Mandating, not just recommending, the use of non-medical masks will help convince more Canadians to wear them as the economy reopens, just as wearing seatbelts is now the norm, some social scientists and physicians say.
In Canada’s largest city, wearing non-medical masks is now mandatory for people riding with the Toronto Transit Commission, with certain exemptions, to prevent the spread of the novel coronavirus. A bylaw extending the rule to indoor public spaces goes into effect on July 7. Similarly, mayors in Peel Region, which includes Mississauga and Brampton, west of Toronto, and York Region to the north also plan to introduce such bylaws.
In Quebec, Premier François Legault announced that public transit users in the province will be required to wear masks starting on July 13.
Governments are passing laws that require the wearing of masks, but they’re difficult to enforce. That’s why behavioural scientists say it’s so important for the public to get on board with many health authorities who now consider face coverings a necessity.
Kim Lavoie, a professor of psychology in behavioural medicine at the University of Quebec at Montreal, is among the experts calling for governments in Canada to consult social scientists on preventive measures like wearing masks as lockdowns lift in the absence of vaccines or effective treatments for COVID-19.
“Wearing a mask is something we control. Washing our hands, staying home, skipping that party are all things we control,” Lavoie said.
“People forget that the virus isn’t more powerful than our collective will to get rid of it, and there are things we can do. But right now, they’re behavioural.”
Many aspects of the pandemic are beyond our control. Wearing a mask isn’t one of them, experts say. (Evan Mitsui/CBC)
Dr. David Fisman, an epidemiologist at the University of Toronto’s Dalla Lana School of Public Health, said masks could help more people get back to business and “regular life.”
“We think it’s sort of low-hanging fruit and a no-brainer,” Fisman said.
“Me wearing a mask protects you. If I have COVID, you wearing a mask also protects you from breathing in my virus,” Fisman said.
While Fisman called Canada “a country of rule followers,” there are people who oppose mandating masks, saying it impinges on individual rights and freedoms.
But with COVID-19, one person’s behaviour affects the next person — the basis for secondhand smoke laws.
“It’s no more [an infringement] than asking you to wear a seatbelt,” Lavoie said. “You’re not free to drink yourself under the table and then get behind the wheel. If you don’t have a PCR test at your house to test yourself negative, then you have to consider the possibility that you might be infected and not know it and be putting us all at risk.”
Protecting yourself a major motivator
Lavoie is one of the researchers behind a large study called iCARE (International assessment of COVID-19-related attitudes, concerns, responses and impacts). Together with collaborators from Johns Hopkins University’s project on cases and Oxford’s policy tracker, they’re regularly surveying Canadians and people around the world on how they feel about and adhere to policies.
The goal of the research is to disentangle what motivates people of different ages and socioeconomic backgrounds to change their behaviour to inform health-care policy and messaging.
Awareness, motivation and confidence are important to changing behaviour, says Kim Lavoie, a professor of psychology in behavioural medicine at the University of Quebec at Montreal. (Submitted by Kim Lavoie)
Based on 50,000 responses since the end of March, Lavoie said the findings to this point suggest that concern about getting infected with the virus is a major motivator.
“One thing people don’t realize is how contagious it is,” she said.
Most people recover at home, but people of all ages have also been severely sickened, some for months, says the Public Health Agency of Canada. Patients say long-term symptoms and consequences such as heart damage are coming to the fore.
An urgent need
While making mask wearing the norm would help prevent transmission, Fisman said mixed messaging and “dithering” by Ontario’s government have hindered mask use from becoming commonplace.
“Once the signal comes from our public health leaders that this is the expectation and this is how we’re going to move forward, I think people will fall in line pretty fast,” he said.
A woman wears a protective face mask as she waits to enter a bank in downtown Vancouver on June 2. (Jonathan Hayward/The Canadian Press)
Wearing masks could be considered a behaviour that needs to be adopted urgently and collectively, Lavoie said.
She pointed to how behavioural change boils down to three factors:
Awareness of the need to wear masks.
Motivation, such as protecting yourself, loved ones or neighbours who may be vulnerable to serious complications.
Confidence in the ability to execute the behaviour.
Cost can be a barrier. That’s why Alberta’s government is distributing 20 million non-medical masks at drive-thru restaurants.
Shift from self-consciousness to the norm
Mitsutoshi Horii, a professor of sociology at Chaucer College in Canterbury, England, studied the uptake of masks in Japan during the 1918 flu pandemic. The practice continues in Japan during flu and hay fever season, as well as during COVID-19.
Horii said when the 1918 flu pandemic hit, the Japanese government prohibited traditional folk rituals around health as part of its efforts to promote modernization and to avoid colonization.
“Then the mask came in and that gave people a sense of direction. When you’re facing uncertainty, you want to do something. By doing something, we establish a sense of control,” he said.
WATCH | Canada’s patchwork of mask measures:
Federal government and health officials are reluctant to make wearing a mask mandatory in Canada, citing a focus on education and issues with enforcement. 1:58
Horii contrasts that with his experience in the U.K. now, where wearing masks is not common.
“Personally, I still feel embarrassed to wear a mask” in the U.K., Horii said, even though they’re now compulsory on public transit in England and will soon be required in stores in Scotland.
He said he thinks changing the rules would encourage him and others to overcome self-consciousness.
“At the same time, I bought some masks and we’re ready to wear [them] at any time. We just need a bit of a push to do it.”
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
