Thread by @jeffgilchrist

Why aren't people wearing masks?

A behavioural psychologist explains why Canadians still aren't willing to wear masks even when multiple viruses are causing children to be hospitalized at unprecedented rates ( theglobeandmail.com/podcasts/the-d… ). H/T: @_SunshinyDays 🧵1/

People should listen to The Decibel podcast but I will try to summarize the points here in text. Dr. Kim Lavoie (@kimlouiselavoie) is a psychologist at UQAM, Canada Research Chair in Behavioural Medicine, and co-director of the Montreal Behavioural Medicine Centre. 2/

Why aren't we seeing more people masking at this point in the pandemic? One issue is we haven't empowered people to properly do situational risk and when and how masks should be used. Now that masks aren't mandated, people need decision tools to help make risk assessments. 3/

Dr. Lavoie provides an example of bringing her 11 year old son to a chess tournament at a large college over the weekend where there were 500 parents and kids jammed into the cafeteria while only maybe 10 people wearing masks. 4/

She wondered why so many other people were not assessing that it was high risk, not just in general but right then. 5/

There is a lack of knowledge and understanding of what situations are high risk and the consequences if you don't protect yourself and others right now. As a result, what we are seeing in hospitals now is that pediatric emergency departments are overwhelmed. 6/

Kids are struggling to breathe, not just because of COVID but from other infections like Influenza, RSV, and now being impacted by bacterial infections too. 7/

Using pandemic management strategies that heavily rely only on vaccines are driving some of these consequences and to the detriment of promoting other behavioural prevention measures such as masking. Most importantly, we never really created a social norm of mask wearing. 8/

[Jeff comment: Governments and public health are not using the word airborne so many people don't understand that respiratory viruses are spread in the air through aerosols which masks and better ventilation will reduce the risk ( )]. 9/

How do we improve?
1. Help people evaluate risk (places, conditions we need to be wearing a mask)
2. Promote masks as being accessible, low cost, non-intrusive prevention tools for everyone to wear in these high risk situations.

10/

3. We need to make masking a symbol of community unity and values: resilience, solidarity, showing we care for others in our population that are more vulnerable. Even pre-pandemic, Asia has done a fantastic job of this.

11/

4. We can create a social norm but we need to stop demonizing the mask where they have become a symbol of oppression and a pandemic we want to forget, and people being told they are scared or sheep for wearing masks.

12/

Dr. Lavoie thinks this demonization started because we had a very authoritarian policy around masking ("Do it and be compliant to what I am saying you should be doing"). 13/

Most provinces created policies that people had to wear masks or they would be punished and remove access to things if you don't (shopping, restaurants, flying, etc...). This was a model of punishment if you do something "bad" and not reward if you do something "good". 14/

So governments and public health across the country have done the opposite of what behavioural scientists would have advised them to do. 15/

When you train the public to wear masks to avoid punishment and then remove the punishment (no more mandates), the motivation and behaviour to wear masks is going to go away too. 16/

Public Health never really showed the population not only how and when masks should be used, but also the benefits, the pros, and the non-negatives. 17/

Dr. Lavoie points out that we are still hearing some pediatricians today say that it is harmful for kids to wear masks in school and impacts their development and learning. 18/

"There is absolutely no evidence anywhere in the world of this, absolutely none but right now across Canada there are thousands and thousands of kids that are home sick, missing school entirely..." 19/

"... and God knows what else in terms of Long COVID and other respiratory symptoms, not able to get the care that they need." There *is* evidence however that getting sick is bad for kids and families. 20/

Early in the pandemic when public health said people didn't need to wear masks because there weren't enough for healthcare works or that there wasn't enough evidence yet, sowed the seeds of doubt in many minds that masks weren't helpful. 21/

Public Health should have been very transparent about the things they didn't know and err on the side of caution. 22/

Evidence already existed from previous pandemics and flu seasons that masks were helpful so instead Public Health should have said that there is good theoretical evidence that masks are helpful. 23/

In the early stage of the pandemic as a society we need to prioritize the limited supply of masks to the people that really need it, and right now that is our healthcare workers. Then reassure people they are working on ramping up supply so everyone will have access to masks. 24/

In the meantime this is what you can do while waiting for access to masks, such as stay home and minimize your contacts for a short period of time until mask supply is accessible to everyone. 25/

Modeling behaviour makes a huge difference and is completely predictable that people would resist a "told what to do" policy and then not have those same leaders actually doing the thing they are asking others to do. 26/

Politicians are doing photo ops of themselves indoors in crowded places not wearing masks themselves after asking everyone else to wear masks to help the overflowing Children's hospitals. 27/

