Monday, June 27, 2022

Open Letter to Universities Removing Mask Mandates

Open Letter to Dr. Deborah MacLatchy, PhD, President and Vice-Chancellor of Wilfrid Laurier University, president@wlu.ca, and Dr. Vivek Goel, CM, President and Vice-Chancellor of the University of Waterloo, president@uwaterloo.ca  [NOTE: I sent this as a letter to both, without the images.]

RE: Removing mask mandates at your universities.

My daughter and I are both starting university programs in September, and I'm hoping you will reconsider removing mask mandates. I'm wondering about your reasoning for this change in policy in light of recent studies that indicate continued mask-wearing is necessary due to the BA.4 and BA.5 mutations that are predicted to increase cases significantly leading into the fall. I'm newly retired and was ready for my next adventure in grad school, but now I will be spending the next two months considering whether it's worth it to return to school since it now poses a risk to my health. I'm sure anyone immunocompromised is also having to face this same conundrum, which is particularly heartbreaking for students at the very beginning of their schooling who were previously confident in the wisdom of these two world-renowned universities to keep staff and students in masks.

A recent article stated that your decision is "consistent with a variety of indicators including campus data, case counts, test positivity rates, local hospitalization and wastewater data, and consulting public health guidance" (Baker), so I'm left wondering, is it the case that you believe Covid is over because we're in another valley between waves and don't recognize the three month pattern that's been well documented, or is it that you are looking at lower death counts and haven't considered LongCovid in your assessment of whether or not to protect your incoming students, or is it that you're hoping to place the responsibility for safety on individuals, instead, to remove your own responsibility in their wellbeing?

I'm also curious to know what alternative precautions you're taking to protect staff and students? Is your ventilation system working well enough to filter air to keep CO2 levels below 700ppm in all rooms in all buildings? Have you installed HEPA filters or CorsiRosenthal boxes in rooms with inadequate ventilation? Have you installed CO2 monitors to allow staff and students to see clearly that levels are optimal in each area? How many rooms have windows that open? We're at the bottom of a wave right now, but nowhere near zero. Wastewater shows we're already starting the next wave. Now is the time to implement all measures to prevent the next wave from being as big as the last.

In that CTV article, you claim that this decision might change again if necessary, but there are two problems with that promise. First, masks are necessary now. We're at the start of the next wave, and the new and more fatal BA.5 mutation is becoming dominant in Ontario. Removing protections when cases are low creates more cases! You implore staff and students to "respect the comfort levels of others who may still choose to wear a mask" (Baker), which presents not masking as the default, rather than encouraging all staff and students to continue wearing a mask merely without it being enforced. That communication choice might come back at you when staff and students get sick. We all ought reasonably know we need to mask, vax, and ventilate in order to prevent transmission as much as possible, but public health messaging has led some to erroneously believe that getting it once helps immunity (when it makes it worse), or that it's just a flu (despite the hospitals being over capacity), or that the pandemic ended when mandates ended (it really, really didn't end). The more mandates are lifted, the more this false good news is spread, along with this virus. That one statement furthers this careless messaging leading people to discard one of the best precautions we have.

Many medical professionals tracking this virus are imploring people to continue wearing masks and maintaining protective policies. Associate Professor Tara Moriarty, University of Toronto Medicine wrote last week that,

"Each successive infection increases risk of death and serious complications, in unvaccinated AND vaccinated individuals. If you're relaxing masking, don't. BA.4/BA.5 are growing rapidly now in Canada.…Vaccine protection against infection is waning. …BA.4/BA.5 proportion of total sequences nearly quadrupled 3 weeks ago.…These surges in new variants overtaking others have happened 4-6 weeks before new waves in the past.We often don't know we're into a wave until we're in the thick of it because of waste water testing delays….More than anything else, resist the feeling that you should relax about masking. Keep on doing it. It helps protect you and others."

Dr. Abdu Sharkawy also recently stated, "Maybe not the best time to abandon ship and assume we finally licked this after being wrong wave after wave after…". And Dr. Fahad Razak, the director of the Science Table in Ontario, says BA.5 is likely to pass 50% of all cases this week, which has faster transmission than BA.1 and may be more deadly than Delta. In South Africa, the death rate from BA.5 is over three times current Covid-19 death rates (Kavanagh, 2022). As explained in Nature, "antibodies triggered by vaccination are less effective at blocking BA.4 and BA.5" (Callaway, 2022). Dr. Eric Topol, a cardiologist, explains that each additional infection further increases the risk of illness and this is supported by a recent study (Al-Aly, Bowe, Xie, 2022). And Dr. Kashif Pirzada, MD, was on CTV News on June 18th to alert us that the BA.5 variant is coming, prior infections don't help immunity, and most of us are over six months from vaccination. Covid is mutating quickly with waves every 2-3 months. We need to do everything to make our lives Covid-proof, including wearing a mask indoors.

