Mandatory face coverings will be required in all indoor public spaces this Friday, July 17, but the new measures must “complement” physical distancing and other hygiene guidelines, caution York Region Public Health Officials.

The Region's medical team stated their case in favour of mandatory masks and face coverings at a Special Council Meeting last Thursday, which lasted more than six hours through a series of presentations, discussions on merits, enforcement and education, and closed-door sessions.

There, the team led by Dr. Karim Kurji, York Region's Medical Officer of Health, said a decision on the use of masks is best made by Regional Council, but made a case for its efficacy going forward.

“Face coverings are an additional measure and not a substitute for other things like physical distancing,” said Dr. Fareen Karachiwalla, Associate Medical Officer of Health. “The question before Council today is whether all various factors that I'll present warrant moving beyond recommending face coverings to requiring their use for purposes of what we call ‘source control' – wearing a mask to protect others around you and not necessarily yourself, and that is in keeping with the latest science.”

The pandemic, she said, is “somewhat unpredictable and can change quite a bit from week to week” and last week was still too early to accurately gauge the impacts of York Region moving into Stage 2 of Ontario's re-opening plan.

“If you look at the evidence as a whole, it is growing in support of the effectiveness of face coverings,” continued Dr. Karachiwalla. “If you compare places with very high rates of face coverings with those that don't have as high rates, including the US, there is a positive effect on things like death rates [and] daily growth of cases. Modelling studies have also found that more widespread use [of masks does] prevent a substantial portion of both cases and deaths, and one or two modelling studies actually point to how the effect is most optimal when the uptake [in mask use] in the population is closer to 80 per cent.

“We also know based on studies looking at performance of face coverings that some face coverings can actually be a suitable alternative to medical masks, particularly when they are made up of at least two layers of tightly-woven yet breathable fabric and adequately cover the nose and mouth and go below the chin.  One modelling study even found that even with the lower quality face coverings, a benefit can be had when the uptake is high – that 80 per cent range.”

While the Region did not have “definitive estimates” on the use of face coverings in York Region in either different settings nor different communities, survey data and “some observations” gave them a “rough idea” and they calculated that average face mask use stood at approximately 65 per cent.

“In addition to our own observations, a population survey that was recently conducted on Canadians found that in Ontario about 56 per cent of people report wearing face coverings and they do this more often when going to places like grocery stores or pharmacies and, interestingly, a bit less so on transit and when going into their own workplaces,” said Dr. Karachiwalla.

But, benefits of a more universal approach to face covering use are myriad, she noted, including resulting in “feelings of empowerment in the community” because people feel they are doing something to “take action” against COVID-19, and it can also help reduce the stigma for those who are wearing face coverings “because they themselves are at higher risk” and normalizes their use.

“One of the interesting findings of some of the studies I am looking at is the fact that face coverings can provide a very strong visual cue of the fact the pandemic continues to be ongoing and actually because of this visual cue or symbol oftentimes [people are] more likely to follow physical distancing because of that signal,” she said. “That is informative for us and provides a bit more context and information to some claims that face coverings might result in actually riskier behaviour because of a false sense of security. More universal use of face coverings can also help frontline workers, so at grocery stores or retail outlets, for example, feel more protected [and] comfortable while at work.”

Yet, there are also “unintended risks”, she said. While wearing face coverings is “usually quite safe” exceptions must be made for people who have breathing difficulties, have certain medical conditions, or can't safely put on or take off face masks independently. Exemptions should also be made for younger children. Another potential negative she underscored for members of Regional Council was the adverse impact mandatory face coverings would have on individuals, such as the hearing impaired, who rely more than most on lip-reading and facial communication.

“What is really important to keep in mind is the possible impact on people that are unable to wear face covering because of medical reasons. These individuals may feel pressure to disclose their health status, and that is typically not required, and may experience some negative social reaction from others if they are not wearing a face covering, or isolation if they feel more reluctant to go out into the community. Any policy must be quite mindful of this and public education is needed to inform the community of reasons why people may not be able to wear face coverings.

“Other equity considerations to keep in mind [are] regularly procuring a face covering could represent a financial or time barrier to some families, and depending on enforcement, monetary fines can add a financial burden.”

That's why, she said, the primary goal with recommending mandatory face coverings is education – providing a “verbal reminder to patrons as opposed to strict enforcement.”

“Face coverings are not a standalone intervention,” she said. “They are just one type of intervention and they must be complimented with others like the physical distancing, hand-washing and, of course, the cornerstone of public health intervention, which is testing and contact tracing. These are things that York Region is performing quite well on.

“Regardless of the decision that Council takes today, York Region will continue to actively monitor trends in disease, manage and educate the public, track the evidence very carefully and continue to evaluate and re-evaluate the need for any changes in direction.”

By Brock Weir