Public health messaging over face masks changed again this week when the U.S.-based Centers for Disease Control and Prevention (CDC) updated its guidance to say face coverings can help protect the wearer as well as those around them.
The new guidance, which landed on the CDC website on Tuesday, cited recent studies suggesting multi-layer cloth masks can “reduce inhalation of … droplets by the wearer.” Previous guidance said masks were useful primarily in blocking the wearer’s droplets from reaching others.
The CDC’s update now matches recommendations from both Health Canada and the World Health Organization (WHO). The Public Health Agency of Canada (PHAC) said in an emailed statement on Wednesday that “wearing a mask can help protect the wearer and others.”
However, this message seems to have been muddled due to previous conflicting guidance, which has mostly emphasized masks as a way to protect those around you.
Canadian health experts are also divided on whether the updated CDC guidance is helpful – some hope it can convince reluctant people to start wearing face masks, while others worry the message may be misinterpreted.
Dr. Amy Tan, a clinical assistant professor at the University of Calgary and member of the physician group Masks4Canada, says the “evidence has been there since August” to show that cloth masks, provided they fit well and are made of three layers with a polypropylene filter, do protect the wearer.
And if that can persuade people to wear one, so be it.
“If the small inconvenience of wearing your mask isn’t enough to appeal to the collective good, then now we can say: ‘it can protect you too, so wear it,”’ Tan said.
Colin Furness, an assistant professor at the University of Toronto’s School of Public Health, isn’t convinced the updated guidelines are accurate.
While he isn’t ruling out the possibility that cloth face masks might help protect those wearing them, he says people need to remember the caveats – three layers plus a good fit – to that claim.
“If (the CDC) is trying to appeal to peoples’ sense of self-preservation by saying: ‘masks could protect the wearer, therefore you should wear a mask,’ that could be a way to motivate people.
“But on the other hand, I don’t endorse that because it could make people think ‘OK, I can put on a mask and it’s substitutable for physical distancing.”’
The CDC update is the latest in what’s been an evolving policy on mask-wearing over the last eight months.
Face masks were discouraged by many public health officials in Canada back in March, with some saying a home-made covering could actually lead to further spread if it meant constantly touching the face to make adjustments. The discourse then shifted to say masks were useful in protecting others, but not ourselves.
Tan says changes in guidance show “science is working.” And advancements are made in all facets of medicine on a daily basis.
“We’ve never lived in a time where we had a global pandemic,” she said. “In eight months there’s been a lot more science generated…. We’re just seeing this happening publicly and in a very compressed time.”
PHAC also acknowledged that, saying “the government is continually reviewing new evidence and research” and that new evidence guides its recommendations.
Furness agrees that public health policy was expected to change as we learned more about the virus and how it’s transmitted.
He said every expert – himself included – could point to things they got wrong about COVID back in March, when a mask’s ability to “disrupt the ejection of droplets” wasn’t really taken into consideration.
“It was just a giant blind spot,” he said.
“I mean, think about our knowledge back then. Everyone was afraid and we didn’t know much.”
Dr. Christopher Labos, a Montreal-based physician, says COVID-19 was looked at in the same way as SARS or the flu in the early stages of the pandemic. With both of those viruses, people tend to be very symptomatic and infectious when showing symptoms.
“The original messaging was if you have no symptoms, there’s no point in wearing a mask because you’re probably not sick,” he said.
“But what’s changed is the growing realization that a lot of people have coronavirus and don’t know it. So guidelines shifted to suggest a universal masking policy, because you don’t know if you’re walking around with the virus.”
Labos also believes there may have been reluctance to promote face masks in the early stages of the pandemic out of fear people would confuse “the different mask categories, and what their roles are.”
N-95 respirators, worn by medical professionals in high-risk situations, offer “almost complete protection,” because of their tight seal around the face. But a surgical mask or home-made cloth face covering won’t protect the wearer to that degree.
“It probably does protect you a little bit … but in terms of quantifying it, in terms of saying it with any degree of certainty, that becomes a lot more complicated,” Labos said.
The experts say it’s important to remember that mask-wearing should be viewed as just one component of the public health strategy.
