By Vanessa Acheson
Universal masking of those above the age of 2 yrs old in indoor spaces is a never before attempted public health policy impacting millions across the province of Ontario.
Despite that non medical mask use among the general public has historically been highly discouraged by leading health authorities due to compelling evidence of their lack of effectiveness and the risk they pose to the public health (Appendix 1). This strongly suggests that not only is significant scientific scrutiny warranted, but so is risk management and ongoing risk monitoring and reporting of unintended consequences. As such, we need systematic measures in place to report, analyze and document these risks as well as an evaluation plan to show beneficial outcomes. Only then can we have the evidence we need to determine if this controversial policy serves the public health.
Scientific Scrutiny ?
Decades of high grades of evidence that found masks are of limited/nil benefit to control disease transmission in the community, with several indicating increased risk, have been overlooked. Rather, inadequate policy level evidence is used. The New England Journal of Medicine admits masks are “talismans” and their purpose is to reduce the transmission of anxiety rather than disease control. Even political lobbying has been admitted as grounds of support. To date, suggestions that mask mandates have had a positive impact, and studies claiming success show serious flaws. (Appendix 2)
In relation to the CDC’s recommendation for cloth masks, Dr. Michael Osterholm, Director of the Center of Infectious Disease and Research Policy stated: “Never before in my 45-year career have I seen such a far-reaching public recommendation issued by any governmental agency without a single source of data or information to support it.” The WHO adds “At the present time, the widespread use of masks by healthy people in the community setting is not yet supported by high quality or direct scientific evidence and there are potential benefits and harms to consider.” There are also serious gaps in evidence regarding the realities of asymptomatic viral shed. As well, the limited capabilities of a cloth mask, with particle penetration of almost 97% is glaring. Particularly considering the pore size of cloth face coverings range from ~ 20-100 microns while the SARS-COV2 virus is 200-1000x smaller than that, at 0.1 microns.
Did a Risk Assessment Team Uphold Their Obligations ?
Regardless, health officials claim they have a green light to impose mandates by citing the precautionary principle. This is despite warnings of experts who stress that for a policy of this magnitude ”It is necessary to quantify the complex interactions that may well be operating between positive and negative effects of wearing surgical masks at the population level. It is not time to act without evidence.” However, when using the precautionary principle, health policy experts confirm that, in situations where evidence is lacking: “Monitoring and evaluation are important considerations for these types of decisions.”
Risks and Inequities
By narrowly defining the issues associated with universal masking, health officials and schools boards have neglected to consider the scope of unintended consequences. Including numerous factors and social determinants that could increase risk and pose inequalities to certain populations. All the while, public health officials continue to overpromote masking as a gesture of good citizenry.This has stoked a divisive environment in our communities towards those who cannot mask or to those who seek accommodations granted under the law. Placing them at high risk of associated harms from discrimination, isolation and even violence towards them as well as employees ordered to enforce masking.
Considering Ontario’s diverse populations and variations of public settings, a one size fits all mask mandate constructed without transparent ,meaningful risk assessment and ongoing risk monitoring/reporting and evaluation fails our citizens. Vancouver Regional Health Officer Dr. Patricia Daly and Dr. Mark Lysyshyn state: “In the hierarchy of measures to prevent COVID transmission, non-medical mask wearing is one of the lowest, and should not replace more effective measures.” They go on to suggest numerous more reliable and risk free infection control measures. Ontario health officials however, continue to over promote masks benefits and give blanket assurances of their safety. This is harmful. Particularly considering the WHO warns that masks carry “critical risks and uncertainties” and list numerous risks in their June 2020 guideline (appendix 3). As such, we need to demand Ontario health officials uphold competencies and standards expected of them to ensure we are protected against the threat of a potentially ineffective and/or counterproductive policy at this critical time.
Appendix 1 Health Authorities Confirm Mask Risks:
Throughout the height of this, and past pandemics and prior influenza epidemics, leading health officials stated numerous dangers associated with public mask use including:
Dr. Teresa Tam, Canada’s Chief officer of Health confirmed this: “ Even in a hospital setting, we find that it’s removing personal protective equipment that can actually lead to infections.”
“If not used properly, masks may lead to a greater risk of pandemic influenza transmission because of contamination.” Public Health Association of Canada
Dr. Jenny Harries, Englands’ deputy chief medical officer, told BBC News:
“ What tends to happen is people will have one mask. They won’t wear it all the time, they will take it off when they get home, they will put it down on a surface they haven’t cleaned. “Or they will be out and they haven’t washed their hands, they will have a cup of coffee somewhere, they half hook it off, they wipe something over it.
“ In fact, you can actually trap the virus in the mask and start breathing it in. ”
Asked if people are putting themselves more at risk by wearing masks, Dr Harries added: “ Because of these behavioral issues, people can adversely put themselves at more risk than less.”
Dr. Adams, The Surgeon General in the USA said “Folks who don’t know how to wear them properly tend to touch their faces a lot and actually can increase the spread of coronavirus”
Dr. Mike Ryan, executive director of the WHO health emergencies program:
“There is no specific evidence to suggest that the wearing of masks by the mass population has any potential benefit. In fact, there’s some evidence to suggest the opposite in the misuse of wearing a mask properly or fitting it properly”
Numerous health authorities including Ontario experts Dr David Williams and Dr Barbara Yaffe who stated that universal masking was of no benefit and confirmed associated risks of the public wearing masks.
