How Many More Will Die Before We Stop Politicizing Masks?

Despite the record-setting COVID-19 cases across North America, recommendations about how to celebrate the New Year vary. In Canada, Quebec instituted a curfew and Ontario asked people to conserve rapid tests for use when symptoms appear, rather than using them to socialize. Indeed, perhaps the most consistent thing about the entire pandemic has been the lack of consistency in the public health responses. Some variation makes sense. As the second-largest country in the world, Canadians cannot expect the pandemic to unfold identically from coast to coast to coast. But even when taking population density and case counts into consideration, we have still seen drastically different responses across the country.

The Fifth Wave Brings Varied Responses

In the face of the fifth wave, Quebec has not only instituted a curfew, but they also moved schools online until at least January 17th. Ontario, facing very similar record-breaking daily case counts, continues with a more or less “business as usual” approach and thus far has only delayed the opening of schools by two days to provide time to distribute N95 masks to staff.

Public health experts recommend the use of K/N95 masks to reduce transmission of Omicron.

Source: Markus Winkler / Pexels

Some universities are returning to remote learning until at least the end of February, while others still maintain that in-person classes will begin by mid-January. Some campuses have mandated the use of N95 masks, while the majority have not yet made changes to their mask policies. In other words, the issue of masking is once again taking centre stage.

COVID-19 Daily Coping Study

In March 2020, I launched an online diary study with my students and colleagues to track Canadians’ responses to the pandemic. Masks were not yet being discussed at length and the general advice was to leave the PPE for the healthcare workers. As such, we did not include questions about mask-wearing behaviours or attitudes.

As more data came in from around the globe concerning the relative effectiveness of various types of masks in reducing the spread of COVID-19, messaging on masks began to change. Canada's Chief Public Health Officer, Dr. Theresa Tam, first recommended wearing non-medical masks indoors on April 6, 2020. At that time, we added questions to our study about people’s attitudes and behaviours concerning masks.

Political Polarization of Masks

What we could not have predicted back in March or April of 2020 was how politicized the issue of mask-wearing would become. In fact, even John Hopkins’ own pandemic modelling events failed to account for the potential influence of political polarization and public health-shunning leaders. I do not need to rehash the controversies that have arisen over masks; suffice to say that the issue has torn families apart and catalyzed countless protests.

New recommendations about what kind of masks to wear (e.g., N95 vs non-medical masks) are now emerging as we enter the fifth wave of the pandemic with a more transmissible variant. What can we learn from the successes and failures of public health messaging concerning masks during the earlier waves of the pandemic?

After adding questions about masks to our study, 1,527 Canadians participated in our 28-day study. Each participant was sent a daily link at 6 p.m. to tell us about their day, including questions about mask-wearing behaviour. All the data I am discussing here was collected before mandatory mask mandates were issued in any jurisdiction in Canada, and thus the behaviour people reported was based on their own assessment of the risks and not their willingness to follow the law.

What Predicts Mask-Wearing Behaviour and Attitudes?

Individuals who were older and had more risk factors for severe COVID-19 complications were more likely to wear masks.

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Some of what we learned was not that surprising. For example, the people most likely to report frequent mask-wearing and support for the issuing of mask mandates were the individuals at greatest risk of severe COVID-19 complications. Individuals who were older, who believed the pandemic to be a more serious or severe threat, who lived in an urban (vs. rural) area of the country, and who had personal risk factors reported the greatest frequencies of mask-wearing during the months prior to any mask mandates in Canada.

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How Political Partisanship Can Be Deadly

But, when we looked at support for mask mandates, we began to find some more surprising patterns. More specifically, we looked at how patterns of support for mask mandates varied before and after May 20th, 2020. Why this date? On May 20th, 2020, both Dr. Tam and Prime Minister Justin Trudeau announced in a press conference that they, personally, would be wearing a mask when in public. On the surface, this may seem like an innocuous announcement, but it may have been one of the many seeds from which the controversies surrounding COVID-19 mask mandates in Canada sprung.

For participants who began the study before May 20th, believing that the pandemic was serious was associated with more positive attitudes towards the notion of governments mandating the use of masks in public. After May 20th, however, the picture changed such that a wide variety of demographic and personality factors predicted attitudes towards mask mandates. Most notably, holding more liberal political views and having a lower level of psychological reactance were both associated with greater support for mask mandates, but only for participants joining the study after the remarks made by the Prime Minister and Dr. Tam. In other words, it appears that prior to the announcements on May 20th, political views had very little to do with Canadians’ attitudes towards mask mandates, but after May 20th, the political division began to grow.

Perhaps if the other political leaders across the country had followed suit immediately with similar messages, mask-wearing would have become a universal and uncontroversial action of goodwill in a collective battle against COVID-19. Perhaps Canada would have carved out a typically Canadian story of unity in the face of crisis, but instead, we followed in the footsteps of the divided nation to our south.

Unfortunately, the polarization around mask-wearing only increased after the actual mandates appeared, and they continue today, across the continent. In more conservative regions of the United States and Canada, mask-wearing frequencies are lower, along with lower vaccination rates.

What is one thing you can do in 2022 to help the world cope with the pandemic?

Source: Towfiqu barbhuiya / Pexels

Will 2022 See the End of the Pandemic?

When our paper was published, the world had seen 111 million cases of COVID-19 and 2.5 million global citizens had died. Only 8 months later, the number of worldwide deaths has more than doubled to 5.4 million.

Whatever the next round of public health recommendations concerning the fifth wave may be, let us hope that this time the message is not lost in its association with the messenger. Let us hope that the message is delivered clearly from our leaders across the country and the full range of our political spectrum. Viruses do not select their hosts based on political affiliation and thus we must do all we can to help our public health experts deliver their message to all Canadians.

As we enter this New Year, let us make the collective resolution to step away from defining the world in terms of "us vs. them" and to find the shared humanity in all of us. Our capacity to make the fifth wave the last wave may depend upon our ability to do just that.