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A pedestrian wearing a mask walks down the empty streets of downtown Edmonton as people stay in to protect against getting the COVID-19 virus, in Edmonton on March 22, 2020.JASON FRANSON/The Canadian Press

Alberta health officials, struggling to persuade citizens in the provincial capital to follow basic pandemic rules, are adjusting their message rather than turning to mandatory restrictions – a move experts argue could backfire.

Edmonton accounts for 60 per cent of all active cases of COVID-19 in Alberta, and has been a hot spot for more than a month.

Deena Hinshaw, Alberta’s top doctor, said this week that 11 per cent of Edmontonians who have symptoms of COVID-19, or are waiting for test results, are attending social gatherings and work. This violates the mandatory isolation rules that serve as the foundation of the province’s public-health requirements. Edmonton is at a “critical” juncture in its effort to tamper the spread of the virus, said Dr. Hinshaw, Alberta’s Chief Medical Officer of Health.

In response, Alberta rolled out “voluntary” guidelines for Edmonton designed to limit interaction with other people ahead of the Thanksgiving long weekend. Edmontonians, for example, should cap family and social gatherings to 15 people, compared with up to 50 for the rest of the province, she said.

The new guidelines, which also suggest people limit the number of cohorts they participate in to three, give Edmontonians a chance to avoid mandatory restrictions, she said. Ontario, meanwhile, has reintroduced restrictions in Toronto, Ottawa and Peel region to stem the spread of the virus.

Both approaches are problematic, according to experts who specialize in public-health communications.

“In general, these voluntary guidelines are confusing and not helpful for most people,” Kate Mulligan, a professor at the Dalla Lana School of Public Health at the University of Toronto, said. This approach usually means that the government is unwilling or unable to enforce the guidance, she said.

The message – to cap social and family gatherings at 15, for example – should be aligned with the rules in order to be effective, Dr. Mulligan said.

“Many people will look to the hard rule," she said, noting that voluntary guidelines rather than mandatory restrictions also weaken accountability. “Public-health leaders need to take a very strong stance and we’re not seeing that in many of our jurisdictions.”

Alberta posted the second-highest rate of new infections in the country, behind Quebec and ahead of Ontario, when it announced a record 364 new cases Thursday. Edmonton accounted for 76 per cent of these new cases. Ontario counted 939 new infections Friday, setting a provincial high.

Overall, the province had 2,225 active cases as of Friday, including 1,167 in Edmonton proper. There were 86 people in hospital – a number that has been steadily increasing for the past month – including 11 in intensive care. A total of 282 people have died.

The province places communities with active infection rates of more than 50 per 100,000 people on a watch list, identifying them as places that could require additional measures.

The citywide rate is 114 per 100,000 people and in some parts of Edmonton it nears 180. Across the province, the rate is about 50 per 100,000.

Alberta and Ontario’s geographical approach to new guidelines and restrictions reflects their desire to keep as much of their respective economies open as possible. However, this type of local approach creates confusion, according to Heidi Tworek, a professor of history and public policy at the University of British Columbia.

“In an epidemic situation … the clearer your message is, the better. And the more granular you get, the more difficult it is.”

Dr. Tworek believes jurisdictions can benefit from voluntary guidelines, but only if they are uniform and the hard rules are clear.

Alberta Premier Jason Kenney reiterated that the province cannot “enforce our way out of this.” Instead, he said on Friday, personal responsibility is the solution.

“I know we’re all tired of this – God knows I am – but we can’t just wish it away. It’s real. We’ve got a spike in cases right now," Mr. Kenney told reporters.

"And I’m just calling on Albertans to be Albertans, to do what they do best, which is a responsible use of freedom, rather than expecting government to come in and tell everybody how to live their lives.”

Alberta Health Services' COVID-19 advisory group last month said the province must target its messaging toward groups most likely to disregard public-health advice.

Broadly, the group said, this includes men, younger people, individuals who consider themselves politically conservative, and those disinclined to trust government or science.

Dr. Hinshaw, when asked whether the province plans to tweak its approach to communications, said Alberta is conducting focus groups to better understand what motivates residents to take certain steps. That work, however, is not done, she said.

The province’s economic relaunch plan has lifted most of the restrictions that were put in place in the spring, with the vast majority of businesses now able to open. Some, such as restaurants, still face some restrictions around capacity and physical distancing.

Edmonton, Calgary and several other municipalities have imposed mask requirements in public spaces, though there is no provincewide mandate. The increase in cases in the Edmonton area prompted Strathcona County, east of the city, to require masks earlier this week.

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