The science and ethics of mandatory masks

Peterborough is adapting to life with masks — but why is the mandatory order justified?

In July, when Peterborough was operating under stage two of the province’s reopening plan, Karen Taylor, director of programs at the Canadian Canoe Museum, was in the midst of planning the museum’s reopening. “There was a lot of work that went into how to interpret the protocols that we received from Peterborough Public Health and what that means in our environment,” she says.

The museum installed a plexiglass barrier for the front desk, established a one-way flow for patrons to move through the galleries, replaced the interactive displays with alternatives and created a mandatory mask policy for indoor spaces.

As Taylor and the rest of the museum team prepared, they had to adjust to changing circumstances. The province announced Peterborough could enter stage three, for example, which increased the number of individuals allowed in a space. And a few days later, Peterborough Public Health issued a directive to local establishments to develop and enforce masking policies for staff and patrons, starting on August 1.

“We had already determined on our end that masks were going to be required, so it didn’t change things,” Taylor says. In fact, she says it was helpful to have the public health body backing up their decision. The directive “is supportive for our front line; it makes it easier [to enforce].”

“Since opening we have had zero pushback on it,” Taylor says. “People are coming prepared with masks. There has been a smattering of people who haven’t had one who just purchased one at the desk.”

Making masks mandatory

The directive from Peterborough Public Health (PPH) came after other Ontario health units issued similar directives and city councils across the province passed bylaws mandating masks. In cities like Toronto and London, Ont., the measures required establishments to enforce masking policies and also made individuals responsible for wearing masks themselves.

Peterborough’s directive differs from those. Our public health unit’s directive is aimed only at establishments and not individuals; and though city councillors have encouraged masking, none have brought forward a motion to create a bylaw. In an email to Peterborough Currents, the health unit’s manager of environmental health, Julie Ingram, wrote, “This is the best way to achieve consistency in implementation and ensure that members of the public and employees of establishments comply.”

According to the directive, all establishments and transit operators must create a masking policy and enforce it in good faith, meaning that best efforts must be made to inform the public of the policy and encourage people to wear masks, but not ask for proof of an exemption. (To read the order and its details click here.)

Ingram writes that directing the order at establishments also helps with a “progressive enforcement approach,” where PPH will focus first on education for operators and employees before enforcing the directive with fines.

The directive acts on a growing body of evidence that is not conclusive or definitive but strongly suggests that widespread masking helps to prevent the spread of the virus, according to Ingram. But Ingram adds that masking only has an impact if there is widespread compliance. “It appears that we require 80 percent compliance for face coverings to have an impact,” she writes.

One study referenced by PPH is an analysis using computer modeling which concludes that widespread masking during a COVID-19 outbreak, especially if adopted before the 50th day, will help to reduce the spread of the virus.

The study notes that in countries (such as Canada) where there isn’t an established acceptance of masking, reaching the 80 percent threshold may take longer and require more interventions from public health bodies and governments. The study recommends that governments institute universal masking policies.

For many Canadians, this pandemic is their first experience wearing a mask outside of a hospital setting, and the concept was introduced poorly, says Dr. John Bowman, an assistant professor in the faculty of medicine at the University of Toronto and an expert in bioethics.

“Canada got off to a very wobbly start with the question of masks, as did a lot of countries.” The initial direction from the Public Health Agency of Canada was to not wear masks, Bowman points out. In May, the message changed. “There was a lot of back and forth which I think really eroded public confidence.”

Statistics Canada surveys have shown that the majority of Canadians are wearing masks as a COVID-19 precaution – 87 percent of survey respondents reported doing so in July. Ingram writes, “If all those people who support wearing a non-medical mask wore one, that would represent a strong level of public compliance.”

In spite of these indications of widespread support, there have been small demonstrations protesting mandatory mask policies across Canada, including in Peterborough.

“When a person is to say this is an infringement on my rights, I kind of get it,” says Bowman. Mandatory orders are “particularly difficult in societies … that value individual liberty and freedom, where a person’s autonomy is the strongest ethical compass.”

Nevertheless, “what this pandemic has done is say yes there is autonomy, but we absolutely have to consider the safety and well being of the largest community,” Bowman says. “So, although we could not say that this is 100 percent evidence-based, we can say that all indications appear to be this and the precautionary principle is we need to enact this for the safety and well being of other people.”

On the worker to enforce

For Bowman, the key ethical consideration with Peterborough’s directive is who will be enforcing these policies and what risks these workers might be taking on. “A lot of this stuff has been pushed onto people who should not be dealing with complex social issues. A grocery store staff worker having to take on an aggressive conversation about masks, what a shame. I have a lot of respect for the people working those jobs because they’re taking the brunt of it.”

Jatin Chanana is the owner and operator of Dreams of Beans cafe and frequently works at the front of the house. He says that when he asks patrons to wear a mask it comes down to opening the conversation for patrons to say they have an exemption, rather than demanding an explanation.

“As a business owner I luckily haven’t had a customer come in and refuse to wear a mask based on the fact that they don’t want to wear a mask,” he says. “I’m not really sure what I’m supposed to do if I do have somebody like that come in.”

Jatin Chanana wears his mask behind the counter of his restaurant, Dreams of Beans. (Photo: Ayesha Barmania)

Chanana says he’d like some more guidance on how to respond to a situation like that. “It would be nice to have information on that – like am I supposed to call the police?”

In spite of these questions, Chanana says the new policy helps him feel comfortable at work. “I feel a lot safer with people wearing masks. I think it’s a basic thing and a mental thing as well. With people wearing a mask I’m less likely to get something from them.”

Ingram writes, “The bottom line is that as a community, we are living with this pandemic and by wearing face coverings, we are helping to protect each other.”

But she urges respect and understanding in the directive’s implementation. “Everyone needs to remember that there are people who should not and cannot wear a face covering — you cannot tell by just looking at someone, so we all need to be kind.”

This article was adapted from a Peterborough Currents email newsletter sent to subscribers on August 24, 2020. To read the original newsletter, click here.


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