Here’s a trick question that could save your life: What’s your first line of defence against COVID-19?
No, not the ever-elusive vaccine.
A shot in the arm is your last line of defence if it’s not coming anytime soon. The most medically effective (and cost effective) protection - right here, right now, not months from now - is staring you in the face.
Masks - more masks, better masks, double masks, for many months to come. All the more reason to clear the air about masks that filter the air of deadly viral particles.
The silence from our top health experts and political leaders at every level is deafening - and contaminating. Our governments, so quick to give detailed instructions for building codes and precise measurements for passport photos, still can’t give us the straight goods on the best masks and best practices.
Under President Joe Biden, the U.S. government is now overtaking us not only on vaccine distribution, but mask dissemination. The Atlanta-based Centers for Disease Control and Prevention announced Wednesday that double-masking can filter more than 95 per cent of the COVID-19 virus if two people are wearing them at close quarters, protecting each other at one and the same time.
The story of masking in Canada is a tale of mixed messaging last year, followed by unmitigated neglect this year. We have fantasized about mass vaccinations in the moment, fetishized all those phantom fomites (countertop germs) and obsessed about elusive “iron rings” in nursing homes (predictably porous), while ignoring the most basic public health protection still under our control.
Scientists initially warned people off protective masks - reserving them for front-line medical workers and wrongly asserting they wouldn’t benefit the rest of us. Proven wrong, they later exhorted us to find our own masks, or improvised cloth coverings, for as long as the best N95 respirators were in short supply.
It made perfect sense to update that advice in light of changing evidence early last year. It’s utter nonsense that all these months later we haven’t been told far more about how to properly mask ourselves.
With high school students returning to class within days, I wrote over the weekend about the need to raise our game with masks. The response to my column, clamouring for more information, tells me that our governments are still not giving us the guidance we need and that the media keep missing the story.
Endless snarling about delayed vaccines or snarking about hapless politicians is little more than second-guessing from first to last - and leaves us no further ahead, as the Globe’s health policy columnist André Picard argued this week. Some critics are so busy chasing their tails they can’t see past the ends of their noses at the life-saving power of the mundane mask.
Some of the punditry worships at the altar of epidemiology as the new cosmology, though its accuracy is closer to astrology - never quite wrong but rarely all that right to be much use. If the virus keeps changing - variants are the new variables - extrapolating is an endless guessing game.
Why have we elevated epidemiologists to a rarefied priesthood of expertise when the more verifiable and actionable information is coming from the physicists and engineers who understand fluid dynamics and vapour trails? It’s a question that preoccupies Mario Possamai, a senior adviser to the Ontario government’s SARS Commission.
“Between SARS and the advent of COVID-19, there were huge advances in our understanding of how aerosols behave,” he told me. “Much of that research was done by physicists and engineers - and not by the epidemiologists and infectious disease experts who dominate public health.
“There was a professional rivalry that has led to the epidemiologists and infectious disease experts dismissing the expertise of physicists and engineers.”
The reflexive response in many workplaces was to protect workers with Plexiglas and face shields. But aerosols aren’t linear, they are insidious - going their own way in much the same way as second hand cigarette smoke spreads indoors but dissipates outdoors.
Absent expert advice, the fearful response from many people has been to discard perfectly good masks - much like milk that is past its best-before date, but not necessarily bad after. That makes sense in certain health-care settings, where masks are covered in aerosols from intubating or sneezing, but governments need to reassure ordinary users that good masks can be reused merely by rotating them out every few days (lying fallow while the fomites fade away).
The only certainty is that this year’s variants are more transmissible than last year’s COVID-19. We are counting on - and waiting for - the efficacy of last year’s vaccines, but what we need more than ever, sooner than ever, is better masks, and better masking, to cope with the new COVID-19.
It is to the discredit of Canadian deference to authority that we are not demanding more information about how to protect ourselves indoors, in confined spaces, where the air flow is minimal and the aerosols are maximal.
The CDC says putting a cloth mask on top of a surgical mask ensures a snugger fit, and it also offers detailed assessments of KN95 manufacturers (which don’t undergo the rigorous certification of an N95 and may not fit as snugly, but can offer significant protection).
I argued last year that we needed to make masks mandatory - Ford kept fobbing it off on municipal councils - but by summer the policy was widely adopted, and later imposed on students in class. Yet all these months later, with the government’s guidance on masks so derisory, a compulsory policy is illusory.
If you buy clothing or furniture in Ontario they come with government-ordered tags attesting to new material, yet masks remain uncertified and unsanctioned. Why not full-page newspaper ads and online advisories with detailed recommendations? Where are the TV commercials with celebrities and scientists - or hybrid celebrity-scientists - walking and talking us through the masking?
The good news is that we now know masks are more effective and protective than we ever fathomed. The bad news is that we’re not helping Canadians get their hands on better masks - nor equipping them with the details they need to inform themselves and protect everyone else.
Martin Regg Cohn is a National Affairs writer.