeply, with more than half of reported cases involving children and teens, hospitals are being inundated with unseasonably high number of children with RSV and the emerging Omicron variants BQ.1.1 and BF.7 are on the rise, Tam reported. Still, she refrained from recommending a return to indoor mask mandates or other restrictions, noting those decisions rest with the provinces.

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Ontario Premier Doug Ford recommended Wednesday that Ontarians “wear a mask when you can, when you’re within risk,” but would not say whether he’s entertaining bringing masks back to classes.

Alberta Premier Danielle Smith has vowed to never again do so, as part of her pledge to prohibit any future public health restrictions on COVID.

“No mandate is going to work if the pubic doesn’t listen to it,” said Dr. Andrew Morris, an infectious diseases specialist at Toronto’s Mount Sinai and University Health Network hospitals.

“Would masking help the situation now? Probably, almost certainly it would help if people masked. The issue is, will mandating it work?”

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COVID has highlighted what western countries didn’t appreciate before, or enough, he said, that “things like clean air, good ventilation and air filtration and masks” help reduce the spread of infected respiratory particles.

But, just as there is a cost to HEPA filters and upgrading ventilation systems and keeping windows open because it makes heating more expensive, there are costs to people being masked, Morris said.

“There are environmental costs because you’ve got all this garbage, and there are other costs, which include that people don’t like it, it pisses people off, it makes communication more difficult and it makes recognizing people’s’ faces more difficult — all these things,” he said.

Clean indoor air would make things like masking less necessary, he said, and there should be a huge focus on that. “To me, that’s very clear.”

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The idea of a return to mandatory indoor masking would likely have been unacceptable three months ago, when the weather was warmer and people were just coming out of multiple bad waves of COVID-19, Morris said.

“If someone said (now), ‘We’re just going to be masking for three weeks and then we’ll stop, we need a bit of a breather for the health-care system,’ then maybe people would say it’s acceptable. Maybe. I don’t know.”

If the viral season grows worse in the coming weeks, as many predict it will, if pediatric hospitals that are already cancelling surgeries and redeploying staff become even more swamped, “people might change their beliefs as well, especially if more and more people are getting repeatedly sick,” Morris said. Those opposed to masking, “may see things differently.”

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But it’s not clear in his mind whether mask mandates would appreciably change the trajectory — how much would they attenuate the spread of viral infections? “That’s a different question.”

It’s not just viruses straining hospitals and the health system, but a pandemic backlog of millions of procedures and surgeries, staffing shortages and reduced overall access to health care. A nationwide shortage of children’s’ fever and pain medications is also sending children who normally could have been treated at home to emergency rooms, which have become the pandemic lifeboats for a leaking system. “The final common pathway is hospitals,” Morris said.

The British authors of a recent editorial published in Archives of Diseases in Childhood argue face masks have “little utility” for young, school-aged children. Masks need to be properly fitted, and it’s not uncommon to see little children with masks under their chins or noses, they wrote.

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“It’s normal to want to protect kids from infections,” co-author Dr. Alasdair Munro, a specialist in pediatric infectious diseases at the University of Southampton in England tweeted. “There is no point using interventions which do not appear to work and may have relevant harms associated.”

However, a study published electronically overnight Wednesday from the New England Journal of Medicine concluded that, among school districts in the greater Boston area, the lifting of mask mandates was associated with an additional 44.9 COVID cases per 1,000 students and staff during the 15 weeks after the state’s masking policy was rescinded in February 2022.

“Districts that chose to sustain masking requirements longer tended to have school buildings that were older and in worse condition and to have more students per classroom than districts that chose to lift masking requirements earlier,” the team wrote.

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Morris said the paper isn’t a slam dunk. It was an observational trial, “and there are a lot of biases,” he said. “The kids that go to these older schools with poor ventilation tend to be more urbanized kids who probably also had recent infections,” meaning they may have been less susceptible to a second infection if they had already been infected a month earlier.

“People are calling for masking in schools, but kids have so many other places where they interact where they may not end up wearing masks, and it may not end up sufficiently reducing their interactions,” said Morris, a member of Ontario’s COVID-19 science advisory table.

Still, he believes widespread masking would be helpful right now, “especially in poorly vented spaces. But whether a mandate would work or should be implemented, I’m uncertain.”

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Taylor, a professor in the University of British Columbia’s department of psychiatry and author of The Psychology of Pandemics, understands why people might be reluctant to mask up this winter. Masks have become signals “of what might come in terms of a resurgence of infection, and all that entails,” he wrote in an email.

“Masks also signal or symbolize one’s attitudes and social status,” Taylor said — from pro-mask, and willing to conform to any mask mandate, to people who “strongly value their personal freedom (and) are likely to reject adorning themselves with symbols of conformity.”

“Adding to this, masks aren’t a major bullet,” Taylor said. “They’re helpful in reducing infection, but far from perfect. For some people, the hassles of wearing a mask exceed the perceived benefits.”

National Post, with additional reporting from The Canadian Press

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