Thread by @BogochIsaac

1/
Masks....my least favourite topic of the #COVID19 pandemic.

There is an argument to mandate these in Canada.

I think (at this point in our epidemic) this is not the right approach...at least not for now. We may come to it, but certainly not now.

tinyurl.com/yablxv4j

2/
Nobody is arguing that masks don't work at an individual level. They help reduce the probability of transmitting infection - we've known this long before #COVID19.

Proximity and duration of exposure to an infected person are key factors, especially in indoor settings...

3/ ...so put a mask on when going indoors in a public setting, especially one where you can't physically distance yourself from others, & especially in areas of #COVID19 transmission. Pretty straight forward.

But mandates for masking? Right now? In Canada? Not now. Maybe later.

4/
*Build trust now before any possible mandate*

We have a lull now in Canada. Now is the time to do this.

We may get a second wave in the fall/winter where mandates may be enacted depending on outbreak/location. Don't shoot your shot too soon (below).

5/
Now is also the time to NORMALIZE mask use, give 'em out like halloween candy on public transport & in businesses, OPTIMIZE communication of when/where/how to wear one.

If/when the time comes to mandate, a regional approach is best - target high impact region/setting.

6/
And if/when masks are mandated, give them away free of charge. *THIS IS AN EQUITY ISSUE*

You cannot exclude people from interacting with the world around them. Some cannot afford or make a mask.

Check out this successful program: bit.ly/3eAim5P

7/
Public Health requires public trust.

Think about mandating masks in regions with 0-to-few cases. Consider what a "mandate" is. Consider enforcement, and consider what that does to public trust.

For those who continue to cite the "precautionary principal" see below.

8/ Enforcement: Remember that disaster with Toronto By-Law officers handing out $880 fines for being in a park during the lockdown? Remember how well that turned out for public trust in public health? Yeah. Don't do this. If you think about mandating, how do you enforce?

9/ Enforcement II: If it is not enforced, is it really a mandate? Or is it a strong recommendation (which is what we already have).

Have a listen to this guy (@cdavidnaylor - with the best thread on this)...he knows a thing or two about a thing or two:

https://twitter.com/cdavidnaylor/status/1274404137745240064?s=20

10/ Enforcement III: Equity. There's that word again.

Just read the title:

"Millions of dollars in COVID-19 fines disproportionately hurting Black, Indigenous, marginalized groups: report"

Now forget fines, and think about access to transit & business.
tinyurl.com/y85xlyo5

11/
Timing & location are key: Are you going to mandate masks in settings with 0-few-cases? Burn your public trust here? What happens if/when there is an outbreak in the fall & you really need that public trust for masks or re-imposing public health restrictions? You need buy in.

12/
Science: Good luck with a reasonable discussion on twitter.

Think about the incremental value of masks in *community* (not individual) settings. Look at assumptions & primary data in the models. Sadly they don't do as much as we would like. @AntibioticDoc knows what's up.

13/
Politicizing this: yeah...let's avoid that US-type scenario with some reasonable discord.

For some in the Canadian #masks4all camp: thank you for softening your stance and listening to reason.

For those who don't/wont wear one: strongly worth reconsidering.

14/
In Canada, when you consider timing, current burden, geography, enforcement, practical measures, politicization, data, messaging/communication, and forecasting...now is not the time to mandate masks. We *may* get there (key word: "may"), but we are not there yet.

ps: I like a lot of what @ASPphysician says here:

https://twitter.com/ASPphysician/status/1277240006894026752?s=20