Canadian leaders botched mandatory masking. Here’s how to fix it.

Amir Attaran: The excuses against mandatory masking are so bad they qualify as comedy. It’s not too late for a national mask plan to prevent a second wave.

Masks hang on the door of a shop in Toronto on June 6, 2020 (CP/Frank Gunn)

Masks hang on the door of a shop in Toronto on June 6, 2020 (CP/Frank Gunn)

Of all the strange things to happen in Canada since COVID-19, the strangest is the question about whether wearing masks around others in public places should be mandatory. As cities finally get on board with this idea, vocal skeptics are trying to stop it taking hold.

But remarkably not one of the arguments against mandatory masking stands up to scientific or legal scrutiny—which makes me wonder, where does the rancorous debate and misinformation about masks come from?

Our leaders, sadly. Prominent newspapers, officials, politicians and legal experts who know better—or who at least could study the question before speaking—have fed the public excuses so breathtakingly ignorant that they qualify as comedy. Since masks save lives, and everyone needs a chuckle six months into this pandemic, I write this article both to set the record straight and to give certain of our misinformed leaders the derision they have so heartily earned for their decisions to date.

‘Masks don’t work’ —the Montreal Gazette

I do not doubt that masks are ugly, socially awkward, uncomfortable, steam up your glasses and make your skin break out—but it cannot be said that they don’t work. Back in March 2020, I wrote in Maclean’s that Canadians should wear masks—something that many, including the Montreal Gazette, Quebec’s public health director, and Canada’s Chief Public Health Officer, Dr. Theresa Tam, vocally, dogmatically, and without evidence opposed as wrong.  

What a mistake. It has since become apparent that wiser countries which embraced and adopted masks sooner have had fewer deaths

Look at Hong Kong. It has a similar population as Quebec, but while Quebec is spacious, Hong Kong is just 0.07 per cent the size, so people live cheek-by-jowl. The crowded conditions make social distancing almost impossible and are perfect for transmitting the coronavirus. The epidemic also got a month’s head start in Hong Kong because it neighbours China, where COVID-19 began, and it had excellent opportunities to spread with Hong Kong’s massive street protests of the last months. Hong Kong’s population is also older than Quebec’s, and more prone to dying.  

Taking all this together, surely you would expect Hong Kong to be slammed, and Quebec to be spared. But that is wrong. While Quebec has suffered 5,600 deaths, most of them within a stone’s throw of the Montreal Gazette offices, Hong Kong has had just eight—a mortality gap of 700-fold.

Of all the possible reasons for this difference, none is clearer than masks. Hong Kongers rushed out to buy masks as soon as COVID-19 emerged in January, and fully 99 per cent of them masked up within three weeks of the epidemic’s start. They have kept up defences even as cases receded. Lately Hong Kong’s government is giving out free masks, including possibly the world’s most advanced—a six-layer, copper-infused, washable, reusable cloth wonder whose filtration performance exceeds the scarce, throwaway N95 respirators that Canada never has enough of. Pretty impressive, given Hong Kong’s other troubles right now.  

No doubt widespread mask use makes sense in Canada too. Nobody can “prove” so because Canada has not tried yet, but convincing mathematical estimates show that if 90 per cent of people wore mid-quality (70 per cent protective) masks, that can send disease transmission crashing down six-fold to well below the threshold of an ongoing epidemic. Add that on top of the social distancing we are already practicing, and the benefit is even greater.  

In short, masks do work, in Hong Kong or in the math, regardless of what mistaken officials and newspapers once said to the contrary. 

‘Wearing non-medical masks has always been [about] protecting others if you’re infected; it’s always you protecting others’ —Dr. Theresa Tam

If one made a mission of souring the already unappealing notion of wearing a mask, possibly the greatest sabotage would be to misinform Canadians that masks can’t protect the wearer but only those crossing the wearer’s path. “Wear a mask, make yourself ugly, and you might still get sick!” is nobody’s idea of a great pitch.

