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I have given plenty of thought regarding what should be a non-controversy: masking. This thread prompted by posts from @drmwarner https://twitter.com/drmwarner/status/1276602530710147078?s=20, demonstrators outside Queen's Park on my way home from work yesterday, and a call from the always clear-thinking @BogochIsaac
I will start off my saying that there is no irrefutable evidence that cloth masking works to prevent spread of disease. Yes, some countries that have mandatory masking in public have done very well, but others have done well without masking.
A useful read on the topic--one that made her a huge target of scorn in the UK--is from one of my all-time evidence-based heroes, @trishgreenhalgh: https://onlinelibrary.wiley.com/doi/10.1111/jep.13415. A will add the important caveat that it was written when a country was (and still are) in crisis.
So I will accept that the evidence is imperfect. I will point out that the evidence of the benefit of hand hygiene and even fomite (surface-to-hand-to-disease) transmission of this disease is on equally shaky ground, and yet our whole society has responded to the concept of ...
... needing to avoid touching surfaces, and sanitizing our hands to a degree that has rendered cash contraband, caused substantial shortages of hand sanitizers, and resulted in even toxic sanitizer to be used unwittingly. https://bit.ly/3i8VYCB
What I said yesterday is that all levels of government have handled this so poorly. To wit: the Gov of Canada website https://bit.ly/2CPP59h tells people to do everything (distance, wash hands, etc.) but then "recommends" face masks. Isn't everything else a recommendation?
On the other hand, the Government of Ontario website--which is overall clearer on face coverings--says "Face coverings will not protect you from getting COVID-19. The best way to protect yourself is to ..."
The City of Toronto is much better in terms of clarity, bundling things all together:
But if anyone is confused about the value of face masks, you know why. So let's get to nudging behaviour and clarity of message. We'll start off with clarity: “Masks are one way of reducing the spread of COVID-19” This is as evidence-based as "washing hands is one way of ..."
Second, let's make it easy as easy as possible and normalize it. @BogochIsaac tweeted about this last week https://twitter.com/BogochIsaac/status/1275410850745106432?s=20. This helps people do the right thing. But people are rightfully stuck about "mandatory" and when and where to do so. There is a way forward ...
We are going to start off with the various things that can be used to change behaviour. My go-to model is the Behaviour Change Wheel by @SusanMichie https://bit.ly/3dGNj7h . There are different behavioural approaches, and all of these are necessary. Note the outer "levers".
So what to do about masking. Should we have mandatory masking today? In Timmins? What about Kingston (where there have been close to no cases throughout the pandemic, but now they have mandatory masking in place)? Can we do this in a way that makes sense? Yes. Follow me ...
People are used to making changes on the fly. We do it all the time. Most people check the weather on a daily basis to figure out how to dress and people with allergies check pollen levels.
Can we do this with something that is legislated or mandated? We already do. These are legislated. Yes, people can be fined, but that is not the purpose of the bans--which are legal acts supported by provincial legislation and enacted locally.
The purpose is to clearly explain--in a context-specific manner--what is acceptable and expected and, if necessary, enforceable. We don't need masks for all everywhere right now: that makes no sense. But there are several places where we do need masks ...
... and those are in congregate indoor settings or crowded outdoor settings in locales where there is substantial ongoing transmission. Let the local Medical Officer of Health decide what the protection level is ... support it with free masks, clear communication, and legislation
So am I for #Masks4All? Yes and no. When and where appropriate--as dictated by epidemiology and the social context--everyone should be mandated to wear a mask. But alone in my backyard or going for bike ride? No. In a store in PEI? No. Let's get this right.
