Every level of government has their own area of responsibility. Like any team, we complement and support each other. The provincial government is responsible for public health and for our pandemic strategy. If City Council decides to take additional measures, beyond provincial health guidelines, we should provide good justification.
Understanding the provincial Covid response
The overall numbers have not been good for Alberta. Our mortality rate has been much better than other provinces, but the rapid rise of infections has the potential to change that. Premier Kenney’s response has differed from other provinces, but it makes sense to me.
Here’s what we know about transmission. From Dr. Hinshaw last week:
40% of infections were linked to households, social gatherings and other types of private events
10% to continuing care facilities (ie seniors care facilities)
4% to childcare or k-12 schools
3% to outbreaks in acute care facilities (ie hospitals)
30% the source remains unknown.
By banning all private gatherings Premier Kenney aimed directly at the biggest source of transmission. He had to declare a state of health emergency to allow this government intrusion into our private lives. Enforcement of private gatherings is obviously challenging, but at least there is clear rationale for the restriction.
Many assume that Premier Kenney’s choice to keep businesses open is ideological. You can’t attend a funeral, but can go shopping? That sounds backwards, but funerals and other social events with close extended contact are risky in ways that shopping is not.
Premier Kenney indicated that very few outbreaks have been connected to restaurants—somewhat surprising seeing as these are riskier public interactions. Similarly retail spaces have not been tied to many outbreaks. If there isn’t clear evidence that outbreaks are occurring in public business environments why restrict those activities? Ask yourself if Ontario’s lockdown 2.0 makes sense—again closing small independent stores, while leaving big box ‘essential’ stores open?
It was expected Premier Kenney would announce a province wide mandatory mask rule for public indoor spaces. Instead Premier Kenney expanded on the current mandatory mask bylaws in Edmonton and Calgary to now include all indoor workplaces. It appears the province is making an educated guess (they didn’t present any data about outbreaks at the workplace) that aligns with what we know about the main route of transmission—extended close contact with an infected person. It is likely that many workplaces are risky spaces. Close quarters with poor ventilation.
Given that so few of the known outbreaks are connected to schools lots of people are rightly disappointed that school will shut early and open late after Christmas break. But Premier Kenney obviously has an eye on Christmas. It is likely we will see a rise in numbers at the end of December and he is trying to reduce the rate of increase ahead of that expected spike. He also indicated that staffing at school due to illnesses or quarantining was adding pressure to school operations.
The source of 1 in 3 transmissions is unknown. That is an unfortunate indication that contact tracing has collapsed. That likely means that infected people are not quarantining—likely because they are unaware of their close contacts with infected individuals. That is a lot of uncertainty, but remember that extended close contact in socially animated spaces is where the greatest risk occurs. Walking by someone in the mall isn’t usually enough to infect you.
Above and beyond
There is pressure for City Council to assist our provincial health partners with additional health measures. But when municipalities go beyond provincial health guidelines we are entering risky terrain. You’re asking City Council, who gets outbreak information at the same time as the public, to analyze complex, often incomplete information, and make public health policy. We don’t have additional guidance from Alberta Health. Yes, Alberta Health recommends mask use. But recommendations are different from a mandatory rule.
Premier Kenney is obviously sensitive to arguments about infringement of personal freedom. So perhaps it is telling that he didn’t announce a province-wide mandatory mask law. Compared with severe restrictions on our private lives (requiring the special powers of a state of emergency) a mask law is comparatively tame and far less intrusive.
Should City Council pass a mandatory mask bylaw for all indoor public places, even though there are few outbreaks confirmed with those activities? Should we pass a mandatory mask bylaw for all indoor workplaces? There is more justification for that restriction. Should we do both?
Many assume that a local mandatory mask bylaw is a clear, easy option for slowing spread. Others are skeptical. It is then up to council to judge the science, enough to justify a new bylaw and enforce them. Passing a bylaw is easy. Its what comes after that’s unclear. There are consequences and tradeoffs for any public policy that we must consider.
Persuading the public
At the same press conference Tyler Shandro, Minister of Health, said that “we can't order, restrict and enforce our way out of this pandemic. We need people to change their behavior.”
With the lion’s share of transmission occurring in private spaces, where it is difficult to enforce rules, we need to persuade not just coerce Albertans. We know that there is a significant portion of Canadians skeptical of the pandemic. A recent survey found that about 18% of Canadians are unlikely to follow health guidelines and are more likely to distrust the government officials setting them. Though vaccines are on the horizon, it might be more than a year before enough are vaccinated to get to herd immunity. Things are already getting tense. People are tired and stressed. People are snapping at each other.
This isn’t the first time public health officials have needed to convince people to change behaviour to slow the spread of a disease. This educator drew a helpful parallel between encouraging condom use during the AIDS epidemic and this pandemic. Shaming people didn’t work. What worked was education and easily available condoms. Gaining widespread mask use might follow a similar path. Educate and make masks easily available.
City council’s main job, as I see it, is keeping this community together. The choice is not only between a mandatory mask bylaw or nothing. Education, widely available masks, and setting ground rules for Covid etiquette might accomplish the same thing, but more peacefully. Clear justification of Covid restrictions is important for persuading people.
Covid best practice: multi-layered protections
It is surprising that so little transmission occurs in continuing care/acute care facilities and schools, but perhaps not. Those institutions all have strict, multi-layered controls, including masks. This is perhaps the clearest evidence of the effectiveness of Covid best practices.
The current focus on mask use distracts from the bigger lesson—no single measure is sufficient to slow the spread. We know that people aren’t perfect. We can’t maintain discipline 100% of the time. That’s why a multi-layered approach of protection is so important. If one layer fails, another may protect us. That’s what hospitals, long term care facilities, schools and large industries, such as Cancarb locally, have in common—multi-layered controls including masks.
