To Mask or not to Mask, that is the Question

After the public announcement made by Dr. Robert Strang on May 23 2023 that brought an end to the Health Protection Act Orders enacted in Nova Scotia, some organizations are changing their positioning around masking.

Prior to the May 23rd announcement, the Halifax Public Libraries (HPL) website, under their Status of Library Service page, stated that “masks are highly encouraged” in their facilities. When contacted regarding this statement HPL responded by stating, “we encourage Library visitors to feel welcome and comfortable during their visit – this might include wearing a mask or not.”

Halifax Public Libraries Status page prior to May 23 2023

HPL later went on to state that while “Nova Scotia Public Health continues to encourage mask wearing as one measure to prevent illness,” the Library “supports individuals’ health choices.”

Since the announcement by Dr. Strang early last week, the HPL website now shares a different message. Masks are no longer highly encouraged, but people are welcome to wear one if they see fit, and people are encouraged to “respect others’ decisions around masking.”

Halifax Public Libraries provides access to several online services and databases, in order to foster “equal access to resources for everyone and support individuals’ freedom to seek information and form their own opinions.” That mission also extends to “helping people access and understand medical research,” and as such, HPL provides access to ProQuest, Gale, and the Cochrane Library databases as part of their digital service offerings.

Halifax Public Libraries Status page after May 23 2023

In January of 2023 the Cochrane Library published a meta-analysis – considered to be the gold standard in evidence based medicine – of 78 random control trials that looked at various interventions used to prevent the spread of respiratory viruses, such as mask wearing and hand washing.

This study purportedly found that the use of cloth, surgical and even N95 masks makes little to no difference in controlling the spread of respiratory viruses. While the authors claim that their findings are uncertain, they went on to state that “the pooled results of RCTs did not show a clear reduction in respiratory viral infection with the use of medical/surgical masks,” and that there “were no clear differences between the use of medical/surgical masks compared with N95/P2 respirators.”

When asked if HPL was aware of this study, they stated that “Halifax Public Libraries does not validate or authenticate the contents of the materials in our collection, including the Cochrane Library or its resources.”

While the January 2023 meta-analysis by the Cochrane Library would seem to be a nail in any company’s masking policy’s coffin, there is, perhaps unexpectedly, some controversy surrounding it. It has been criticized for cherry-picking the studies it reviewed, and for not including lab controlled direct studies that allegedly show the efficacy of masks in reducing the ‘outward’ dispersion of viral particulates. 

The uproar caused by the review led Karla Soares-Weiser, the Editor-in-Chief of the Cochrane Library, to release a statement in March of 2023 with the intention of correcting the “inaccurate and misleading interpretation” that masks don’t work.

It would appear, then, that the debate over the efficacy of masks to prevent the spread of respiratory viruses is still in full swing, as it has been since mid-2020. Prior to the COVID-19 pandemic, however, there seemed to be something of a consensus on the efficacy of masks to reduce the spread of respiratory infections.

In Canada’s own Pandemic Influenza Preparedness Plan of 2018 (CPIPP), it is stated that wearing a mask may prevent the spread of influenza-like-illness from an ill person to a well person by “blocking large-particle respiratory droplets propelled by coughing or sneezing,” but that there is little evidence “as to how effectively the wearing of a mask by well individuals will prevent them from becoming infected.” 

Early in 2020, Dr. Denis Rancourt, researcher and member of the Canadian Covid Care Alliance’s Scientific and Medical Advisory Committee, surveyed the then available literature on the efficacy of masking in his review Masks Don’t Work. Nova Scotia’s own Civil Liberties association also lists various studies carried out over the decades on the efficacy of masks, with the general consensus being that their effect is negligible.

Within Nova Scotia’s own Occupational Safety General Regulations under section 13 – Respiratory Hazards – there is no mention of cloth or surgical masks when outlining the appropriate PPE to be worn in situations involving respiratory hazards that may cause injury or disease.

When asked for comment on section 13 of the regulations, a representative of Nova Safe, the new safety branch of the department of Labour, Skills and Immigration, stated that cloth and surgical masks are not considered respirators under the regulations, but they are intended as “source control,” to protect others from the person wearing the mask. The representative also claimed that throughout the pandemic the “OHS Division followed the guidance and recommendations provided by Public Health.”

While the mandate to wear masks in all indoor settings in Nova Scotia hasn’t been in effect for some time, Nova Scotia’s Public Health continues to recommend the wearing of masks even after Dr. Strang’s May 23rd announcement, stating that a “mask helps stop droplets spreading when someone speaks, laughs, coughs or sneezes.”

The Public Health Agency of Canada also encourages people to feel free to wear a mask even when it is not required. However, under their Regulatory Considerations for non-medical masks they note that “it is understood that non-medical masks do not provide a complete barrier to virus-sized particles produced by the wearer when speaking, laughing, singing, coughing or sneezing,” but “it is reasonable to believe that some protection may be provided.”

Neither agency provides the scientific sources that inform their recommendations and reasonable beliefs.

Photo Credit: Halifax Public Libraries

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