Dr. Fauci was emphatic that masks were not necessary and that they posed a risk. Now he says he originally discouraged mask use because he did not want to reduce supplies of medical masks for healthcare workers. If true, this suggests he purposefully deceived the public and/or brings into question why he did not recommend cloth masks vs. medical masks earlier.
Canadian infectious disease expert, Dr. Karim Ali, head of infectious disease at Niagara Health has recently withdrawn his support of the Canadian #Masks4Canada. He now agrees with his local officer of health Dr. Hirji who will not impose an order for the Niagara region after determining the evidence is not strong enough for a mandatory order.
Appendix 2 : Where is Proof of Beneficial Outcomes?
Appendix 3 : Did Universal Mask Risk Assessment Consider Numerous Risks Including Those Stated in WHO’s June 2020 guideline That Include:
– potential self-contamination that can occur if medical masks are not changed when wet, soiled or damaged
– possible development of facial skin lesions, irritant dermatitis or worsening acne, when used frequently for long hours.
– difficulty communicating for deaf persons who rely on lip reading
– false sense of security, leading to potentially less adherence to well recognized preventive measures such as physical distancing and hand hygiene;
– disadvantages for or difficulty wearing them, especially for children, developmentally challenged persons, those with mental illness, elderly persons with cognitive impairment
disadvantages for or difficulty wearing them, especially for children, developmentally challenged persons, those with mental illness, elderly persons with cognitive impairment, those with asthma or chronic respiratory or breathing problems, those who have had facial trauma
– risks to the environment caused by disposable masks
– WHO confirms difficulty wearing masks in hot and humid environments. Were
environmental conditions considered by policy makers or the humidity buildup inside of a mask that increases infection risk?
– Did policy makers consider the only randomized control trial ever conducted on cloth mask found they posed a 13 % higher risk of infection ?
– WHO confirms the risk of “self-contamination due to the manipulation of the mask by contaminated hands” Masks harbor contaminants capable of causing serious illness if they are handled, stored, or disposed of improperly ( 1 , 2 , 3, 4, ) Even among trained medical personnel contamination by the incorrect removal of masks is a persistent problem.
– Considering people touch their faces 15-23 times on average, can lay people, especially children, master the near-aseptic technique necessary to avoid contamination?
– Are health officials collecting/monitoring data from numerous settings including Family Doctors and Emergency Rooms that may flag a rise in respiratory conditions such as bacterial pneumonia, pleurisy etc that could be related to use of a contaminated mask ?
– WHO confirms potential headache and/or breathing difficulties. Headaches can be the result of numerous things including oxygen deprivation. Has risk management created a list of symptoms that may indicate a negative reaction to masking ?
– Because a fraction of carbon dioxide previously exhaled is inhaled at each respiratory cycle, hyperventilation is not unexpected and could lead to risks including fainting and head injury. Is data from first responders, schools or ERs etc being monitored related to increases in falls or associated adverse events ?
– WHO confirms masks pose a difficulty with communicating clearly. Yet, professionals such as pharmacists, lawyers and teachers are now masked. Have schools noted impacts like drops in students grades or, how is feedback captured from students who cannot hear due to a masked teacher ?
– Masks have been shown to have potential impact upon cardiorespiratory exercise capacity and there have been concerns raised regarding wearing a mask while exercising. Did risk assessment consider work settings that involve physical exertion or the risks to the elderly who have reduced exercise capacity ?
– Have psychological impacts of mask wearing upon children been analysed? At present, there are no means for parents to report such harms meaning they go unaddressed despite the long term consequences they may have upon mental health
– Around 70% of older adults suffer hearing loss as do 12.5 % of children (due to ear bud overuse)- Has risk assessment extended to the harms and impacts upon well being such as alienation of these populations?
– Dr Bonnie Henry the provincial officer of health for British Columbia stated on Global Television that “Masks for long periods of time are NOT recommended for anyone in any situation.” A director of OSHA also confirmed the risk of mask use. Meanwhile, employees and students are expected to mask sometimes for hours on end. What data has the Ontario government found on the risks of prolonged mask use?
– Although officials admit masks are to protect others, prolonged and inappropriate mask use among populations most vulnerable to masking harms continues. People now wear masks while driving alone in their cars, while riding a bike, outdoors with no/ brief passerby exposure. Have officials assessed the risks to these populations and shown consistent transparency about the realities around the role of a mask for self protection ?
– It is commonplace to now see both mask and distancing enforced. This is despite the Ontario provincial policy confirming that masks are mandatory only when 6 feet distancing is not possible. Have health officials made people aware of this policy detail? Considering unmasked citizens who maintain a 6 ft distance, could decrease risk associated with mask use?
Appendix 4: Need for Transparent Communication Regarding If The Threat of COVID-19 Warrants Risks of Mask Mandates? :
Health Canada provides a daily update of Covid-19 cases across Canada. Coronavirus disease 2019 (COVID-19): Epidemiology update: https://health-infobase.canada.ca/covid-19/epidemiological-summary-covid-19-cases.html