Science magazine had been trying for days to speak to the elusive George Gao, head of China’s Centre for Disease Control and Prevention.
When the magazine asked him if he could point to any mistakes that might explain why Western countries were struggling to flatten the coronavirus curve, he didn’t miss a beat.
“The big mistake in the U.S. and Europe, in my opinion, is that people aren’t wearing masks,” he said.
“You’ve got to wear a mask, because when you speak, there are always droplets coming out of your mouth. Many people have asymptomatic or pre-symptomatic infections. If they are wearing face masks, it can prevent droplets that carry the virus from escaping and infecting others.”
That advice is contradicted by the World Health Organization, the government of Canada and federal public health officials like Chief Public Health Officer Dr. Theresa Tam. On its webpage, the WHO says that “if you are healthy, you only need to wear a mask if you are taking care of a person with suspected [COVID-19] infection.”
“Putting a mask on an asymptomatic person is not beneficial, obviously, if you’re not infected,” Tam said Monday.
Only medical masks such as those labelled N95 are designed and fitted to filter out particles that carry the COVID-19 virus. Other masks, such as surgical masks, are looser fitting and made of material that may reduce concentrations of some aerosol particles.
A 2015 randomized clinical trial found that cloth masks, for example, did not block influenza and respiratory viruses and actually increased the rate of infections among health care workers, and even surgical masks blocked only slightly more than half of virus particles.
Asymptomatic spreaders
Dr. K.K. Cheng, director of the Institute of Applied Health Research at the University of Birmingham in the U.K., said that Tam’s advice makes a dangerous assumption — that an asymptomatic person is not a spreader.
“The important thing about this coronavirus is that some patients start to shed virus, and become infectious, even before they have symptoms,” he said.
“In public health, a principle is we try to limit the source of harmful exposures rather than do mitigation, if we can. Hand-washing is a form of mitigation.
“I’m not suggesting in the least that people should stop washing hands. It’s very important. But if you’re out in public in a supermarket, or in a subway train or on the bus, I think it makes a lot of sense for everyone to wear a mask.”
While officials in the West caution that the explanations for Asian countries’ greater success in controlling the pandemic are complex, officials from the countries themselves — such as Gao and Cheng as well as some South Korean specialists — often point to masks.
Now some European governments are choosing to follow pro-mask policies.
A man wearing a protective mask measures the body temperatures of Austrian soldiers entering the foreign ministry in Vienna. Austria has started requiring masks in some public places, such as supermarkets. (Ronald Zak/The Associated Press)
Austria on Monday banned members of the public from entering a supermarket without one. Austrian Chancellor Sebastian Kurz said that is only the first step toward wider adoption of masks.
Next door, the Czech Republic requires everyone to wear a mask in public. The country has experienced a lower-than-average spread of COVID-19.
The Centers for Disease Control and Prevention in the U.S. is also reportedly considering whether it should revise its guidance on masks, according to the Washington Post. It, too, recommends that only those with symptoms and those caring for them wear masks.
Masks or elbows
Of course, the fact that many countries where mask use is widespread have been more successful at flattening the curve does not necessarily mean that the masks themselves account for the difference. Most experts would point to a mix of factors, including more aggressive testing and tracing of infections and tight controls on movement of the population.
But Cheng said much of the opposition to masks arises because officials in Europe and North America “have never really grasped the point that wearing masks is not primarily to protect the wearer. The original motivation is to protect others.”
“In a severe pandemic, the main objective of any public health intervention is to limit the source of infection, things that are coming out of our respiratory tract,” he told CBC News.
For Cheng, the concern expressed by some public health officials — that people will end up wearing masks that aren’t up to the highest standards — is a red herring.
He said any mouth and nose covering is superior to telling people to cough into their elbows, as the government of Canada does now.
“I just don’t understand that. Really, it’s a simple mechanical thing,” Cheng said. “If people wear masks as a self-protective measure and want to protect themselves from others, then I think you really need a hi-spec mask, and no one has got an oversupply of those.
“But we don’t really need that if everyone practices this.”
The most sophisticated masks must be saved for the health care workers who face the greatest exposure.