But this is precisely Tam’s latest misinformation, despite evidence from over a century’s medical practice proving that masks work in both directions.

Masks work because they are barriers, punctured by microscopic pores that let air pass, but not small droplets (which definitely transmit virus) or smaller aerosols (which might). In the operating room, the staff wears masks to block their germs infecting the cut-open patient on the table. In the infectious disease ward, the staff wears masks to block the coughing patient’s germs infecting them. Both directions. Doubting it is comparably silly as wondering whether another infection barrier, condoms, protect sexual partners in one direction but not the other.  

Which makes it so strange that Tam gave contradictory advice, more than once. Remember that she only came to the wrong advice that masks work in a single direction after backpedalling on her even-more-wrong claim that the public need not use and could be harmed by masks. Her commitment to wrongness is so thorough that she turned a hat trick of it, by claiming that “very recent studies” drove her change of view.   

That is doubtful. Tam has never said which “very recent studies” affected her, nor does it appear scientists published any landmark study at the time. On the contrary, about 30 studies of masking already existed, which scientists in The Lancet later mashed together to demonstrate that masks of various kinds reduce the risk of transmitting respiratory viruses by a whopping 85 per cent—with no evidence that they work in only one direction.  

Regrettably it seems that being wrong and getting caught has left an indelible impression on Tam. With her in charge the Public Health Agency of Canada has hardly tried to teach Canadians how to wear masks—a fact lamentably proved by legions of bare noses and ill-wrapped hipster beards. Instead of equipping citizens with high-tech cloth masks like Hong Kong has, PHAC still recommends that Canadians make primitive masks out of chopped-up T-shirts.  If you have old Megadeth, Slayer, or Death Cab for Cutie T-shirts hanging around from your rock ‘n’roll days, those would suit PHAC perfectly.  

We don’t want to force anyone to do anything.’ —Doug Ford

How and when society ought to meddle in one’s freedom is an ancient and banal discussion in public health—seatbelts, motorcycle helmets, smoke alarms, water fluoridation and salt iodization are some examples. It will resurface several times before the pandemic is over—mandatory COVID-19 vaccination, anyone?  Masks are just a warm-up.

But governments meddle for far less. Where I live in Ottawa, the city government has made it law that my outdoor furniture must be “kept in a clean, neat and tidy condition”—or else I will be fined a minimum of $500, and up to $100,000. Our cultural attachment to lawn-and-order forces me to fire up the mower each time my grass is “out of character with the surrounding environment”. All across Canada there are laws about the mowing of lawns, the behaviour of fortune tellers and, thank goodness, the scooping of dog poop.  

When society sees fit to impose these rather trivial mandates on Canadians, it becomes impossible to argue that forcing them to wear masks against a fatal disease is, somehow, an unprecedented excess of government power. Government forces us to wear clothes, for goodness sake!  Surely it can force us to wear masks too.

Yet Doug Ford quivers like jelly over that issue, even though Ontario daily leads the country in new COVID-19 cases. Oddly he wasn’t such a wimp last year, when he forced gas station owners to display government propaganda denouncing the carbon tax or pay fines up to $10,000.  When the gas pump owners objected, Ford personally pledged to enforce the law.  

But come to saving Canadian lives, instead of the profits of Big Oil, and Ford demurs. Why? “We just don’t have the manpower for bylaw and police officers to be chasing people without masks”, he parries. Right, they’re already busy staking out the gas pumps.

Here Come the Kens and Karens!

So what is the real reason for Ford’s inaction? Nothing but the ear-splitting wailing of those Canadians who antisocially refuse to wear a mask.  You’ve seen their videos “go viral”, so to speak. Handling these erupting souls is at once a political, legal and psychological challenge.

