Medcan’s Medical Advisory Services (MAS) team has consistently recommended the usage of masks as an important layer in keeping our employees, families, and loved ones safe since the beginning of the pandemic. In light of the recent removal of mask mandates across Canada, MAS would like to reiterate the fact that the virus is still very much present within our communities and masks can still play an important role in certain settings. While the seven-day rolling average of COVID case counts is over 8,000 across Canada, experts believe daily case counts are over ten times based on wastewater testing. In Ontario, for instance, wastewater analysis estimates 100,000 to 120,000 daily infections (Ontario Science Table, 2022) compared to ~2,000 daily infections reported through PCR testing.
In addition, we are now seeing an increase in hospitalizations, caused by the more transmissible BA.2 subvariant of Omicron. In this regard when we discuss masks we are focused on the best-protecting masks: N95 or KN95 masks. While public health agencies are removing mask mandates, employers have an obligation under the Occupational Health and Safety Act to take every reasonable step to protect their employees from illness, and therefore may choose to continue to enforce mask mandates in certain settings. Workplaces, schools and travel settings will each have their own unique circumstances to consider when determining masking policies. The MAS team further examines considerations for masks in these settings:
Employers may have already relaxed screening measures such as testing, contact tracing and vaccination passports for employees and/or customers. When coupled with the removal of mask mandates, there is an increased risk to individuals and business operations that will need to be considered. Employers should assess how failing to mitigate risks could impact their organization through employee absences, lack of contact tracing resulting in increased spread, and workers’ compensation claims. Organizations should also consider the comfort level and mental health impact on their employees due to the removal of mask mandates. Hesitant employees may feel anxious about attending in person with relaxed mandates. Ongoing support for these employees, including guidance (i.e. how to effectively implement individual protective measures) and through the provision of masks, will be important in navigating this transition. On the other hand, there may also be employees feeling ready to move away from masking entirely. Effectively communicating to both groups with empathy and understanding will help establish a common ground. In each case, employers should consider mask mandates in relation to their impact on transmission rates throughout the worksite and the specific nature of their worksite. Where employees are deemed mission critical to business operations, and particularly in critical infrastructure services like electricity production, security, water supply, etc., employers will want to take all necessary steps to mitigate risk. Masks are an important risk mitigation tool in reducing transmission within the workplace.
Numerous public health agencies across Canada have permitted schools boards to remove mask mandates within their institutions. However, health experts are largely against this decision and believe it is too soon given the current environment of increasing cases and with only a few months remaining in the school year. Transmission risk remains a factor in schools and it is worth noting that many children are not yet fully vaccinated or cannot get vaccinated. For example, as of April 3rd, only 40.1% of children ages 5-11 are fully vaccinated in Canada (Health Canada, 2022), and about 1.8 million children under five years old, who also attend either school, daycares, or child centres, are not yet vaccinated. Consequently, children will continue to increase community transmission risk, especially for the immunocompromised, elderly, and unvaccinated populations. Fortunately, children continue to be for the most part spared from any significant burden of illness. Real-world data suggests that mask use, specifically in schools, helps reduce transmission. A recent U.S study suggested that mandatory masking in schools reduced COVID-19 cases by approximately 72% during the delta surge (Boutzoukas et al. 2022). Extending mask use within schools until cases are lower would be advisable. It is important to note that there have been concerns raised regarding a negative impact of masks on children, by impeding social and language development. These are real concerns that need to be weighed against the low burden of illness in children but the high transmissibility to household contacts.
Mask use as it pertains to air travel has the potential to be the next mandate removed as travel restrictions become more relaxed. Studies suggest that the risk of inflight transmission remains low in close quarters, due to effective aircraft engineering strategies like high laminar airflow and high-efficiency particulate air (HEPA) filtration, seat positioning, and extended gate ventilation systems (Rosca et al. 2021). Despite this, travelers should consider continuing to mask as a personal risk management tactic. MAS’s own Dr. Aisha Khatib, Clinical Director of Travel Medicine at Medcan, has been studying travel-related SARS-CoV-2 transmission. She was recently interviewed by Time on this topic and encouraged individuals to continue masking, preferably with N95/KN95 masks, while traveling. Dr. Khatib highlights that those travelers choosing to forego their masks due to quality filtration should at least consider wearing one during the deplaning process as air filtration systems turn off at this time and can increase the risk of transmission. Additionally, Dr. Khatib advises that combining masks with other mitigation strategies like social distancing during boarding, disinfection protocols, and pre-flight screening and testing all lower inflight transmission risk. Remaining masked when traveling remains one of the most effective mitigation measures and, when worn correctly, protects the traveler even around others that are unmasked. Overall, individuals who continue to mask should wear a protective mask that fits well and can wear consistently, with the N95 or KN95 being the more protective option than surgical or cloth masks.
As we see public mask mandates relax, it’s important to remind ourselves that organizations have the right, and in many respects the obligation, to make their own decisions regarding these protective measures. Individuals too have their own right to do what feels most comfortable, notwithstanding potential mandates. As MAS has outlined, the decision for organizations with respect to mandating of masks will largely depend on their own unique circumstances. Future variants will likely continue to emerge, the severity of which is unknown. Until all aspects of the science on COVID-19, vaccines, and public health measures are understood, we should all consider a precautionary approach and be ready to pivot at any time.
Nothing communicated as a part of Medcan’s Medical Advisory Services should be considered, or used as a substitute for, individual medical advice, diagnosis, or treatment nor do does this constitute the practice of any medical, nursing, or other professional health care , diagnosis, or treatment. Individuals should always talk to their Medcan health care provider for diagnosis and treatment, to ensure treatment is tailored to your specific health and wellness needs. The Medical Advisory Services are based on reliable scientific evidence and information available at the time of preparation. Source information and recommendations are subject to change based on scientific evidence as it evolves over time. Medcan is not responsible for future changes or updates to the information and recommendations and assumes no obligation to update based on future developments.