Since the pandemic began, masking recommendations in Canada have centred on the idea of protecting others: my mask protects you, your mask protects me. However, more contagious and potentially more dangerous variants of COVID-19 have some asking if it's time for an upgrade, so that people can rely on their masks to protect themselves as well as others.
Until recently, the supply of high-grade masks such as N95 respirators was limited, so they were mainly reserved for front-line health workers. The public was urged to rely on cloth masks to help limit the potential spread of droplets containing the virus from the nose and mouth.
However, the supply of N95 respirators for front line-medical staff has now caught up to demand in Canada and imports are more prolific. As a result, N95s and their international equivalents — such as the KN95 from China and KF94s from Korea — are becoming more widely available to average consumers. This has some advocating for their wider use in the community, and calling on Health Canada to change its messaging around which masks the public wear.
"In Canada we've always been reactive. We've always done things a little too late, a little too little," said Dr. Kashif Pirzada, an emergency physician in Toronto.
Pirzada is the co-founder of a group called Masks4Canada, which pushed to make public masking mandatory early in the pandemic. More recently, the group co-wrote an open letter to the government urging it to acknowledge what Masks4Canada, along with over 600 Canadian and international experts say is an overwhelming amount of evidence showing the virus is airborne.
"It's one of the best explanations of why it's spreading. And if we remember a very related virus, SARS-CoV-1, was airborne as well," Pirzada said. "Even if it's not airborne, we know [COVID-19] is more transmissible, so at least we can be more proactive about it and a higher quality mask may help. I think that's enough to really promote it right now."
The Journal of American Medical Association, Internal Medicine, published a study in December 2020 that examined how well different masks protect the person wearing them. The fit filtration efficacy (FFE) of various masks was measured using a device that detects particles behind the mask, with the following results:
Three-layer cotton mask: FFE 26.5 per cent
Non-woven polypropylene mask with fixed earloops: FFE 28.6 per cent
Medical procedure masks (surgical mask): FFE 38.5 per cent
N95 respirator: FFE 98.4 per cent
The study also found that the FFE of cloth and surgical masks can be increased with modifications that improve fit, such as double masking or tucking and knotting a surgical mask.
Other studies, including research by the U.S. Centers for Disease Control (CDC), indicate that the snug fit of N95 masks prevents air leakage, which is part of the reason they outperform many other surgical masks when filtering out droplets infected with the COVID-19 virus.
WATCH | Why your masks may not be as protective as you think:
Pirzada says the wider use of N95-style masks could be key to stopping some of the outbreaks seen across the country, such as the one at the Canada Post Facility in Mississauga, Ont., where 273 employees contracted COVID-19 in January.
"Distribute and require advanced masks like N95s in crowded workplaces or at-risk workplaces, and help people get them to do common grocery shopping and other things," he said.
What Pirzada is suggesting may sound like a leap from Canada's current masking guidelines and policies, but it is not unprecedented. Earlier this year, some countries in Europe started mandating the use of N95-style masks in public, including the Czech Republic, the German state of Bavaria and Austria.
In Europe these respirators are called FFP2 masks, named after the European filtration standard of 94 per cent they are required to meet.
"The FFP2 mask does provide better protection to the person wearing it, which is also an incentive to increase compliance," Dr. Katharine Reich, the Chief Medical Officer of Austria, told CBC News.
"We wanted to increase compliance, because we often saw people who were wearing the masks down the nose and under the chin. The FFP2 masks are much more of a rigid material, so the proper wearing of this mask is much easier."
In Austria, FFP2 masks are required by anyone over 14 years of age in all public spaces including shops, public transport, long-term care homes and schools. To ensure access for all citizens, Austrian grocery stores sell them for less than a euro, or about $1.50 each. The Austrian government also provides free masks to everyone over 65 years old, as well as to those with low incomes and to homeless shelters.
This was possible, Dr. Reich says, because Austria started manufacturing its own FFP2 masks about six months ago. She says the country now has a stable domestic supply, and enough to provide them for all citizens.
Today, Canada is getting closer to self-sufficiency with its own mask supply.
In March last year, the Government of Canada issued a call to action, asking Canadian businesses and manufacturers to scale up and re-tool their businesses to help in the fight against COVID-19. More than 6,000 companies answered the government's call and over 1,000 of them started making personal protective equipment (PPE), including Vitacore in Burnaby, B.C.
"I think that it's in our national-security interest for us to be able to manufacture locally, especially things such as respirators that are just required during emergencies such as this," said Mikhail Moore, president of Vitacore.
When the pandemic hit, Moore used his background in engineering to build his mask-making facility from the ground up. He says the company now produces more than six million respirators a month.
"So with the scale-up that's occurred, we're producing even more respirators than are required by front line workers at this point. And so we are kind of opening the doors to the general public to be able to wear respirators as well," Moore said.
They are not the only company ramping up production.
Medicom in Montreal and Dent-X in Vaughan, Ont., say they're also producing N95s in the millions each month. 3M says its new plant in Brockville, Ont., will start shipping its first Canadian-made 3M N95 respirators next month.
The Public Health Agency of Canada, however, still advises Canadians to wear cloth masks.
"We are recommending you consider a three-layer, non-medical mask which includes a middle filter layer," Chief Public Health Officer Theresa Tam said in a press conference in November, 2020, and since then the recommendations have not changed. Only those at higher risk of exposure, or of more severe disease or outcomes if they contract COVID-19, are told to consider wearing a medical-grade surgical mask if one is available to them.
When Health Canada was asked why the guidelines have not changed, it said that, "Public Health is aware of recent discussion around the use of N95s in the community," but added that it "will not be changing its stance on masking ... as there is no evidence to warrant a change."
Dr. Kashif Pirzada questions why Health Canada wouldn't advise Canadians to wear the highest level of protection they can get.
"We should just take the most cautious path possible and limit [exposure] as much as we can," he said.
"We're not far from mass vaccinations. We just need to buy two to three months, and then we're hopefully there."
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