Mask exemption cards highlight struggle to find balance

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Shortly after Edmonton’s mask bylaw took effect at the beginning of August, requiring people to cover their faces in indoor public spaces to curb the spread of COVID-19, the city attempted to help people who are exempt for medical or other reasons by providing official exemption cards.

The program was shut down within days amid concerns that the cards were being abused by people with no legitimate reason not to follow the bylaw. Roughly 6,000 cards were handed out.

Like Edmonton, jurisdictions across Canada that have imposed mask requirements have also carved out exemptions, including for people with medical reasons or reduced mobility that make it difficult to wear face coverings.

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Even though most of those rules make it clear that no proof is required to claim an exemption, mandatory mask policies have led to the creation of mask exemption cards, either homemade documents downloaded from the internet or, in some cases, official cards handed out by public bodies.

The cards in Edmonton and other cities have underscored how governments across Canada are struggling to balance the benefits of widespread mask use with a small number of people with legitimate reasons to not wear them, and who have legal rights to be accommodated under human rights laws. At the same time, public-health experts have warned that the cards could hurt compliance and encourage people to erroneously claim medical exemptions. Medical groups have cast doubt that some conditions such as lung diseases would preclude mask use.

Mask bylaws have included exemptions for health reasons that include conditions that make it difficult to breathe, mobility issues that can make it difficult to put on and remove a mask, or mental-health conditions such as PTSD that can make it difficult for people to keep their face covered. There are also exemptions for small children, typically under 2.

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In Edmonton, the city is now looking at whether it can fix the exemption card program and is examining potential fines for misuse.

Mayor Don Iveson said the cards were a well-intentioned attempt to ensure people who couldn’t wear masks were treated fairly.

“While we all want to believe that Edmontonians would act ethically and only those who truly need the card would go out of their way to get one; this sadly proved to be not the case,” he said during a recent news conference.

“Clearly, some individuals abused the privilege.”

Mr. Iveson called for a provincewide mask law that would require medical proof, similar to special parking passes for people with disabilities. The provincial government has rejected calls for an Alberta-wide mask mandate, saying instead that it’s an issue best addressed at the municipal level.

Quebec, Nova Scotia, and Newfoundland and Labrador have provincewide mask requirements.

The Toronto Transit Commission, which has required face coverings for bus, subway and streetcar passengers since early July, is distributing cards that say “I’m unable to wear a mask” and Vancouver’s transit authority, TransLink, plans to give out similar cards when its mask requirement takes effect later this month.

Toronto Public Health posted a notice to its website that said it’s aware of homemade mask exemption cards being distributed in the city, where a bylaw requiring masks in indoor public spaces has been in place for more than a month, but that the agency does not endorse them.

Toronto’s Associate Medical Health Officer, Dr. Vinita Dubey, said the bylaw makes it clear that someone claiming an exemption is not required to provide proof.

“There are legitimate exemptions for why people can’t wear a mask,” Dr. Dubey said. “If you can’t wear a mask [for medical reasons] then disclosing that is your personal health information and we did not feel that that that was justified.”

Dr. Dubey said the city is approaching the issue through education rather than enforcement, though the bylaw does carry $1,000 fines for businesses that don’t create their own mask policies and put up signs to inform the public about the bylaw. The city had yet to issue a fine as of last week.

She urged the public to be compassionate when they encounter someone not wearing a mask who might have a health condition or another reason covered by the bylaw.

“We want people to be respectful of people who legitimately cannot wear a mask,” she said. “We’ve asked people to be honest and truthful about whether they really need an exception, and we are certainly relying on that.”

In the Vancouver region, TransLink will require masks on the region’s transit system beginning next Monday and has created exemption cards for people who cannot wear one.

Spokeswoman Jill Drews said the goal is to make the bylaw easy to follow, including for people who cannot wear a mask for medical reasons, and the agency is not worried about large numbers of people wrongly claiming exemptions.

She said transit systems in Toronto and London, England, took a similar approach, largely focusing on voluntary compliance and education rather than enforcement, and have seen mask use increase dramatically.

“We’re not vetting people for this. It’s the honour system,” she said, referring to the mask exemption cards. “It seems like once you tell people or give them a little instruction of what’s expected of them, they’ll follow it without much more needed than that.”

In Calgary, masks have been required in all indoor public spaces since Aug. 1. Businesses are not required to ask for proof if someone claims an exemption and there has only been one ticket issued, said Barb Doyscher of the city’s community standards department.

Ms. Doyscher said before the bylaw was implemented, about 35 per cent of people in Calgary said they regularly wore a mask. While the city does not have hard data, she said, anecdotally, compliance already appears to be very high.

In Hamilton, where a mask bylaw took effect in late July, the hands-off approach – both to enforcement and exemptions – has worked, said Monica Ciriello, acting director of the city’s licensing and bylaw department.

Ms. Ciriello said there have been businesses going further than the bylaw and taking a firmer stand on masks, which is permitted. For example, some local grocery stores have insisted that people who can’t wear a mask use an alternative way to shop, such as curbside pickup or online sales.

Transport Canada is requiring medical proof for air passengers claiming an exemption to mask rules.

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Dr. Amy Tan, a physician who teaches at the University of Calgary’s medical school and who has advocated for mandatory mask rules with the group Masks4Canada, said she supports exemptions in mask bylaws.

However, she said the number of health conditions that would preclude someone from wearing a mask is low, and she’s concerned that distributing exemption cards will encourage people to claim an exemption when they don’t need one.

“There are very few appropriate medical reasons for exemption from masking,” Dr. Tan said.

“Because true exemptions are so few and far between, you don’t need thousands of cards.”

She said that the Canadian Thoracic Society recommends mask use and has said there’s no evidence that wearing a face covering will exacerbate an underlying lung condition. The Canadian Lung Association recommends people follow the advice of local health authorities and says there is no harm from wearing a mask.

Governments and businesses who demand that people wear masks must also ensure those rules respect human-rights laws, which prevent discrimination and denial of service based on disability or health reasons.

Local governments have cited those laws to support their exemptions and unofficial mask exemption cards available online, in some cases distributed by anti-mask groups, have also pointed to provincial human-rights laws.

The Canadian Human Rights Commission has described online cards purporting to be from the agency as fraudulent.

Human-rights commissions in several provinces have said there’s nothing in their respective human-rights laws that would prohibit mask requirements, but they’ve also made it clear that businesses are required to make reasonable attempts to accommodate people who cannot wear a mask for medical reasons.

Ena Chadha, the chief commissioner of the Ontario Human Rights Commission, said that means businesses need to think creatively to come up with ways to serve people who cannot wear masks. That could include alternative ways to deliver a service, such as through curbside pickup or providing access to a store after hours.

At the same time, the law says the duty to accommodate can’t place undue hardship on a business and there are exemptions for health and safety reasons.

“We are in the whole new world with respect to COVID human-rights issues,” Ms. Chadha said in an interview. “There has to be a lot of dialogue and a lot of creative exploration of solutions, a lot of good faith and compassion. It flows both ways.”

She also said businesses, and other members of the public, should resist the urge to assume someone claiming a medical exemption is not telling the truth.

“We can’t just go around either doubting the person who needs the accommodation or saying that an organization is bad because they’re trying to enforce a rule,” she said.

Editor’s note: A previous version of this story said Quebec was the only province with a provincewide mask requirement. In fact, Nova Scotia and Newfoundland and Labrador have also introduced mask requirements.

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