The case for masks
FYI. This website has by far the best visualization of how Covid is spread. Very helpful in understanding the many factors of transmission. It highlights the importance of good ventilation.
There are three routes of transmission: large droplets (primarily), aerosol particles and contaminated surfaces. That masks help slow the spread of a virus that’s primarily transmitted through the air seems fairly logical. Masks filter your breath reducing the amount of virus that is expelled. Of course masks don’t do this perfectly and efficacy ranges greatly depending on:
Proper fit
Type of material
Regularly washing or replacing your mask
If you’re looking for the science, here is a literature review of a number of primary research studies created for policy makers on this issue.
The biggest drawback is the huge range of efficacy. It’s the difference between a comfortable, regularly washed, non-medical mask made of tightly woven cloth and an ill fitting scratchy mask that you’re always fiddling with. It’s the difference between this neck gaiter, which the Washington Post declared ‘was worse than no mask at all’ and the 3-ply masks recommended by Canada’s Chief Public Health Officer, Dr. Theresa Tam.
There is also the question of how significant aerosol transmission is. For the American CDC “there is no evidence of efficient [aerosol] spread.” While Health Canada has traced outbreaks to aerosol transmission. That uncertainty has bearing for how effective face shields versus cloth masks are. It’s one thing for the CDC, Health Canada or Alberta Health to judge the science. Another for a municipal council.
Every layer of protection helps, but when it’s hard to quantify the benefit political discussion about benefits and trade offs are harder. The case for masks is one thing. The case for a mandatory mask bylaw is a different thing altogether.
Covid etiquette
When people ask me to ‘show me the evidence or the science’ what they usually mean is that they don’t feel they should be forced to wear a mask. Or that the benefit is not worth the infringement of personal freedom. Weighing the public interest versus any personal infringement is a good question and reasonable people can differ on how this is balanced. If you’re a mask skeptic, this is your better argument.
There is a reasonable argument to be made against any Covid restriction. We must not restrict freedom beyond what is necessary for the greater public interest. But some anti-maskers take their argument too far.
Of the many emails I have received on this issue, the most troubling are from businesses. Many are worried of the negative reaction if they ask a customer to wear a mask. In Nelson, BC a worker was spit on when she asked a customer to wear a mask. In Medicine Hat a customer took offence and protested outside the Coles Bookstore because he was asked to wear a mask. A friend of ours works at a retail store in Medicine Hat. Her job is to greet customers and ask them to wear a supplied mask. This week one man told her to F-off. We should not be afraid to talk to each other.
It’s one thing to argue that the government can’t force you to wear a mask. Another thing to argue that you have the right to enter a private business on your terms, not theirs. Freedom to not wear a mask means others have the freedom to wear one. And in a private space, the right to ask you to wear one.
For a moment think of those who must work for 8 hours in constant contact with the public, not just you who visits a store for a short period. So if a private business asks you to wear a mask, put it on. Asking you to wear a mask is not discrimination even if you have a health condition. If you can’t or don’t want to wear a mask, you can politely decline. I’m sure any business would be happy to accommodate you in other ways. Your freedom is not unlimited. We need a reminder about how freedom actually works.
Freedom to breath ends where my lungs begin
We’re familiar with the maxim, ‘the freedom of your fist ends where my nose begins’. We get so focused on our personal liberty we forget how much of our freedom depends on constraining the freedom of others. A world with ultimate freedom is a dangerous place. I would be free to do anything to you.
But as more and more of society has urbanized the limits on our freedoms have kept increasing. The closer we live to each other, the less I am able to do. We have strict regulations for buildings in cities because a fire in your house is not just your problem, but your neighbour’s problem too.
Freedom in the early settler days is very different from freedoms in a modern, high density society. We are seeing perhaps the pendulum swung to its most extreme. Never mind my fist, my own breath must be constrained. Faced with a contagious airborne virus we realize that even our breath can be a danger to others! The freedom of your breath ends where my lungs begin. I understand how restricting this can feel, but this is the reality for the duration of the pandemic.
Light at the end of the tunnel
What this pandemic is asking of us is not easy. In times of difficulty our instinct is to come together, precisely what public health officials are asking us not to do.
It can be hard, even for well meaning people. Safira’s grandfather died (not from Covid) Friday morning. The law says we cannot visit family. We cannot grieve together. Would you blame us if we broke the law? If we didn’t go, how would you feel in our place?
Ed Lachapelle was the patriarch of this family, with hundreds of loved ones. The funeral limit is 10. That barely covers his immediate family. Safira’s Dad and Uncle are planning to schedule Ed’s memorial service/Covid peaceful protest at Costco, since it’s the only place where 100 people can congregate. They’re joking, but it’s just the sort of prank Ed would have loved.
And yet it is clear why funerals are such high risk situations. Extended close contacts. This is also what happens when people follow rules, without internalizing the rationale behind the rule. They’ll look for loopholes. Voluntary compliance is more useful than coerced behaviour.
Regardless of what happens when council debates a mask bylaw there are things we can all agree on.
Focus on education. The general lessons are:
Extended close contact in socially animated spaces is where the greatest risk occurs.
Multi-layered protections, including masks, are the best strategy for slowing the spread.
Focus on courtesy:
Make sure access to masks are widely available so people can easily change their behaviour, if they choose to.
Make accommodations: a face shield may make sense for some people
Don’t be offended if you’re asked to wear a mask. You can politely decline and make other arrangements. We have to be able to talk to each other.
Western democracies were always going to have a challenging time with this pandemic. Our countries are based on personal freedom. And we are faced with a pandemic that requires us to do the opposite—to put others ahead of ourselves.