Leaders in Ontario pretty much all agree that face coverings help reduce the spread of COVID-19. What they can’t agree on is whether wearing them should be mandatory — and, if so, who should give that order.
For weeks, health officials have recommended that Canadians wear masks in situations and places where physical distancing isn’t possible (such as riding public transit, entering a crowd, or shopping at a store), but, in most parts of Ontario, the recommendations have been just that. However, as pandemic restrictions loosen, an increasing number of local officials are making rules to enforce face covering in indoor public settings. Critics of this patchwork approach say that it creates confusion and that, by not making a clear, uniform policy on where and when to use masks, Ontario is undermining its reopening plan.
“Emerging scientific evidence and the success of other regions around the world that have been using masks as part of the interventions against COVID-19 [show masks are] a low-risk, high-benefit intervention that will help reduce transmission as an adjunct to other interventions,” says Jennifer Kwan, a family physician in Burlington. Kwan is a representative for Masks4Canada, a group of health-care workers calling for a mask strategy from upper levels of government. She and other medical professionals in the group believe that a standard set of rules would help normalizing face coverings and prevent confusion. They say face coverings should be mandatory in crowds, indoor places outside the home, and on transit for everyone but young children or people who can’t wear masks due to medical conditions or disabilities. Kwan says that “if we can have provincial leadership on this, it would help ensure consistency and relieve pressure off to the individual public-health units and businesses.” Thus far, the province has disagreed.
Premier Doug Ford has consistently said that, while people should wear masks, a provincial order mandating that they do so would be unenforceable. Ontario’s chief medical officer of health, David Williams, said in a news conference on June 18 that such decisions are best left to local officials with local knowledge: “As this evolves, we're going to see some variations in that, and I think a lot more are going to probably require mandatory wearing of [masks] as the numbers of people out and around increases.”
In lieu of a provincewide rule, Ontario has indeed seen local rules come into effect. On June 10, Wellington-Dufferin-Guelph Public Health announced a mandatory mask policy. On June 26, the region of Windsor-Essex enacted a similar rule, and the Kingston, Frontenac, Lennox and Addington Health Unit announced its own mandatory mask policy. On June 29, mayors and chairs in the Greater Toronto and Hamilton Area agreed to ask the province to make face coverings mandatory in indoor public spaces. The same day, Ottawa’s top doctor announced that the city would consider such an order. The following day, Toronto city council voted to make masks mandatory in indoor public spaces as of July 7.
Wajid Ahmed, the medical officer of health for the Windsor-Essex County Health Unit, says he thinks regional officials are better suited than the province to making this sort of decision, since they know about the nuances of their areas. He timed his mandatory mask order to coincide with the region moving into Stage 2 of the province’s reopening plan. “In the pandemic situation, sometimes we need clarity in terms of what the expectation is,” he says. “We feel that, at this time, there's enough awareness in our community that if we make it clear that this is the expectation, the acceptance in our community will be high.”
Nicola Mercer, the medical officer of health for Wellington-Dufferin-Guelph Public Health, says that, in her region — the first in Ontario to make masks mandatory — the order has led to a significant uptake in people wearing masks. While there’s no hard data, Mercer says, anecdotal evidence shows that mask usage has significantly increased. “Sometimes it's probably very close to 100 per cent,” she says. “But certainly well over 90 per cent of the people in indoor retail establishments are wearing masks.” The decision to issue the order, she says, was made in conjunction with local politicians.
Niagara Region’s medical officer of health, Mustafa Hirji, says that making such an order should not be the responsibility of a medical officer of health. “I don't represent the people. I'm an unelected official who looks at the science in front of me to implement scientific guidelines in terms of protecting the health of a population, but I don't speak for what the people think or what they want,” he says. “When we make decisions around what kind of society we're going to have and what the appropriate balance of freedoms versus restriction for societal benefit are, in general, those are decisions that should be made by elected bodies.” Hirji says that he recommends face coverings but that there is not enough evidence supporting their benefit to make him mandate their use — that decision, he suggests, is best left to local government.