In Ontario, "emergency departments are on fire" nearing the 20 hours average wait time seen at the peak of the Omicron wave in January (Crawley). Diego Bassani, PhD, Senior Epidemiologist at Sick Kids, said yesterday, the virus is "not endemic, not seasonal, not the flu. It's a pandemic, quasi-periodical, increasingly immune evasive, and still severe (during the acute phase and post-infection). And it is PREVENTABLE." One study found, "Among feasible interventions tested in our model, mask wearing is the most effective against airborne transmission (8-fold reduction in cumulative dose absorbed) and is the only one that also protects against short-range transmission" (Sun et al., 2020), and a more recent study study found a combined intervention (mask, vax, and ventilate) shows a 25-fold decrease in cases even in the presence of a super-spreader event (Villers et al., 2022). Mask mandates work. You have a pivotal tool to prevent a horrible illness, so why toss it aside before the worst is over?

Other studies are beginning to see the extent to which Covid can destroy immunity. In a recent pre-print, the newest results of tests show that SARS-CoV-2 has mechanisms that fight against our antibodies as well as cellular (T cells) and innate (NK cells) immunities. We don't have enough mechanisms in our bodies to clear this virus (Lee et al. 2022). Between 20-30% of cases turn into lasting symptoms of "difficulty breathing, overwhelming fatigue, or deadly blood clots" that are being overlooked by society because they're so variable and often internal. Instead of seeing healthy people suddenly in wheelchairs that visibly marked Polio cases, we have a mass disabling event with people experiencing organ failure or significant cognitive decline (Mazer 2022). It's further been linked to Alzheimer's, Parkinson's, strokes, neurodegenerative disorders, and bleeding in the brain (Goodyer, 2022).

Are you confident your assessment of risk is accurate enough to take a chance with so many people?

Secondly, once you take the tube out of the toothpaste, it's hard to get it back in! Once people get used to not wearing masks on campus, they won't easily start wearing them again. I understand the desire to bring good news, but removing protections presents the very mistaken implication that being indoors with hundreds of people without masks on is perfectly safe when, instead, we need to reinforce that it's still very much a risk to health and wellbeing of staff and students. School boards were put in a difficult position due to the Ministry of Education's control over them, but universities don't have that excuse to fall back on when people become disabled or die from this policy change. As a high school teacher, I've seen first hand that making masks a choice creates division. When we all have to mask, then masks aren't discussed or questioned. Once the rules are removed, people start to align themselves based on face covering, setting up antagonistic situations in the classroom and on campus. The mask policy will help prevent more than just the virus.

Removing such a simple protection as wearing a mask removes the freedom for anyone immunocompromised -- along with anyone who doesn't want a brain-invasive illness with potential permanent consequences -- to attend classes safely, creating an obvious inequity in access to education. You're comfortable limiting the number of books people can borrow and for how long because we all have to be concerned for the needs of others, but now there's no limit to people's ability to spread a fatal virus in your buildings. One-way masking, that is, wearing a mask in a room of unmasked people, is significantly less effective at preventing spread. You're also putting people at risk of the grief experienced when they get Covid at school and unwittingly spread it to family members. At the end of this school year, a quarter of my students couldn't write final assessments due to illness. Cases in my classes increased after mask policies were removed.

I implore you to reconsider removing mask mandates in your buildings, or at least help me to understand your rationale of following Ford's questionable public health rules that have resulted in emergency room wait times averaging 20 hours. I immediately tweeted a response to the article on the removal of mask protections at your institutions, concerned for my own daughter attending university in the fall, and a random stranger replied to me that people need to see my daughter's pretty face. Some people are more concerned with image and beauty than continued health and cognitive functioning. As institutes of higher education, I would hope you care more for the intellectual development of your students than a superfluous desire to see their pretty smiles.

Finally, consider a Pascal's Wager approach: if you're right, and masks really aren't necessary to protect staff and students anymore, then it causes no harm to enforce them for at least another term. But if you're wrong, and they really are necessary, then no longer enforcing this protection could have serious consequences to staff, to students, and to your reputation. Is it worth it?

