On a bike ride the other day, I decided to make a point of noticing how many other riders were also wearing helmets. It was a clear majority—probably 80%? Although we were not on difficult trails or busy streets. Most roller bladers, e-scooter riders, and skateboarders were also helmeted.

Interesting.

Then I got home and looked up whether it was actually mandatory to wear a helmet when riding a bike in Ontario. And for adults, it is not.

Interesting.

Particularly given that Covid is contagious, incurable, airborne, rampant, the third leading cause of death in Canada, and a huge burden on the healthcare system… Yet hardly anyone wears a mask.

Public health messaging

You might think I’m about to say this is public health messaging failure, but I think it’s actually a huge success… In terms of their intention anyway, which was to discourage masking.

Because ongoing masking would make it seem that Covid was still a problem, and then there might be some pressure to do something about it. And their political masters, the politicians, didn’t want particularly want to do anything more about it. Two years, man. Enough!

But no, you might say, public health still tells people to mask. People just don’t because it’s not mandatory anymore, and because masks are uncomfortable.

So how do you explain bike helmets? Condom use? Sunscreen (sticky!)? None of these products are mandatory, and none are more comfortable to wear than to go without, yet somehow the mature majority manages to routinely use all of these for protection anyway.

No, I think the messaging achieved just what it intended to. They said:

1. You can wear a mask to protect yourself.
2. Masking is recommended for people at risk of severe outcomes from Covid, such as those over 65 and the immunocompromised.
3. Everyone’s choices on masking need to be respected.

Let’s break it down.

Can you protect yourself with a mask?

Well, it depends. For one thing, on whether you are able to mask. Babies, toddlers, people with certain mental and physical disabilities cannot.

Sucks to be them, I guess. Welcome to Covid city.

And if you’re immunocompromised—a transplant recipient, someone undergoing cancer treatment, needing to take immunosuppressive medications for certain illnesses, HIV positive, etc.—you can be infected more easily than other people. And as a cherry on top, vaccines aren’t going to be as effective for you. So even wearing a great mask might not be enough; any slight fit problem could result in infection.

But frankly, there’s some risk even if your immune system is not compromised. If you’re the only one masked in a group, you’re entirely reliant on the fit and quality of your mask to protect you. (For some tips, see Mask buying guide.) Whereas if you’re in a masked group, there’s just a lot less virus in the air, so your mask doesn’t have to be perfect. All masks work better as source control than at intake protection.

Is it only the immunocompromised and elderly who need protection from Covid?

Nope. Because there are different types of risks from Covid.

Risk 1: Acute Covid

The sickness you get a few days after infection—that’s acute Covid. That’s the only risk Public Health tends to talk about.

It’s of course true that the elderly and immunocompromised are more likely to die from acute Covid than other vaccinated adults. And naturally, that these same groups are the most likely to be hospitalized with it, along with—this is less well known—children ages 0 to 5 (although they, fortunately, don’t often die of Covid).

But you know, just because you didn’t go to the hospital doesn’t mean that acute Covid didn’t cause you any problems. Sure, there’s a significant contingent who are asymptomatic or mildly symptomatic—but also quite a few who get really sick, sometimes for a surprisingly long time. Apart from being highly unpleasant, this can be mightily inconvenient.

Even if you don’t regularly mask in crowded indoor spaces, why isn’t routine for everyone to resume doing so in the 10 days or so before a big event in their live—vacation, concert, wedding, big job interview, award ceremony, family reunion, whatever it is? It just seems stupid. Wearing a mask is easy. Missing out on a once-in-a-lifetime event is hard.

Risk 2: Post Covid condition, aka Long Covid

These are symptoms that either linger or newly develop after the acute phase of Covid, and stick around for 8 weeks or more after the infection. There’s a whole constellation of them, the most common of which is fatigue, but also muscle pain, tinnitus, loss of taste or smell, headaches, depression, anxiety, “brain fog”, insomnia, cough, shortness of breath… The severity of symptoms can range from mildly annoying to completely debilitating.

“An estimated 1 in 10 infections results in post #COVID19 condition, suggesting that hundreds of millions of people will need longer-term care.”

Dr. Tedros, World Health Organization, April 26, 2023

People like to debate those odds*, and what all should actually count as Post Covid condition, but there’s no doubt that:

• It’s not rare.
• There’s no treatment or cure for it.
• It affects people of all ages and health statuses.
• There’s no predicting who will end up with it.

* Hot off the presses is this study, that better defines Long Covid, and shows (quotes here from researcher Hannah Davis):

• The overall prevalence of Long Covid is 10% at 6 months!
• The prevalence for those who got Omicron (or later) AND were vaccinated is also 10%!
• Reinfections had significantly higher levels of Long Covid. Even in those who had Omicron (or later) as their first infection, 9.7% with those infected once, but 20% (!!) of those who were reinfected had Long Covid AT 6 MONTHS AFTER INFECTION.
• Reinfections also increased the severity of Long Covid. 27% of first infections were in cluster 4 (worst) vs 31% of reinfections.

Risk 3: Increased susceptibility to other illnesses

Even if you’ve recovered from your Covid, you’re not noticing pesky symptoms 8 weeks later, doesn’t mean that Covid hasn’t harmed you.