St. Catharines mayor Walter Sendzik, though, calls that a “reckless approach to public health.” Municipalities, he says, don’t have the necessary public-health knowledge and need guidance: “For 14 weeks, we've been following the directions of public health. And, all of a sudden, you then turn around and say to the 12 municipalities, ‘It's up to you. If you want to do masks, you mandate them.’” Sendzik believes that Niagara public health should have made masks mandatory when the region entered Stage 2 of Ontario’s reopening plan.
Niagara Falls city councillor Carolynn Ioannoni is also critical of Hirji’s stance that local politicians should be the ones to make this call. “I was really disappointed,” she says, adding that she feels municipalities have relied on public health for guidance and recommendations up until this point and should continue to do so.
Both Sendzik and Ioannoni question Hirji’s argument that there’s not enough evidence to warrant restricting people’s freedom. “We shut down the economy,” Sendzik says. “We took people's freedoms away — freedom to travel, freedom to go outside in groups of more than five, freedom to go see their parents in long-term care. You want to talk about removing freedoms? We've already done it.”
Hirji, though, notes that those rules, which have “big, far-reaching implications that affect all of society,” were enacted by elected officials — and that there was good evidence that physical distancing and shutdown rules would help reduce transmission of the virus.
While Sendzik can work with council in St. Catharines to pass a bylaw mandating masks — several days after speaking with TVO.org, he announced his intention to raise the issue in that forum — he says a regional approach would be more effective. “We are a major destination as a region. So we are facing a summer of influx from people who are travelling and wanting to get out of their house to travel to a place where they can get their kids out of the car and see the [Niagara] Falls and travel through vineyards and all the other things associated with what makes Niagara so special,” he says. “And, in that part of it, we have an even higher risk of transmission of a virus than the other communities.”
He argues that, if masks are mandatory in some municipalities within a region, but not in others, that sends a mixed message and could make people less likely to wear them: “There shouldn't be gray areas.” Hirji says that Sendzik has the option to work with other elected leaders at the regional level to pass mandatory mask rules: “The mayor St. Catharines, by virtue of his position, is also a regional councillor for Niagara Region, so he could always bring forward a bylaw there as well.”
Lawyer Rob Shirkey, who has been advocating for mandatory mask rules, says there is little question that the province, medical officers of health, and local officials all have the power to make such rules. He also says that, when it comes to mandatory mask policies, the question of enforcement, as raised by the premier, is “a bit of a red herring” — and that bylaws would be books of blank pages if enforcement concerns were a bar for legislation. In his opinion, the approach advocated by Masks4Canada (and taken by Mercer and Ahmed) is the right one: under it, the emphasis is more on education and establishing norms than on punishing people who don’t wear masks where they should. “The order that I put forward would empower the retail establishment to have a policy in place, just like they have ‘no shirt, no shoes, no service,’” Ahmed says.
In Hirji’s view, an order based on education, not enforcement, is no different from a recommendation. He does, however, think that more work needs to be done to make mask-wearing the norm. “I think if you impose a rule on people when they don't largely buy into it, you're going to cause a lot of people to refuse to follow the rule out of spite and anger about that being forced upon them,” he says. “If you have a more collaborative process where you build support over time, I think you'll have a lot more compliance longer term doing that … And I think an approach through a bylaw, where you have a public debate, does allow that kind of social norm to build up over time.”
Shirkey agrees that establishing new assumptions and expectations is crucial, especially given the fact that mask recommendations have changed in the last few months: “We gave a million and one reasons not to wear masks. We can't just say none of that happened. That's informing our discussion today.” He says that an “unequivocal mandate” to use face coverings “elevates the quality of the intervention in one's mind. More importantly, I think it creates a new norm.”
Hirji, Mercer, Ahmed, and Kwan all believe that more should be done to educate people about mask usage and to encourage them to wear them. Masks4Canada has called on the government to distribute masks to people free of charge, and Hirji agrees that would be a good idea. The doctors also stress that masks are not a panacea but — along with handwashing and, most important, physical distancing — pieces of the puzzle when it comes to reducing viral transmission. “This virus is still in our communities,” Mercer says. “You can still, not just get it, but you can still give it to others that you love that are more vulnerable.”
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