With respiratory infections surging, how can Ontario parents navigate the masking question?

The former director of Ontario’s COVID-19 science advisory table says that the province should be mandating masking in schools, child care centres and other essential settings amid a surge in respiratory virus infections that have overwhelmed pediatric hospitals.

Dr. Fahad Razak made the comment to CP24.com this week.

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He said that while masks “are not a panacea” and “only reduce risk; not eliminate it,” they can help to take some of the pressure off hospitals, especially when combined with other protective measures.

His comments come in the wake of the Hamilton-Wentworth District School Board (HWDSB) passing a non-binding motion to ask students and staff to wear a mask in all public school board buildings. A number of other boards, including the Durham District School Boards, have voted against stronger-worded motions to either formally require masking or request that public health officials use the powers of their officers to do so.

“For public health, it's always more effective if this is done centrally and collectively, rather than downloading decision making onto individuals, families and parents and children. So this is not the ideal sequence you'd like to see in the province,” Razak said of the Ford government’s largely hands-off approach to masking. “I've been on the side of having a masked mandate for quite some time. Not only in a public schools and daycares but also in other areas that are essentially indoor settings that people have to use in order to go about their daily lives. So public transit, grocery stores, healthcare settings.”

Chief Medical Officer of Health Dr. Kieran Moore has recommended that Ontarians resume masking in public indoor settings, however, he has stopped short of issuing a mandate so far and several government officials, including Health Minister Sylvia Jones, have insisted that masking must remain “a personal choice.”

Speaking with CP24.com, Razak said that he is “realistic” and appreciates that a mask requirement likely isn’t “imminent anytime soon in public settings, including schools.”

But he said that parents, in particular, should be doing “whatever they can” to protect their children given the number of young people who are ending up hospitalized with respiratory infections.

Here is Razak’s advice to parents as they navigate what could be a challenging few months:

IS THERE STILL VALUE IN EVEN INTERMITTENT MASKING?

Razak says that it will be important to “reduce risk as much as you can this winter” and that includes masking, where possible. He said that in his family, he has a four-year-old child who is “pretty understanding” and wears their mask regularly and a three-year-old for whom getting to wear a mask can be a struggle. His message to parents: do your best to get your child to wear masks as much as they can when at school but don’t fret too much about those times when they inevitably take it off.

“We are living this and we encourage them to wear masks. Our four-year-old will, our three-year-old will intermittently,” he said. “Look anytime that someone is wearing high-quality mask well is a time where their risk of exposure goes down. So if you can't achieve that over the entire period of the day but you can do it over part of the day that's better than not wearing it at all. There is no perfection here. It is about reducing risk wherever you can.”

WHAT AGE SHOULD CHILDREN START WEARING MASKS?

When Ontario had a mask mandate, it applied to all children ages two and up, however Moore now says that children ages two to five should wear masks in indoor public settings only “if they can tolerate the mask and safely put it on and off.” Razak told CP24.com that there is really no universal age for when children should start wearing masks in school, as “parents know their own kids the best.”

“If you have a child under five who seems to be fairly mature around the use of masks and is not finding it too much of a burden and is able to keep it on, I'd say go for it. On the other hand, if it's a big fight, I would say it's not worth it. They're not going to wear it properly, they are not going to keep it on,” he said.

Razak said that older children have all been impacted by the “viral surge” we have seen in recent years and are likely to be more able to appreciate the importance of masking. He said that parents should provide “concrete examples” and really try to explain to their children how masks can protect them and those around them.

WHAT ABOUT SHORT INTERACTIONS? SHOULD YOU STILL MASK?

Razak said that while it may “feel performative” to put a mask on for a brief interaction, such as dropping a child off at daycare his own attitude is “why not?”

“I don't have a strong scientific opinion on it. I would just say that you can wear a mask in indoor settings when kids are around, it's probably helpful,” he said. “The longer you're wearing it is probably more helpful. So if it's only a couple of minutes, it's probably very little effect. But If it's a longer period of time it is probably more needed.”

IS THERE A POINT IN WEARING A MASK IF NOBODY ELSE IS?

There is still protection for individuals who wear a mask “even if you are one of the few people doing it,” Razak says. He says that masks are, of course, more protective if they are being worn by a significant number of people in a given setting. But at this point in the pandemic, Razak said that people probably have to be “realistic about what you can and can’t control.”

“Masks have two effects. They protect the wearer based on what they are inhaling and then they protect everyone else around you because if that individual is sick, some of those respiratory particles that would carry infections are stopped by the mask before being circulated in the room,” he said. “So wearing a mask in a room, even if you're one of the few people doing it, does help you.”

WHAT CAN PARENTS EXPECT OVER THE COURSE OF THE WINTER?

Razak said that there are likely some “really difficult weeks and months” ahead but he said that it remains to be seen whether it will be as bad as this “current surge,” which has prompted several children’s hospitals to limit surgeries in a bid to free up capacity.

Health Minister Sylvia Jones did tell reporters on Friday that there are some signs that the spread of RSV in Ontario is slowing. However, Public Health Ontario has warned that influenza cases continue to multiply. Last week 14.4 per cent of all tests for influenza came back positive, compared to 13.7 per cent the previous week.

“These viruses can have a very sharp uptick and downtick so people will be watching very closely to see if we have a receding wave. But even if we're starting to recede any ability we have to offload these periodic hospitals is helpful right now,” Razak said. “Every child that doesn't become sick enough to end up in hospital is one less child that has to be cared for in these critical care settings.”