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Increasing COVID-19 cases and a flu season looming over an already-strained Ontario health system mean now is the time to reinstate some mask mandates, the former head of the province’s science table said Friday.

Emergency rooms across the province had to close for hours or days at a time throughout the summer, with some closings persisting now. Many ERs are reporting high patient volumes and long wait times, with children’s hospitals in particular reporting high demand.

The kind of strain seen through August and September is normally seen in the midst of a bad flu season, which is worrying, said Dr. Fahad Razak. Health care workers and the system itself have been under relentless strain for the past 2½ years of the pandemic, and there is “very little capacity” to respond to accelerating COVID-19 cases, Dr. Razak said.

“Personally, I would say that the criteria to require something like a mask mandate is clearly here,” said Dr. Razak, an internist at St. Michael’s Hospital.

“For anyone who says, ‘Let’s not do that,’ I would ask, ‘What is the alternative at this point? How do we keep the system that has so little capacity, how do we get it to continue to run over the winter?”

Public Health Ontario said in a report this week that the proportion of the new BQ. 1 and BQ. 1.1 Omicron subvariants in the province, which appear to be more transmissible, is growing twice as quickly as the currently dominant BA. 5 strain.

COVID-19 activity in the province is generally stable, Public Health Ontario said, though it has been gradually increasing since early September. However, the BQ subvariants have a high risk potential for transmissibility, reinfection and lowered vaccine effectiveness, PHO said.

“A COVID-19 pandemic strategy that relies entirely on immunity from current vaccines and past infection will be limited in its ability to affect transmission,” the report said.

“Continuous [whole genome sequencing] surveillance, monitoring of the impacts of implementation/removal of public health measures, and efforts to increase vaccine equity can all help prepare Ontario for the next stages of the COVID-19 pandemic.”

Dr. Zain Chagla, an infectious disease specialist at St. Joseph’s Healthcare in Hamilton, said Ontario will likely see a BQ-driven wave, as Europe has, though one that may be short-lived. However, he did not recommend a return to mask mandates right now.

“Masking is always controversial,” Dr. Chagla said. “I think we have to evaluate how much the population is willing to do it and how much you can recommend versus other interventions. But I think it’s probably the last thing to pull in terms of all of this.”

It is important to ensure that people over 60 or who are immunocompromised get COVID-19 booster doses, he said.

“Not to say that it’s time to panic, but it is time for especially the highest-risk populations to make sure that they’re up to date with immunity and accessing treatments to keep them away from hospitals,” Dr. Chagla said.

“There’s a lot going on, right? So there is obviously I think the modelling for this year’s flu season is not looking pretty at all.”

Dr. Razak said he and his colleagues are starting to admit patients with the flu to hospital – something he has not had to do in the past two years, when public-health measures such as masking kept not only COVID-19, but other viruses like influenza at bay.

“Flu has historically stressed our system,” he said. “It has caused massive problems.”

Public Health Ontario said flu season has not yet started, though positivity and case numbers are on the rise – increasing from 158 lab-confirmed cases in the week ending Oct. 15 to 321 cases in the week ending Oct. 22.

When asked about mask mandates, Hannah Jensen, a spokesperson for Health Minister Sylvia Jones, said the ministry is committed to ensuring the health and safety of all Ontarians.

“COVID-19 vaccinations and boosters remain the best tool to keep people healthy and out of hospitals,” Ms. Jensen wrote.

“The bivalent vaccine, along with continued access to testing and antivirals and updated public health guidance, gives Ontarians the tools they need to make the best decisions for themselves on how to stay safe [and] healthy.”

Dr. Gerald Evans, an infectious disease expert at Queen’s University, said Ontarians should not be “overly worried” at this point about the BQ subvariants, though the growth rate is a cause for some concern.