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Dr. Kieran Moore, Ontario's chief medical officer of health, attends a news briefing at the Queens Park Legislature, in Toronto, on Nov. 14.Chris Young/The Canadian Press

Amid the official start a national flu epidemic, Ontario’s chief medical officer of health recommended wearing masks indoors to protect young children and an already strained health care system from a “triple threat” of influenza, respiratory syncytial virus and COVID-19. But in spite of growing pressure to bring back mask mandates, he did not advise requiring them.

In a news conference on Monday, Kieran Moore said masking in public will help reduce the risk of infection at a community level. But he emphasized people need to wear them in private settings, where mandates haven’t worked in the past, to protect those at greatest risk of serious illness. That includes family members wearing masks at home, if they have symptoms, to protect younger children.

“Please, parents, grandparents, siblings. If you have any respiratory symptoms, you must mask around those that are vulnerable,” Dr. Moore said, noting even a cold for adults can lead to serious illness in children ages 4 and under.

Hospitals across the country are seeing unusually high numbers of children with seasonal respiratory infections, leading to lengthy emergency department waiting times. Some Ontario pediatric hospitals are operating ICUs above capacity and are limiting surgeries to cope with the surge.

Meanwhile, the Public Health Agency of Canada declared an influenza epidemic has just begun. Its latest respiratory virus detection report on Monday stated that nearly all regions in the country were reporting over 5 per cent of flu tests positive, indicating the start of an epidemic at a national level.

Last week, Canada’s Chief Public Health Officer Theresa Tam asked Canadians to step up precautions against infection, including wearing masks, amid unseasonably high levels of flu and respiratory syncytial virus (RSV). She also cautioned that emerging COVID-19 variants BQ1.1 and BF.7 were on the rise.

In light of the extraordinary pressures these viruses are putting on hospitals, some health professionals and the public have called for a return of masking requirements.

Most jurisdictions, however, have not brought back such policies. In Alberta, where some schools are reporting more than one in five kids off sick, Premier Danielle Smith told media repeatedly on Monday that the government would not implement any type of masking mandate and refused to answer a question on whether she would even recommend them.

“Anyone who feels comfortable to wear a mask should wear a mask. That should be a personal choice and anyone who wants to make that choice, I support them. But we are not going to be mandating that,” Ms. Smith said.

Manitoba Premier Heather Stefanson told reporters last week her province was not looking to impose any mask mandates. In British Columbia and Quebec, masks are required in health care settings, but not in most other places.

B.C.’s Ministry of Health said Monday that while the province is seeing more respiratory illness circulating, it is not yet seeing a surge in hospitalizations.

At a news conference on Sunday, Ontario Premier Doug Ford said he would follow the recommendations of Dr. Moore when it comes to mandatory masking and other health measures.

Dr. Moore said he would consider masking orders in daycares if needed, but did not think further steps, such as venue capacity limits, would be necessary.

“I honestly think a mask mandate would be the furthest we’d have to go. Ontarians have been brilliant [at] adhering to all of the recommendations over the last 1,000 days of the pandemic,” he said.

In addition to wearing masks around those most vulnerable, he recommended daily screening, practising good hand hygiene and cleaning high-touch surfaces, which is particularly important for preventing the spread of flu and RSV, and staying up to date with COVID-19 and flu vaccinations. Babies should be kept away from anyone with cold symptoms, if possible, and away from crowds, he said.

Chris Simpson, executive vice-president of Ontario Health, said parents should not hesitate to bring sick children to their local emergency department. But he said other parts of the health care system are being affected, and the reduction of surgeries and procedures will likely continue.

“So for those out there who need some motivation to help protect the kids, remember that the health care system needs to be there for everybody,” Dr. Simpson said.

With report from Alanna Smith and Andrea Woo