Doc reconsiders mandatory masks
Karim Ali of Niagara Health says evidence for a bylaw is not strong
Niagara’s top infection control doctor is taking a step back from a petition he signed calling on provincial and federal authorities to impose mandatory masking laws to fight COVID-19, saying there isn’t strong enough evidence to support such a move.
Dr. Karim Ali, head of infectious disease at Niagara Health, had joined nearly 1,000 healthcare workers across Canada in signing an open letter by Masks4canada, calling for laws to make masking mandatory in a fashion similar to bicycle helmets and seatbelts.
However, after reviewing an article in the medical journal Lancet posted to Twitter Wednesday by Niagara’s acting medical officer of health, Ali said he sees the issue “through a different lens.”
“I completely agree with Dr. (Mustafa) Hirji on this point, that at this time it would be a weak recommendation. The evidence is not strong enough,” said Ali.
“We should encourage people to wear a mask. On a personal level, it is something I do. As a family, it is something we have decided to do. But the evidence is not strong enough for a mandatory order.”
The Masks4canada letter, signed by at least 11 Niagara health-care workers including Ali, says the signatories believe there is “sufficient evidence of the utility of masks for source control 2) equivocacy of evidence on recipient projection and 3) lack of evidence of harm from masks,” and if worn by enough people will reduce the spread of COVID-19.
The letter calls for masks to be worn in all outdoor spaces outside the home, on public transit and in crowds. It notes surveys show about 48 per cent of Canadians are wearing masks, but recent research shows in order to have a significant impact on the spread of the virus 60 to 80 per cent of people need to use them.
People with medical conditions that make wearing a mask harmful would be exempt, and the letter requested corrosive measures such as fines be limited in favour of public education campaigns. It also called on governments to issue masks to citizens.
Premier Doug Ford has ruled out a masking order for Ontario.
Ali, one of the key leaders at Niagara’s hospital system in combating the novel coronavirus, signed the letter on June 10, but has since been persuaded
by Hirji’s assessment of the data.
Hirji has said masks should be worn when physical distancing — the best tool to reduce the spread of the virus — is difficult, such as when shopping or in large crowds.
Hirji has declined to follow his Guelph counterpart in issuing an order requiring face coverings. On Wednesday, he took to Twitter to further explain why he won’t be issuing a masking order for Niagara.
In an interview, Hirji said while there is more evidence for the effectiveness of masks now than there was in March, it remains “weak.” The research the Masks4canada letter relies on is “observational science,” he said, which uses statistical analysis of infections rates versus masking use in other countries. There is no strong experimental science on the effectiveness of masks in public, he said.
Hirji, who regards masks as a “second line” of defence behind physical distancing, said even if he was inclined to issue an order, he has no useful means of enforcing it.
A medical officer of health can make an order under Section 22 of the Health Protection and Promotion Act. However, the act does not give a health department power to use bylaw officers to enforce the order. Rather, public health would have to take violators to court one at a time.
“So you would have to ask the court to impose a fine or penalty that you recommend,” said Hirji.
This is in part why Hirji said such an order is best made by municipal councils through a bylaw, because those governments can use bylaw officers for enforcement.
Hirji also said he does not believe a Section 22 order that would impact people’s freedoms and businesses is appropriate on an issue for which there remains legitimate scientific and medical debate.
Whereas he has to make decisions based entirely on scientific evidence, political bodies can weigh other concerns.
He also pointed out in most countries where masking was widespread, it was done without a mandatory masking order from government authorities.
“What they did was have a program where governmentissued masks were handed out once a week, and I think that is a policy approach we should discuss here,” Hirji said. “Alberta is going down this road right now, and using fast food locations as the distribution point. So you go and get your Mcdonald’s order and get a free mask from the government of Alberta.”
Hirji said that kind of approach would increase the use of masks without having to make a mandatory order with its problematic enforcement issues.