Masks could be here to stay in Canada — even as provinces ditch mandates
Politicization of messaging could further divide Canadians over masking in the future
Mask mandates will continue lifting across Canada in the coming weeks, leaving people on their own when it comes to whether to pull the polarizing public health tool out of their back pocket to reduce their risk of COVID-19.
But as provinces and territories shift to living with the virus and the true scale of spread in Canada remains uncertain with testing scaled back dramatically, the future of masking will look very different across the country — and it may further divide Canadians.
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Canada's Chief Public Health Officer Dr. Theresa Tam said Friday that federal agencies overseeing masking mandates in Canada for things like domestic travel are evaluating the situation and could make "policy adjustments as needed in the coming days and weeks."
Alberta lifted almost all pandemic public health measures on March 1, with capacity and gathering limits completely removed and indoor masking requirements abolished everywhere outside of only the highest-risk settings, such as hospitals.
Premier Jason Kenney said the province would also take the extraordinary step of forcing municipalities to lift mask bylaws to avoid "uncertainty and confusion" with public health restrictions. Calgary has abandoned them, while Edmonton repealed its mask bylaw on Tuesday.
Timothy Caulfield, Canada Research Chair in health law and policy and professor at the University of Alberta, said the debate over masking will be the next "divisive topic" for the public going forward.
"Masks have been a divisive topic for a very long time, but I think it's really going to become the focal point," he said. "This is going to be increasingly about ideology … this is really about where you stand politically."
Masks will no longer be required in Manitoba as of March 15, after vaccine certificates were lifted earlier this month, while Saskatchewan lifted mask mandates March 1 and Quebec took its first step toward doing so this week. Most students in the province are no longer required to wear masks in class.
Ontario has kept masking mandates in place for now, after lifting all remaining capacity limits on indoor settings and scrapping its vaccine certificate system last week, but will likely drop its mask mandate by the end of the month.
"If the question is asked today, should we lift the mask mandate? The answer is no. I think it's too soon," said Dr. Isaac Bogoch, an infectious diseases physician at Toronto General Hospital and member of Ontario's COVID-19 vaccine task force.
"We can all look at the same data and come to different conclusions. I definitely think there will be a day where the mask mandate can and should be lifted — it's just not today."
Masks aren't 'perfect,' but 'powerful' public health tool
Part of the problem with mask mandates is that clear cut data on their effectiveness can be hard to find, with population level studies on masking facing challenges with capturing how different public health measures factor into controlling the spread of COVID-19.
Another challenge is that masking and capacity limits were introduced at about the same time in much of Canada, so it is difficult to distinguish the effect of one measure over another.
"One of the reasons I think that this topic is so divisive and we're seeing this kind of ragged exit from our mask policies is because the science is uncertain," Caulfield said.
"But now we're at a stage as we're moving out of COVID where the science doesn't really give us a bright line as to when 'OK, now we can stop.' The data is messy, the data is uncertain and still emerging and that creates the opportunity to politicize the message."
Caulfield said that while there's no doubt masks have been an "important public health tool," there has also been a "revisionist portrayal of masks" as ineffective at preventing the spread of COVID-19 — which is simply not true.
"They're not perfect at an individual or at a population level, but they certainly help a little bit in curbing transmission in indoor settings," said Bogoch.
Because the data can be hard to interpret, we don't have clear answers on when mandates should be lifted, he said.
"It's not that they do nothing, but we were also never going to mask our way out of this pandemic or mask our economy back."
Linsey Marr, an engineering professor at Virginia Tech who studies the airborne transmission of viruses, said that while she welcomes the decision to eventually lift mask mandates, she says we also need "on ramps" to potentially bring back their use if there are "future surges of the virus."
"There is a time and place for mask mandates because many different types of studies have shown that they work to reduce transmission," she said in an email to CBC News.
"I hope we can all agree that we need to take measures to avoid overwhelming hospitals, burdening health-care workers, and protecting the millions of people with reduced immunity and increased risk."
The U.S. Centers for Disease Control and Prevention released a report last month that found the consistent use of a high quality mask or respirator in indoor public settings was associated with a significant drop in the odds of testing positive for COVID-19.
Cloth masks were found to reduce the chance of testing positive by 56 per cent, surgical masks by 66 per cent and N95 or KN95 respirators by up to 83 per cent when compared with no mask use — although cause and effect are hard to pin down because the groups weren't randomized.
A recent modelling study published in the Journal of the Royal Society Interface that analyzed the reduced risk of exposure to pathogens found masks provide "excellent protection" and effectively reduce transmission even at short physical distances.
"The evidence is incontrovertible, despite what some people in political circles might say, that masking has a very high impact on diminished transmission," said Raywat Deonandan, a global health epidemiologist and associate professor at the University of Ottawa.
"It is a powerful, powerful tool, and the advantage of masking is that you can control it yourself … because at the end of the day, you always have that option."
'Huge cultural shift' on masking likely won't disappear
Regardless of when provinces and territories decide to lift mask mandates and leave the decision to mask up solely in the hands of Canadians, experts say it's unlikely that masks will disappear completely in Canada.
"There's been a huge cultural shift and a growing acceptance of mask wearing, especially during cold and flu season, regardless of mandates being lifted," Bogoch said.
"I think that we will see a lot more people wearing masks more frequently in the fall and winter months."
Caulfield said the implementation of masks in Canada has been an "incredibly successful" science communication and public health initiative — something Canadians likely won't forget about anytime soon after two years in the pandemic.
"We went from zero mask wearing to, depending on the jurisdiction, over 80 per cent and in some jurisdictions over 90 per cent — that's incredible," he said.
"You don't see that kind of behaviour change very often and I think that's often forgotten. And most Canadians by far supported these policies and really stepped up."