ÉDITORIAL

Masks and Future Waves of the Pandemic

There has been much confusion about masks over the two years of the pandemic.  After initially saying that masks were likely to be ineffective due to improper use, our governments promptly switched to saying that any mask would help reduce transmission, even simple fabric.  There was very little messaging in terms of how best to use a mask, such as keeping it clean and disinfecting your hands before putting it on or taking it off.  Later, people were advised to switch to surgical masks, as cloth masks were no longer considered sufficient. 

Still, there was no widespread messaging campaign to encourage the use of N95 masks, which are often considered more efficient than simple surgical varieties.  Looking over expert recommendations we see some reputable sources saying that surgical masks offer similar protection as N95s, yet many others say that N95 masks are substantially better.  Moreover, options for high quality masks are plentiful.  A company in Quebec is even producing washable non-disposable cloth masks with innovative designs that they’ve shown to be as effective as N95s in filtering viral particles.

Frustratingly, there is little research on the effectiveness of mask mandates.  Since most provinces and countries took a similar approach to masking, it’s hard to tell exactly how beneficial our mask mandates were, as we have few cases with which to compare.  Sweden was an exception, although many Swedes still chose to wear masks even without mandates.  However, Sweden also didn’t impose lockdowns, so the specific impacts of mask mandates are difficult to ascertain.  Still, we do know that Sweden’s society, demographics and culture compare well with Quebec.  Both have substantial rural populations but also a few bigger cities, and significant immigrant communities that are more likely to have multi-generational households.  When seniors, a group especially vulnerable to the virus, live with their grandchildren or household members working in public settings as immigrants often do, the odds of catching Covid increase as others bring it home.  Norway and Denmark have much smaller immigrant communities, are more rural, and had a stronger nursing home system that proved better prepared for the pandemic than the system shared by Sweden and Quebec.

Shockingly, despite its choice not to impose mask mandates and lockdowns, Sweden’s death rate from Covid was approximately the same as Quebec, at around 1625 per million people, compared to 1575 for Quebec and 840 for Ontario.  Certainly how deaths are counted could differ, but we certainly need to look at whether our approach here in Quebec was as effective as it could have been, and if not, how it can be improved for future surges in transmission.

In the past we’ve done little during lulls in Covid transmission to better prepare ourselves for future waves.  We were therefore in a very similar situation this past Christmas to that of the spring of 2020.  Proper preparation now may avoid more lockdowns and curfews next winter.  We need research to pinpoint the weaknesses in our previous mask mandates and other pandemic policies, and to optimize our Covid approach going forward.
Ian Barrett