Politically, Ford is not alone in his wet timidity. Canada’s Health Minister, Patty Hajdu, is probably worse, because she is actively undermining PHAC’s advice to wear masks. Just this week Hajdu cautioned against making masks mandatory lest it “cause increased sources of tension for people”. Who knew that an epidemic of tension, and not COVID-19, was the Minister’s priority?

Even worse, the noisy Kens and Karens are getting help from the lawyers of the Canadian Civil Liberties Association, which argues that under the Constitution mandatory masks are an “unreasonable and unjustified detriment [to] our freedoms”. This is low-octane hooey: the Constitution protects the right to life, not the freedom to destroy it, which is why the Supreme Court says “epidemics” are a rare exception to individual liberty, and unanimously approves of law enforcement that diminishes a “realistic possibility of [disease] transmission”.  

Unfortunately when our political and legal “leaders” abdicate, it falls to ordinary Canadians how to respond when someone refuses to wear a mask. Psychologically, how to manage it?

Be understanding. Some people truly cannot wear masks: little kids and the seriously mentally disabled, obviously, and anyone with a medical condition that makes normal, unmasked breathing difficult. But those conditions are rare. If a person can breathe normally, despite an asthma diagnosis, lung transplant, or whatever else, he or she can wear a mask.  

When the situation arises, there is nothing wrong with politely asking, “Excuse me please, why are you not wearing a mask?” And if the answer is a calm, reasonable refusal, say thank you. But if the person gets agitated or yells back, clearly that person’s breathing is just fine, and it is time to call the authorities to deliver an attitude adjustment.

Mask Up, Wave Down

Currently Canadians are enjoying the calm before the storm of a probable second wave in the fall. Let’s use the time to become Hong Kong.  Granted that it is 8,800 Canadian funerals too late for that, but we can still do more to mask, shelter ourselves, and stanch our losses.

Except we’re not really trying. In the Greater Toronto Area, which habitually registers more COVID-19 cases each week than Hong Kong has all year, masks are only now becoming mandatory—sort of. You must wear a mask on Toronto’s subway, but not its commuter trains, at the same train station. In Montreal, masks are mandatory only in a single neighbourhood of a few city blocks, and barely half Quebecers say they are willing to wear a mask though it will be mandatory imminently. Both places are also tinkering with dangerously premature openings of risky venues like indoor restaurants and bars. 

We so badly need to be better than this.

With all due respect to my fellow Canadians salivating for their indoor beer and chicken wings: stop behaving like snot-nosed scamps thinking you can have it all.  Either we behave wisely now—which means maintaining our current defences and making masks mandatory indoors—or we will pay a dreadful price later: in a second wave of strident disease, death and danger to our children when schools reopen. Choose schools before bars, okay?

And to Hajdu and Tam: where is Canada’s mask plan? Early in the pandemic, you blew it when there were too few masks for our health care workers. Months later, you are again blowing it as ordinary Canadians scrounge for old T-shirts or whatever scientifically untested, ill-fitting, dubiously effective mask they can sew or buy (save in Alberta, where disposable masks are free). You are leaving to Etsy what should be a job of government, and it is pathetic.  

Here is what you should do.

Put a free, washable, reusable, very highly efficient cloth mask into the hands of every Canadian. Probably Hong Kong would share its invention, or the National Research Council could devise its own using the best science. Fabric, elastic, and thread are available, and Canada has plenty of factories and tailors to do the sewing. Assuming that manufacturing and distribution costs $10 per person, the total comes to $370 million—or just seven hours’ worth of Canada’s current economic life-support for something able to chop new infections six-fold.  

Make it a national project with pride. Hire Canadian designers to make dozens of pretty, characterful, multicultural looks (with the obligatory maple leaf). Hire Canadian actors to make funny advertisements about how to wear masks.

Let our artists and scientists conjure a new symbol of Canadian identity built around the noblest of ideals—our survival.

Decades from now, when elderly women and men gather—because you saved them from dying—they will laugh about those ads, and reminisce about which design they chose for their mask.

And if you cannot do that, please resign, and make way for someone who can.