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A woman wears a mask while riding the subway in Toronto on March 14, 2020.Carlos Osorio/The Canadian Press

It’s time to bring back indoor mask-wearing requirements, some health professionals say amid concerns of a potential surge in COVID-19 cases this summer.

In fact, according to Alberta emergency physician Chuck Wurster, public-health authorities across the country dropped the mandate prematurely.

“There wasn’t any indication that it was safe to do that,” Dr. Wurster said, pointing to the influx of COVID-19 patients he has seen in the emergency department as never really having stopped. “Masks should always be the first thing that we use and the last thing that we get rid of.”

Over the past month, countries such as the U.S., Israel, Portugal, France and Italy have seen a rise in COVID-19 cases. And with the emergence of even more infectious Omicron subvariants, particularly BA.4 and BA.5 – which appear able to evade immune protection – there are concerns that Canada, too, will be hit with another wave in the coming months.

Currently, masks are required in Canada for air and train passengers, but in most settings, they are no longer compulsory. Mandating them again in indoor public places is one immediate way to fend off another potential surge, according to some doctors.

“I can’t see why we would be immune from the trends that are happening in the U.S. and Europe,” said Kashif Pirzada, a Toronto emergency physician.

Dr. Pirzada said he understands people are tired of public-health mandates, but it wouldn’t be necessary to wear masks everywhere, or forever. He believes they should be required in such places as grocery stores, on public transit, medical clinics and anywhere people who are vulnerable have no choice but to go; everywhere else could have a strong recommendation for masks.

Tehseen Ladha, an Edmonton-based pediatrician with a master’s degree in public health, also spoke to the continued necessity of mask mandates, given that the number of COVID-19 cases has not sufficiently declined.

“In the past few months, instead of going from peak to valley with the waves, we’ve sort of just been going wave to wave and not really getting down very low with the community transmission,” Dr. Ladha said.

As of June 18, there were 15,047 new weekly COVID-19 cases in Canada. While that’s down from 288,771 cases per week at the peak of the Omicron wave in January, the new case counts are about what they were in November.

There’s a perception that high case counts are no longer a big deal, since they won’t result in deaths and severe illness, Dr. Ladha said. But, she noted, the two outcomes persist. As of June 20, there were 3,350 people hospitalized daily across the country, roughly the same as in late December. As of June 18, there were 137 weekly deaths, near the level recorded on Jan. 1.

Dr. Ladha spoke of the strain on the health care system, exemplified by lengthy ambulance and emergency-department wait times.

“Putting any additional stress on the system right now, it’s just not sustainable,” she said.

Masks can reduce some of that pressure, not only by protecting people against COVID-19, but against many other illnesses that are driving them to seek medical attention right now, Dr. Wurster said. Cases of influenza and other respiratory illnesses have jumped since mask mandates were lifted: “It’s like the unleashing of the hordes,” he said.

Building health care capacity will take time and complex solutions. But wearing a mask is not a huge inconvenience, and is a relatively simple and immediate way for people to keep themselves and each other safe, Dr. Wurster said.

Public-health authorities say mask use is a personal choice, but they have continued to recommend masks in public indoor settings. Even so, Michelle Driedger, a professor of community health sciences at the University of Manitoba, has encountered increasingly fewer people wearing them.

Some are just tired of the pandemic, she said, but even reluctant mask-wearers followed the rules when they were in place. A rule “is a very different kind of thing than a strong recommendation,” she said.

Dr. Driedger said it can be hard for individuals to follow recommendations around mask-wearing when others around them are not. When leaders, such as school teachers or principals, stop wearing masks, it sends the message to others that they don’t need to.

And from the recent focus groups she has been conducting among the Red River Métis citizens in Manitoba, people no longer hear about the pandemic, she said. The lifting of COVID-19 measures and a lack of public health messaging have not given people the impression they need to worry about infection: “Many of them are like, ‘Is COVID still going on?’” she said.

While vaccines are effective for preventing severe illness, Dr. Pirzada said they’re not great for stopping waves. New Omicron subvariants BA.4 and BA.5 appear to have the ability to evade immune protection gained from prior infection and vaccines, especially if that protection has declined over time, according to the European Centre for Disease Prevention and Control.

In Canada, the singular reliance on vaccines to control COVID-19 “obviously hasn’t worked,” Dr. Ladha said. “It’s important to realize we need layers of protection – and masks are an essential layer.”

She said many people still don’t understand COVID-19 is transmitted by air, as she often sees hand sanitizer everywhere in public places yet people going around unmasked.

“If we have ways to clean the air, then maybe in the future, we won’t need masking as much.”

Theoretically, people can stop wearing masks if the likelihood of them getting infected is low, Dr. Wurster said. But the problem is inadequate testing and data, which make it impossible for them to know when that is.

“One of the biggest ironies of this whole masking thing is to have people assess their own risk” about whether to wear one, he said. “But no one can, because we don’t give anyone any data. The public has no information about how risky it is.”

With reports from Chen Wang

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