“The virus that causes COVID-19 can have lasting effects on nearly every organ and organ system of the body weeks, months, and potentially years after infection. Documented serious post-COVID-19 conditions include cardiovascular, pulmonary, neurological, renal, endocrine, hematological, and gastrointestinal complications, as well as death.”

Center for Disease Control (CDC), February 2023

I see this as a different risk than Long Covid—at least you might end up with a treatable condition! But medical experts say it’s a continuum, per graphic below (Long Covid symptoms in pink, resulting disease in blue).

And again, none of this is restricted to the elderly or the immunocompromised. For example…

• Children: Covid-19 Associated With 72% Greater Risk Of Type 1 Diabetes Among Children, Study Shows.
• People aged 25 to 44: Young People Are More Likely to Die of Heart Attacks Post-COVID, Study Finds.
• One out of four people over 50: Cognitive dysfunction of patients infected with SARS-CoV-2 omicron variant.

I’m telling you all now – and believe me, I want to be wrong – that if we don’t slow transmission of this virus and develop new treatments and second generation vaccines, the damage we are allowing to occur to the health of our global population – not just the elderly, the disabled, the vulnerable – but everyone, well, that damage is unsustainable. And the vast majority of that population don’t understand the risk, because they haven’t been given the information.

Conor Browne, bio-risk consultant specializing in Covid-19 forecasting

(I hope you appreciate becoming one of the informed!)

To mask or not to mask: Are both choices equally respectable?

Look, I certainly don’t want us fighting in the streets or even just getting cross with each other over masking.

But to suggest that both choices are equally valid on social level is simply wrong.

Choosing to mask in crowded indoor settings is the better choice. It’s breaking the chains of transmission. It’s kinder. It’s smarter. It’s safer. It’s more equitable. It’s more just.

With sick and disabled people physically and psychologically distanced from them, people who are well and non-disabled have detached themselves from the immorality of their own behavior. “Return to normal” frames indifference to suffering as a morally neutral position and public health as a matter of personal preference. But there is no neutrality in the individual actions that comprise public health; they either cause harm or prevent it. Segregating the “unfit” from the “fit” is not a matter of debate. It is an abomination and a core tenet of eugenics.

Maggie Mills, The government giving up on COVID protections means throwing immunocompromised people to the wolves

But how much Covid is around now, anyway?

It’s no accident that getting rid of data related to Covid—dropping testing, reducing regularity of data updates, no more press conferences—happened about the same time mask mandates were eliminated. It was for the same reason: to get people to forget about the disease, to reduce the political pressure to do anything about it.

But there are still bits of information available—and they do indeed show that some trends are looking better of late in Ontario.

But better doesn’t necessarily mean good. If you look at wastewater trends… This is from Kitchener, but it’s likely similar across Ontario…

Note that the current incidence (1) is much closer to pandemic peak (2) than to the lowest point on this graph (3)—which is not even the lowest point of the pandemic! In fact, we’ve been steadily above even peak 2021 levels for 1.5 years now.

So your risk of catching Covid remains Very High.

Masking as radical activism

So I continue to mask pretty regularly. I do so mainly because:

• I don’t really mind wearing them, particularly for shorter durations.
• I really, really don’t want to get Long Covid or otherwise damage my long-term health.
• There is still a lot of disease circulating.
• The efficacy of my last vaccine is waning daily.

But I do have a secondary reason. I do feel that I am doing a Good Thing here (even if most people consider me an annoying, paranoid, weirdo for still trying to avoid Covid).

Because probably I am not going to catch Covid at my uncrowded, well-ventilated grocery store. But why should I go there maskless, when immunocompromised people can’t take that risk? Not even to buy food? Because not a single grocery store will provide even 2 hours a week of required masking time to keep them safe!

I’d probably also be fine at the library. But why should I go there maskless, when immunocompromised can’t take that risk? Not even for a public service, paid for with tax dollars? Because no library (or ServiceOntario centre, or passport office) will provide even 1 day per week of required masking to keep them safe!

That sold-out performance of Hamilton I have tickets to is riskier—quite crowded, ventilation could be better, it’s three hours long. Still, most audience members won’t get infected, and I might not, either. But why should I go maskless, when immunocompromised people can’t risk going there all? No fun outings for them! Because no theatre, cinema, symphony, or ballet require masks at any of their performances, not even one per month.

Hospital? Yeah, I’d almost 100% catch Covid there, if I waited maskless in the ER for hours, waiting for my turn. Yet there all the hospitals are, dropping mask mandates, doing the harm they promised not to do. Literally killing people.

Last month, Vance Masters was at home, on a treadmill, exercising in preparation for his first evening out since the pandemic began.

Now, the 77-year-old internationally recognized musician is on life support in an intensive care unit, after contracting COVID-19 inside a health-care centre.

His family is speaking out about the lack of protection for vulnerable patients in Manitoba, particularly in the wake of rescinded mask mandates in hospitals and long-term care settings.

Katy May, Winnipeg Free Press

It’s horrible. It demands a fight. It demands resistance.

It’s the least I can do.