“A mask doesn’t prevent infection, but it drastically reduces the chance of infection,” Labos said. “And that certainly helps.”
This report by The Canadian Press was first published Nov. 12, 2020.
COVID-19 case investigations continue to lag days behind case identification in Manitoba – CBC.ca
COVID-19 case investigations in Winnipeg are lagging days behind positive test results, contrary to the premier’s claim Manitoba has no more contact-tracing delays.
On Friday, Premier Brian Pallister said tracing delays are a thing of the past in this province.
“There’s zero backlogs on tracking and tracing right now in our province,” Pallister said during an interview that aired on Rosemary Barton Live on Sunday.
Backlogs, however, remain. CBC News has learned public health nurses in the Winnipeg health region started investigating COVID-19 cases on Monday that were identified as positive on Nov. 19 — a delay of four days — and are still working overtime to catch up on caseloads.
This four-day delay represents a vast improvement from October, when COVID-19 patients reported contact-tracing investigations lagging behind positive test results by as much as a week.
It nonetheless remains well behind the 24-hour timeframe epidemiologists have recommended for starting contact-tracing investigations in order to limit the spread of COVID-19.
“A twenty-four hour delay in getting a hold of somebody in a shelter, that’s a disaster,” said a public health nurse who CBC News is not identifying due to fears of repercussions.
WATCH | Manitoba Premier Brian Pallister insists his province’s restrictions are the most stringent in the country:
Delays are particularly important to avoid in Winnipeg, where people living in homeless shelters are disproportionately affected by the pandemic, the nurse said.
“When you get somebody on the phone that’s living on the street and you’re telling them they have COVID, it’s a lot different than calling somebody who’s living at home and have three people in their house.”
Darlene Jackson, president of the Manitoba Nurses Union, said the four-day lag reported by the public health nurse is in line with what she’s hearing from her members.
“We’re hearing that there is a lag — anywhere from a couple of days, to five days,” said Jackson, adding some public health nurses are required to work evenings and weekends in order to catch up on caseloads.
“We know that public health nurses are still working excessive amounts of overtime. They’re being mandated frequently. They’re working through weekends. They’re not allowed to go home until they finish contact tracing on cases. It’s been it’s been months like this, with no end in sight,” Jackson said.
“I just find it very frustrating. We’re already eight months into a pandemic and it just feels like we’re just trying to get caught up now.”
Dr. Brent Roussin, Manitoba’s chief provincial public health officer, made it clear on Monday the lag involves the time between the identification of a positive case in a laboratory and the handover of information about that case to public health.
“Almost all cases are reached within 24 hours of the report being reported to public health,” said Roussin, adding some case investigations do not begin until the next day after that.
Province adding contact tracers
Case investigations are one aspect of contact-tracing in Manitoba. The province employs an average of 170 people per day — public health nurses and contractors with the Canadian Red Cross — to conduct these investigations.
The province also pays for an average of 80 people a day to notify contacts of known COVID-19 cases. Statistics Canada has been enlisted for this task.
The third aspect of contact tracing involves follow-up calls to infected patients. These are conducted by 43 staff and volunteers at the COVID-19 Contact Centre, jointly run out of the Deer Lodge Centre by Shared Health and the Winnipeg Regional Health Authority.
On Monday, Health Minister Cameron Friesen promised to bolster these 203 positions with 143 more workers.
The public health nurse who spoke to CBC News said that won’t help unless the reinforcements have specialized training.
“We need people who have the knowledge and the education to do proper contact-case investigations. It’s more than just calling people and telling them they have COVID,” the nurse said.
“We’re doing health assessments and directing people where to go if their symptoms exacerbate. We’re dealing with people who are structurally disadvantaged, who don’t have home. I mean, those are things that public health nurses know, not somebody answering the phone at a call centre.”
Contact tracers not allowed to work from home
The Manitoba Nurses Union also chastised the Winnipeg Regional Health Authority for not allowing COVID-19 case investigators to work from home.
Public health nurses are being subjected to unnecessary risks at the office — while some are unable to work because they are sick, isolating or caring for children, the union said.
“I do not understand why public health nurses are not allowed to access their files that they need at home and to work from home,” Jackson said.
