Canada·Analysis

Ontario's government is 'strongly' recommending masks indoors. Why stop short of a mandate?

Despite increasingly urgent calls from doctors for a renewed mask mandate in Ontario, the province is leaving masking up to individuals at a time when, experts say, governments are wary of a backlash over public health restrictions.

Pediatric hospitals overwhelmed by patients ill with a trifecta of respiratory viruses

A couple wearing masks walk on Toronto's Bloor Street on April 10, 2020. Ontario lifted most of its remaining mask mandates for the final time in June of this year, but many doctors are calling for their reinstatement as the province grapples with a surge of hospitalizations for COVID-19, influenza and respiratory syncytial virus (RSV). (Colin Perkel/The Canadian Press)

Despite increasingly urgent calls from doctors for a renewed mask mandate in Ontario, the province has issued a "strong" recommendation — leaving masking up to individuals at a time when, experts say, governments are wary of the political consequences of forcing health restrictions onto the public.

Medical professionals have urged new masking requirements in indoor spaces, including in schools, as hospitals across Ontario feel an earlier-than-usual strain from patients ill with respiratory syncytial virus (RSV) and influenza, as well as COVID-19.

In Ontario, some children's hospitals are scaling back procedures and sending some older patients to adult hospitals, as their intensive care units are overflowing with cases of respiratory illnesses in kids. Pediatric hospitals in Quebec also report their emergency rooms are operating beyond capacity due to the three viruses.

On Monday, Ontario's Chief Medical Officer of Health, Dr. Kieran Moore, recommended wearing masks indoors, including at social events where young children were present, as kids aged four and under were "highly susceptible" to RSV and influenza.

Moore was still "discussing and reviewing" whether masks should be mandatory in schools, he said. 

The Ontario Medical Association welcomed the province's recommendation, but individual doctors are continuing to push for more measures in schools to help reduce the pressure hospitals will face in the weeks ahead.

"Considering how full our hospitals are, [Moore] needs to go further than this. There literally is no capacity in our pediatric hospitals," Toronto emergency room physician Dr. Kashif Pirzada told CBC News Network.

"[Moore] could have addressed the core of the problem by asking school boards to bring in some measures to protect kids and slow down spread amongst kids."

WATCH | Expert: Government fears public wouldn't comply with mask mandate:

Ontario wary of 'political cost' from mask mandates: expert

20 days ago
Duration 1:57
Peter Graefe, an associate professor of political science at McMaster University, says it appears the provincial government would rather push the health-care system to its limits than face a public backlash over masking requirements.

'Political risk' of mandate

Political and health experts say they believe the government is concerned about the potential for a public backlash, with protests over various other pandemic-related restrictions — including vaccine mandates — still fresh in its memory.

"I think part of what's going on here, both at the level of the medical officials and of the premier, is an assessment of the political risk of requiring something that may be very unpopular and not followed that closely by a fair number of Ontarians," said Peter Graefe, an associate professor of political science at McMaster University in Hamilton, Ont.

Ontario's Chief Medical Officer of Health, Dr. Kieran Moore, is not ruling out a mask mandate, but did not give firm details about what might trigger stronger measures from the province. He is pictured at Ontario's legislature, Queen's Park, in Toronto on Monday. (Chris Young/The Canadian Press)

"They would rather push the pressure into the [health] system than to face the potential political cost of public unhappiness with having to wear masks," Graefe said.

Kathy Brock, a professor of political science at Queen's University in Kingston, Ont., said economic factors will likely also be motivating the government.

A mandate could be interpreted as a signal that it's no longer safe to dine out, shop, or visit other businesses — many of which have already struggled through multiple prolonged lockdowns, Brock said.

"Once you make it mandatory, it's more serious, and people are going to pull back again. That's going to hurt the economy, and we can't afford that right now. So this, to me, shows a government who's grappling with some very tough questions."

Toronto's SickKids hospital, pictured on Aug. 4, said it would reduce the number of surgeries it performs from Monday to preserve its ability to provide critical care as it grapples with a spike in respiratory infections. (Carlos Osorio/CBC)

Dr. Thomas Piggott, CEO of Peterborough Public Health, said he has no doubt that compulsory masking would help alleviate the "scary" situation his region's hospitals are dealing with, "but ultimately, I think that's a political decision at this point."

"Masking is an intervention that comes with absolutely no known evidence of harms, and that's the reality. Unfortunately, through the past couple of years, there's been politicization of masking, so instead of a health prevention, it's seen as a symbol," he told CBC Radio's The Current.

Selling voluntary masking to the public

Medical professionals say Ontario's government has a lot of work to do to change those perceptions and encourage more masking, including sharing information and evidence at a community level about the effectiveness — including against influenza and other viruses.

"One thing we've learned very clearly during this pandemic is that masking reduces the transmission of influenza. [It's] not quite as clear for other respiratory viruses," said Dr. Allison McGeer, an infectious disease physician and senior clinical scientist at Sinai Health System in Toronto.

A masked protester demonstrates against government mandates at Queen's Park in Toronto on Feb. 5. Political experts say Ontario's government will be reluctant to provoke a public backlash by implementing a new mask mandate. (Nathan Denette/The Canadian Press)

"We're in this really difficult time where, yes, we want to leave the pandemic behind, but, A, it's not left us and, B, we've learned some things that can help us save lives without doing a lot of work."

Some doctors have also suggested providing free masks at the entrances to schools, malls and recreation facilities as another way to encourage people to wear them indoors.

WATCH | Infectious disease specialist urges more community outreach, free masks:

'Impressive' community outreach needed to improve mask wearing, says specialist

20 days ago
Duration 4:39
If the province isn't going to mandate mask wearing in public settings, it needs a large and sound communications strategy to improve adherence, says infectious disease specialist Dr. Isaac Bogoch.

Kim Lavoie, a professor of psychology and Canada Research Chair in Behavioural Medicine at the University of Quebec at Montreal, suggests the government should also work to draw a contrast between punitive and coercive measures from earlier in the pandemic — like fines for breaching public health rules and excluding unvaccinated people from everyday life — and the benefits of voluntarily masking now.

"More than anything, the public really needs decision-making tools about when and where to mask, what kinds of masks to wear," she said.

"We don't need to mandate things to send a clear message on why this is important and the good things that are going to happen [if we do it]. If we all pull together now, one thing we could look forward to is a healthy holiday season — who doesn't want that?"

ABOUT THE AUTHOR

Laura McQuillan is an online journalist with CBC News in Toronto. She covers general news, social issues and science and has a special interest in finding unexpected answers to unusual questions. Laura previously reported from New Zealand and Brazil.

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