B.C. mask debate: Divide between frontline doctors and public health amid concerns of politicized office

Soaring respiratory infections among children – with an unprecedented number of B.C. youngsters dying just weeks into the flu season – have frontline health-care workers pleading for the revival of mask usage, something the provincial health officer remains lukewarm on.

Some doctors are calling for mask mandates in the most high-risk public settings, such as enclosed, close-quarters buses. Others are pleading for Joe and Jane Public to do what public health won’t require: voluntarily mask up to curb the spread of all respiratory viruses. 

“I would absolutely love it if everybody took the time to think of kids who are suffering, kids who are sick, and put a mask on,” said Vancouver family physician Dr. Anna Wolak.

Provincial health officer Dr. Bonnie Henry didn’t voice particularly strong support for masks on Monday, suggesting they’re only needed in “certain situations." And she repeated her long-held stance on mandates.

“A mandate is a rather heavy-handed measure that we do as a last resort when it’s something that is absolutely needed everywhere all the time,” she reiterated, recommending vaccinations and staying home when sick as the primary lines of defense.

Her counterpart in Ontario, Dr. Kieran Moore, was unequivocal last month in "strongly recommending that all Ontarians, not just those at high-risk, wear a mask in indoor public settings.”

While recent polling showed 79 per cent of Canadians would support the return of face masks to some extent, there are no province-wide mask mandates anywhere in the country, and it’s unlikely any jurisdiction wants to be the first to faced renewed opposition.

POLITICIZED BUREAUCRATIC APPOINTMENT

Recently retired premier John Horgan had repeatedly pointed to Henry as the person making decisions about mandates. With his successor David Eby now sworn in with a new cabinet, CTV News asked the premier's office whether he would continue to have the public health officer take the lead, or if he would take a more active role in pandemic decisions. The office has not responded.

A report analyzing the provincial government’s handling of the pandemic – which had been criticized for excluding any scrutiny of the provincial health office – nonetheless made several observations, including poor communication with stakeholders and repeated complaints communication did not improve after the initial crisis period. 

“After the initial phase, there was strict central control of the messaging, including actively discouraging any questioning or challenging of the PHO,” wrote the report’s authors.

Hamish Telford, an associate professor of political science at the University of the Fraser Valley, gave Henry credit for earning the public’s trust in the early days of the pandemic, but is now concerned her position is becoming increasingly politicized.

“As we've moved into the latter phases of the pandemic, the public health officer doesn’t seem to be offering the government straight-up medical advice, but is couching that advice with political and economic considerations, effectively taking over the responsibility of making these decisions for the government, and the government has gone along with that,” he said.

Telford went on to agree there is a contrast between the messaging from doctors in the community – often one of desperation and dismay at personally treating sick youngsters – and public health officials in their government offices.

“At the end of the day, she is a doctor who should, in my view, be listening to the medical community and the advice they're offering from the front lines,” he said. “She should not be so concerned with public opinion, particularly emails that may come into her inbox from concerned citizens. She really needs to put that aside and focus on the medical dimensions of the crisis we're in.”

SCHOOL MASKING STUDY

Last month, Henry was asked about masking in schools, particularly in the wake of a study that concluded they reduce COVID-19 spread, which she dismissed. 

The lead researcher on the study, which was published in the New England Journal of Medicine, was raised in Metro Vancouver and still keeps tabs on her old stomping grounds. She expressed surprise at Henry’s remarks. 

“The things that were happening in B.C. in the first eight, 10 months of the pandemic actually worked,” said Boston University epidemiologist Dr. Ellie Murray, referring to masking, distancing and gathering restrictions.

“We can't do all those things again, but which things can we do that either are sustainable from that set of things or can be replaced in a more sustainable way?”

Masking, she suggests, is a minimally-invasive way to do that. Her study found that when the Boston school district lifted mandates and allowed schools to decide their own masking policy, about half lifted requirements, while the others gradually did so, allowing for a “natural experiment.”

Murray, who is an expert in causation, was surprised to find that schools that lifted the mandates had 30 per cent more COVID-19 infections than those that didn’t. However, masks are just as politicized in Boston as they are in B.C., and despite the results, mandates were eventually removed entirely there as well.