Coronavirus face masks are mandatory outdoors in Italy. Should Canada do the same?

By now, the world has grown accustomed to having a mask on hand when leaving the house to go to work or the grocery store.

Italy took it one step further on Wednesday, making it mandatory to wear face masks or face coverings outdoors nationwide. It’s the country’s latest effort to curb the spread of the coronavirus, where new infections have jumped yet again.

It’s likely a “game theory approach,” or the science of strategy, according to Raywat Deonandan, an epidemiologist at the University of Ottawa.

“If you see people wearing a mask more often, you’re more likely to normalize it in your own life and you’re more likely to signal to other people that you’re taking it seriously and people feel safer. … It maximizes the usage statistics overall,” he said.

“However, I don’t think it’s necessary. I suspect it has more to do with social signalling than it is about actually diminishing outdoor transmission.”

Efficacy of masks

The science surrounding masks is clear.

Studies show they can help save lives in different ways, such as by cutting down the chances of both transmitting and catching the virus and by reducing the severity of illness if people do become infected.

When it comes to requirements around wearing a mask in Canada, the rules vary by province and region, but most of the emphasis has been on mask-wearing indoors and when distancing can’t be adhered to.

That still stands despite Italy’s decision, said Dr. Isaac Bogoch, an infectious disease specialist based out of Toronto General Hospital.

“When we look at the available data, which is growing exponentially by the day, we see very few transmissions in outdoor settings,” he said.

“While the risk is not zero per cent, it’s really, really, really low.”

The new mask mandate requires Italians to wear masks at all times outdoors, unless they can guarantee they can be completely isolated from anyone other than family. It effectively makes them obligatory in all urban and semi-urban settings, with exemptions for eating in restaurants and bars. 

Given that it’s not entirely impossible for the virus to be transmitted outdoors, people should continue to stay two metres apart, avoid large crowds, and wear masks when these can’t be achieved, said Bogoch.

But Canada has had its fair share of unauthorized gatherings outside that, while against public health policy, didn’t spark large chains of transmission, if at all.

“Think of Trinity Bellwoods Park in Toronto, where thousands of people showed up. We’ve had Black Lives Matter protests in Canada. We’ve had outdoor car rallies,” Bogoch said.

“No one is saying these should have happened, but we did not see a bump in cases as a result of all of them.”

However, there have been instances, like the 40-person barbecue in Ottawa, for example.

The focus should still be where the “risks are the greatest,” Bogoch said. “The risks are greatest indoors.”

So why did Italy implement it?

The major motivation is likely to “normalize” mask-wearing, Deonandan said.

“But also, Italian culture has a lot more outdoor gatherings, like public squares,” he said. “So if your culture is one that has a fair amount of crowdedness outside for long durations, it might make sense to wear a mask outside. I don’t think that’s the case for most of Canada.”

Italy was the first country in Europe to be hard-hit by COVID-19. It also stands as the second-highest death toll in the continent after Britain.

With one of the strictest lockdowns in the world, Italy was able to control the spread by the summer, but infections have surged again.

While daily coronavirus-related deaths still remain far lower than during the country’s first wave, the fear of returning to April-level crisis might be motivating the new outdoor mask policy, said Zahid Butt, an infectious disease specialist with the University of Waterloo.

“Italy suffered a lot,” he said. “They don’t want it to happen again.”

“Pandemic fatigue” may also be a reason why governments are looking to scale up basic measures, said Butt.

The World Health Organization (WHO) warned in a recent report that levels of apathy among some populations in Europe is rising, with the scale of this “pandemic fatigue,” estimated to have reached over 60 per cent in some cases.

The WHO doesn’t specifically recommend masks outdoors for the general population, but it’s not unusual for this to become commonplace as people solidify their pandemic habits, Butt said.

Should Canada follow?

Bogoch and Deonandan aren’t convinced making mask-wearing mandatory outdoors would have a meaningful impact on the pandemic in Canada.

“You have to ask yourself — is the juice worth the squeeze?” Bogoch said.

“I think, in general, people typically fall in line if there’s a policy, but you have to wonder what’s the utility of that type of policy. How much increase in benefit will you get on the control of the virus with a policy like that?”

There may be even less of an appetite for such a measure, given some of the divisive political discourse surrounding masks that has permeated through North America, Deonandan said.

Canada is also on the precipice of a second wave. Like Italy, cases are climbing in much of the country.

The notoriously cold Canadian winters are also on the horizon, which experts have warned could strengthen the spread of the virus. The cold, dry air allows virus droplets to hang in the air longer, and that same air tends to dry out our mucous membranes, making us more susceptible to viral infections. But the main risk for cold weather amid a pandemic is “when it’s cold, we tend to go inside,” Deonandan said.

“That’s the major driver of cold weather transmission. So the face mask-wearing, again, matters most indoors.”

On the other hand, there’s no harm in wearing one outside if you choose.

Lining up outside clinics and grocery stores, you technically don’t need to wear a mask, since you’re standing on markers and keeping your distance, Deonandan said.

“However, doing so makes everyone else feel safe around you. That’s no small thing,” he said.

“So much of controlling this epidemic is in being good to each other and managing psychologies and keeping passions at a calm level. If wearing your mask outside helps in that endeavour, then so be it.”

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