Roussin, who has urged all employers to allow employees to work remotely, encouraged the WRHA to consider doing the same.
“If you can make it feasible, if you can get the work done by being at home, then I would encourage all employers to to look at that,” he said.
Confusion remains in B.C. on who can gather in restaurants under COVID-19 restrictions – Global News
The B.C. Restaurant and Food Association says a new set of COVID-19 restrictions imposed by the provincial government has customers struggling to understand who they are allowed to dine with.
The association’s president Ian Tostenson says restaurants are trying to tell customers to use common sense and follow advice from provincial health officer Dr. Bonnie Henry, but he says that advice has been unclear.
“There is a lot of confusion as to who can dine out as a result of the last couple of weeks with Dr. Henry,” Tostenson said Monday.
“The spirit of what Dr. Henry is saying is eat with people you trust, eat with people in your bubble. But if you try to define that too much it gets too hard.”
The provincial orders issued last week require diners to only eat with someone from their own household. If someone is single, they can eat with one or two other people who make up their pandemic bubble.
For example, three friends who are also married cannot all eat together at a restaurant. Another common mistake is parents cannot take their adult child and spouse for a meal at a restaurant if they live in separate households.
“For these two weeks we’re saying stick with your household bubble, and for some people that may mean one or two people who they have close contact with their pandemic bubble,” Henry said Monday.
The biggest challenge to uphold the order is enforcement.
Restaurants are being told not to ask diners whether they are following the rules. Instead, Henry is asking diners to know the rules themselves.
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“It is not the restaurant’s responsibility to ask people who they live with, or where they are from,” Tostenson said.
“The more that we increase confusion and uncertainty in the marketplace the harder it is.”
There is growing concern from the province that British Columbians are trying to exploit loopholes in the order. The priority for the government is to crack down of social gatherings if that is in someone’s home or in a restaurant.
One thing enforcement can do is crack down on organized events in a restaurant like live music.
“There is a tendency to … see these like a speed limit and it says 80 (km/h), and maybe I can go 86. That’s not what these are,” Health Minister Adrian Dix said Monday.
“These are provincial health orders to help us stop the spread of a virus that is harming our loved ones in long-term care and causing great disruption in our society, and these are the things we’re doing together to stop that.”
© 2020 Global News, a division of Corus Entertainment Inc.
'We are on the verge of significant bankruptcies': Restaurants and pubs struggle under B.C.'s new restrictions – CTV News Vancouver
New measures introduced last Thursday by Dr. Bonnie Henry meant to curb the spread of COVID-19 by limiting social interactions appear to be having the desired effect, to the detriment of businesses.
At a news conference on Nov. 19, Henry ordered B.C. residents to limit social gatherings to their immediate household, or a small pandemic bubble for those living alone.
“This applies in our homes, vacation rentals and in the community and in public venues, including those with less than 50 people in controlled settings,” Henry said.
She made no specific mention of restaurants or pubs, and Ian Tostenson with the BC Restaurant and Foodservices Association said there has been confusion about who can dine out.
“We haven’t seen the latest health order, it hasn’t been written from last week, so as far as we’re concerned, we’re telling people go to a restaurant but go to a restaurant in the spirit of hanging with people you trust in a small bubble,” Tostenson said.
Tostenson estimates over the last 10 days, restaurants have lost about 30-40 per cent of their pandemic sales as those who were confused by the orders chose to stay home.
Henry’s order was an expansion of a previous regional order that only applied in B.C.’s Lower Mainland. During prior news conferences, Henry made clear that while dining out was encouraged, people should only do it with their households.
On Monday, Henry clarified again that she wants British Columbians to spend the next two weeks only socializing in person with others from their household, or a bubble of one or two designated people for those who live alone. That applies to going to restaurants.
The restrictions are also hitting bars and pubs hard. Jeff Guignard with the Alliance of Beverage Licensees estimated business dropped by 50 per cent of pandemic levels.
“So you have people who are down to 25 per cent of where they were in 2019 and that’s just not sustainable. We’re on the verge of significant bankruptcies right now,” he said.
Restrictions are scheduled tin place until Dec. 7.
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