When officials ask the public to mask to help with the current surge but seemingly this recommendation doesn't apply to them, it undermines their credibility and the perception of the real importance of wearing masks. Their behaviour also builds mistrust, cynicism, and anger. 28/

Dr. Lavoie feels the reason why governments do not want to impose any additional mask mandates is because they are afraid of what happened with the convoys. She thinks the convoys didn't happen overnight but slowly built and their message isn't what all Canadians feel... 29/

...but it is the kind of thing that can happen when you have recommendations for the public that don't seemingly apply to those making the rules. People made so many sacrifices during the pandemic and these behaviours stoke our perception of fairness. 30/

If you look at the data, the pandemic has never been worse than it is right now and yet now we have zero policies, zero prevention measures in place of any kind. We have more deaths in Canada in 2022 than in 2021 or 2020 ( public.tableau.com/app/profile/bi… ). 31/ Click "Show replies" 👇

The governments are not really sharing the data they used to make many of those decisions for restrictions and we aren't seeing what the benefits were for making all those sacrifices. 32/

The challenge when you prevent death or illness is that you don't see it, therefore it is hard to show if you have been successful in preventing things. 33/

Dr. Lavoie states there are modeling techniques that estimate how many people have been saved from infection through adherence to all these health measures in the millions but we don't see that on billboards or on our TVs. 34/

People are not seeing the number of people that could have perished if we hadn't implemented all of those strict measures early on. 35/

How do we get people to go back to masking on their own accord?
1. We need to show the public what masks have done for us and look at what they can do for you.
2. Present clearly what are the benefits of masking

36/

3. Promote masks as one of the most essential prevention tools that we have
4. Masks are also the least expensive, most accessible, and least intrusive measure

37/

Since kids are currently the most impacted by the respiratory virus season surge, the fact that masks are not currently being recommended in schools or daycares where transmission risk for kids is the highest and the cause of the healthcare system being overloaded... 38/

... people are wondering why would we need to wear them anywhere else like going to work or shopping? Dr. Lavoie highlights that the messaging doesn't make sense. 39/

Dr. Lavoie is not calling for a widespread all or nothing mask mandate, they should be focused on the places they are needed the most. 40/

If you want to go to a bar or restaurant, that activity is incompatible with mask wearing but is not an essential place to go and you can order takeout if you want. People can individually risk assess for those types of activities. 41/

For places people have to go like pharmacies, grocery stores, school, work, you mandate masks in places where wearing a mask doesn't interfere with what you are doing. 42/

You may not have to wear the masks continuously at work, put it on for meetings but you can take it off if you are alone in your own office. 43/

It is about teaching people where and when to wear the mask and it is not all or nothing. In the meantime, Dr. Lavoie thinks we do need a strong recommendation or even a mandate for certain targeted spaces and schools is definitely one of them. 44/

Does universal masking actually work? Yes, they substantially reduce infections and outbreaks which you can read more about here ( nejm.org/doi/full/10.10… ) and (

https://twitter.com/jeffgilchrist/status/1564223169224916992

). 45/

Babies can even tell that you are smiling under your mask and smile back (

https://twitter.com/DocMCohen/status/1601902178125348864

). 46/

The impact of lifting universal masking in schools around Boston was determined that over a 15 week period after universal masking was lifted the excess cases translated into at least 6500 days of staff absence and 17,500 days of student absence ( nejm.org/doi/full/10.10… ). 47/

Now so many kids are absent from school/daycare and at home sick that even a small percentage developing severe diseases are overwhelming the pediatric hospitals across the country. 48/

You can see the number of pediatric flu hospitalizations is continue to skyrocket this season, much higher than pre-pandemic levels ( canada.ca/en/public-heal… ). 49/

BC Children's Hospital is now putting 2 patients in a single-patient room to help deal with the surge ( bc.ctvnews.ca/bc-children-s-… ), CHEO called in the Red Cross to help manage the load of patients ( ottawa.ctvnews.ca/cheo-to-receiv… ). 50/

Alberta Health Services halted respite care since staff needed to be redeployed ( calgary.ctvnews.ca/ahs-halts-resp… ). 51/

To read more about the science behind masks and their use, check out Bill Comeau's (@Billius27) excellent article ( billius27.substack.com/p/masks-eviden… ). 52/

Bill Comeau's (@Billius27) also did a review of Canada's current post-mandate status ( billius27.substack.com/p/the-case-for… ). "If mask mandates had not been dropped, right now we could be looking at roughly 4.4 million fewer infected by Omicron, 2,300 fewer Omicron deaths..." 53/

"... 230,000 fewer long covid cases, and of course fewer child respiratory illnesses that are currently overwhelming children’s hospitals." 54/

For people who want to share more easily or read all on one page, you can find an unrolled web version here:

https://twitter.com/jeffgilchrist/status/1602301326049804295