Dr. Elaine Shuo Feng is part of an Oxford University team that studied different countries’ approaches to masks. She agrees that health workers must get priority.
“But I don’t think this is a good reason … to tell the public that a face mask is not effective and to work on the supply issue,” she told CBC News. “I think there are a lot of things that you need to do.”
False sense of confidence
Canadian officials have cited the risk that people won’t use masks properly and could expose themselves to greater danger as a result as one of the reasons not to recommend mask wearing for the general public.
“What we worry about is actually the potential negative aspects of wearing masks where people are not protecting their eyes, or you know, other aspects of where a virus could enter your body,” said Tam.
“And that gives you a false sense of confidence, but also, it increases the touching of your face. If you think about it, if you’ve got a mask around your face, sometimes you can’t help it, because you’re just touching parts of your face.”
Cheng said masks, in fact, inhibit contact between the hand and the mouth, and people can be taught to wash their hands after touching them.
“Very few people before this pandemic knew how to wash their hands properly,” he said. “But you don’t go about telling people there’s no point in washing your hands. You show them a video showing them how to wash their hands.
“It’s not a logical argument, really. It’s not beyond the realm of most people’s IQ to learn how to wear a mask properly.”
The WHO’s guidance on the use of medical masks makes clear that their use alone is insufficient to prevent the spread of COVID-19 without proper hand-washing and other measures to protect against human to human transmission.
Not everyone can self-isolate
Cheng agrees that people with symptoms should not be going out at all. But he said it’s wrong to base advice on the assumption that everyone can self-isolate.
“During this phase when we’re locked down, unfortunately, there are still heroes of our society who’ve got to go to work to keep the country going. Health care workers, bus drivers, supermarket workers,” he said.
A woman wearing a face mask selects whole fish at a supermarket in Kuala Lumpur, Malaysia. Some infectious disease experts in Asia say masks were a key part of slowing down the spread of the novel coronavirus disease. (Vincent Thian/The Associated Press)
Cheng said he doesn’t agree with arguments about creating a false sense of security.
“People have raised the hypothesis that if you ask people to wear a mask, they’ll feel invincible, and then they won’t bother with handwashing, for example,” he said.
“There’s absolutely no evidence that this is the case. I would argue it’s the opposite — that this would heighten one’s sense of caution and hygiene, and it would stop people from touching the mouth.”
Shuo Feng stressed that she does not recommend using self-made masks, which do not block the virus.
“I think people better stay at home if they could, stay as much as possible and do the best of social distancing,” she said.
“However, there could be situations that people cannot avoid the crowded areas, and in that case, if they cannot get a surgical mask, then having a self-made mask might be better than not wearing a face mask … it might not be as effective as a surgical mask, but at least it provides some protection.”
Open to change?
In her remarks Monday, Tam did seem to suggest that the government was open to reconsidering its advice.
“We are continuing to evaluate. Of course, we can be flexible if we find any new evidence.”
The Centers for Disease Control in the U.S. denied this weekend that it was about to reverse its advice on masks.
But cracks are appearing in the North American public health establishment. Dr. Scott Gottlieb, a former commissioner of the Food and Drug Administration, said the Centers for Disease Control “should be putting out guidelines … on how you can develop a mask on your own.”
The WHO has advised against the use of cotton or gauze masks in any circumstance. Even for medical masks, the WHO provides strict advice on the correct disposal of used masks and recommends against the re-use of single-use masks.
But Cheng said the wider use of masks can be part of the eventual unlocking of society.
“Maybe two months from now, if we’re lucky, we may emerge from this, and we have to think about how we reopen the economy,” he said.
“We have to reduce social distancing.
“I think everyone wearing a mask for a period of time to be determined would actually help us to get back to normality. People would still have to practise social distancing but without all the schools being closed and so on.”
Shuo Feng said there’s no single approach that will beat the virus, but “now is the right time to talk about face masks and to reconsider the recommendation of face masks to the general population.”
Watch: The National: Clearing up the confusion around whether masks protect against COVID-19
While public health officials tell Canadians not to wear masks unless they’re sick, other countries take a different approach, leading to confusion for some. 2:05
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.
