Are medical masks better for everyone?
On Monday, students and teachers in Quebec high schools will trade in their fabric masks for medical ones — which raises the question, should the rest of us be doing the same?
Guidelines around mask-wearing have evolved in Quebec over the course of the COVID-19 pandemic, but have settled with fabric face-coverings being an acceptable barrier against the virus outside of settings like hospitals, some workplaces, and now, high schools.
“High school students have been asked to wear the procedural (medical) mask, which gives them better protection against the virus, in the current context of high community transmission,” said Quebec education ministry spokesperson Bryan St-louis.
Quebec announced it would provide students and teachers with two medical masks per day when it outlined the details of its back-to-school plan amid the latest lockdown.
St-louis said COVID-19 transmission levels are high among high school students and young adults in Quebec. The latest government data shows youth age 1019 account for 11.2 per cent of the province's COVID-19 cases, and people age between 20-29 account for 15.7 per cent.
“We wanted to standardize this personal protective equipment in high school, a place where young people can find themselves within two metres,” he said.
But cases are high among other age groups as well, so why aren't we all wearing medical masks?
“A medical mask, properly used, is definitely superior to a face covering,” said Dr. Stéphane Perron, a medical specialist at Quebec's national public health institute (INSPQ). “It was in all our documents that the mask is considered superior, that's very clear.”
Perron said he suspects the general public was never specifically told to opt for medical masks because of the shortage at the start of the pandemic.
“For a long, long time there were supply issues,” he said.
Dr. Matthew Oughton, an attending physician in the division of infectious diseases at the Jewish General Hospital, pointed out government websites — provincial, federal, and in the United States — still generally say people should be wearing non-medical masks.
“The reason to do it this way, to not have the public wear medical masks, is the concern about the necessity for health care workers, particularly those giving direct care to people who have confirmed COVID,” he said.
The difference between medical masks and face coverings is the former acts as a filter for both the wearer and anyone in their vicinity, whereas face coverings offer little protection to the wearer, their efficiency relying instead on a group effort. The Quebec government said as much when it implemented mandatory mask-wearing in July, asking Quebecers to protect each other.
However, Oughton said some studies may show evidence face coverings provide at least a bit of protection to the user.
“By no means is the science clear on this,” he said. “But there's one hint that people who wear face coverings, even if they got sick, tended to get somewhat less sick than people who didn't wear face coverings.”
“So the idea being, perhaps — and again, this is a maybe — people who wear face coverings are getting a lower amount of virus that they're being exposed to and further, that that lower amount tends to generate a less severe illness.”
If supply wasn't a concern and everyone wore medical masks, then there would be more protective benefits to the mask-wearer directly — but that just isn't the case, Oughton said.
“But you could always take these flights of fancy further — if supply wasn't an issue, then everyone would have a million dollars in their pocket and life would be great.”
Still, Quebecers who want to wear medical masks can often find them at pharmacies, and those who are at risk of developing complications from COVID -19 are advised to use them.
While masks and other protective measures have played a vital role in the fight against the novel coronavirus so far, they may have to be adjusted if the province begins to see the spread of a more transmissible variant. To date, only one case of the U.K. variant has been detected in the province, dating back to mid-december.
“It's sensible to say that if you have a variant that's more transmissible, then the same degree of preventive measures would be expected to have less effect on a more transmissible agent,” Oughton said.
On the flip side, Quebec's lockdown measures are the reason the province has seen such a low number of influenza cases this season when there normally would have been hundreds, Oughton said.
“The same measures that we are applying — the physical distancing, the non-medical mask wearing, the hand hygiene — all of those measures that are ... moderately effective for preventing transmission of SARS-COV-2 — are probably much more effective at preventing transmission of a less easily transmissible virus like influenza.”
The added measures Quebec should consider if more transmissible variants become common here are like those that were taken in places that have managed to reduce transmission rates, Oughton said.
“So, Australia is one example that's commonly used, New Zealand's another, here in Canada you look at what our Atlantic bubble has done relative to most of the rest of the provinces.”
Australia, for example, implemented a lockdown that spanned several months but, unlike the one in Quebec, virtually everything was closed other than hospitals and grocery stores, and people weren't allowed travelling between regions.
If Quebec were to do that, Oughton said, it would need to implement systems to support the population through the lockdown so people could actually afford to stay home.
“If you don't really get the virus under control, you end up where we are, we're now talking about enacting triage protocols in our intensive-care units across this province to decide who lives and dies,” he said.