Thank you for your time, and I sincerely hope you'll reconsider your position on this matter.

Marie Snyder 

ETA: Check out what could be -- Seneca College stepped up by enforcing masks despite everyone else dropping mandates. Here's their statement:

"The pandemic is not over, and COVID-19 continues to be a threat, particularly for the vulnerable and immunocompromised. . . . Seneca will maintain its vaccination policy through the fall. In the fall term, as now, all employees must be fully vaccinated as currently defined by government. All students, contractors and visitors who come on campus must also be fully vaccinated. . . . As of July 4 masks will continue to be required in all instructional spaces such as classrooms, labs...studios. In those spaces faculty who are teaching and students who are presenting may remove their masks when speaking if...distanced. . . . Masks will also be required in enclosed spaces such as small meeting or consultation rooms where physical distancing is not possible. . . . Wearing masks in other areas such as corridors, libraries, computing commons, cafeterias and other more open areas will be your choice according to your comfort level or personal situation. . . . Because many courses will continue to be delivered online or in flexible format in the fall, we anticipate that campus populations will continue to be lower than they were pre-pandemic. . . . As before, high-quality KN95 masks will be available at Seneca's entrances."

It's not perfect, and they don't seem to get that distance doesn't help as much as we once thought since the virus can hang in the air for hours, but it's much, much better than dropping mandates completely!!

ETA August 21st: Laurier decided to reinstate mask mandates after several other universities did, but we can't get Conestoga College or University of Waterloo (known for their science program and international students) to budge! With UW, I wonder if it's because they have so many Asian students who mask automatically already. I bike through the campus regularly and about half of students mask outdoors, so maybe a mandate there is less necessary. 

_________

References of studies and articles -- tweets and blog posts included a hyperlink within the letter instead:

Al-Aly, Z., Bowe, B., Xie, Y. (2022, June 17). Outcomes of SARS-CoV-2 reinfection. Research Square. https://doi.org/10.21203/rs.3.rs-1749502/v1. 

Baker, J.K. (2022, June 20). WLU and UW dropped mask requirement at the end of the month. CTV News. https://kitchener.ctvnews.ca/wlu-and-uw-dropped-mask-requirement-at-the-end-of-the-month-1.5955309. 

Callaway, E. (2022, June 23). What Omicron's BA.4 and BA.5 variants mean for the pandemic. Nature. https://www.nature.com/articles/d41586-022-01730-y 

Crawley, M. 2022, June 16). An Ontario doctor says ERs are more stressed than he's ever seen. Data backs it up. CBC News. https://www.cbc.ca/news/canada/toronto/hospital-emergency-room-wait-times-ontario-1.6488344 

Goodyer, J. (2022, June 24). COVID-19 could put us at a greater risk of neurodegenerative diseases and stroke. BBC Science Focus Magazine. https://www.sciencefocus.com/news/covid-19-could-put-us-at-a-greater-risk-of- neurodegenerative-diseases-and-stroke/ 

Kavanagh, K. (2022, May 9). BA.4 and BA.5 variants, pandemic fatigue, and waning immunity: A toxic mix. Infection Control Today. https://www.infectioncontroltoday.com/view/ab-4-ba-5-variants-pandemic-fatigue-waning-immunity-toxic- mix 

Lee, M.J., Leong, M.W., Rustagi, A., Beck, A., Zeng, L., Holmes, S., Qi, L.S., Blush, C.A., (2022, June 21). SARS-CoV-2 escapes direct NK call killing through Nsp1-mediated downregulation of ligands for NKG2D. Cold Spring Harbor Laboratory: bioRxiv. https://doi.org/10.1101/2022.06.20.496341. 

Mazer, B. (2022, June 15). Long COVID could be a 'mass deterioration event.' The Atlantic. https://www.theatlantic.com/health/archive/2022/06/long-covid-chronic-illness-disability/661285/ 

Pirzada, K. (2022, June 18). Concern over Covid-19 subvariants. CTV News. https://www.ctvnews.ca/video?clipId=2467812 

Sun, K., Wang, W., Geo, L., Wang, Y., Luo, K., Ren, L., Zhan, Z., Chen., X., Zhow., S., Yu, H., (2020, November 24). Transmission heterogeneities, kinetics, and controllability of SARS-CoV-2. Science, Vol. 273, No. 6526, DOI: 10.1126/science.abe2424. 

Villers, J. Henriques, A., Calarco, S., Rognlien, M., Nicolas, M., Devine, J., Azzopardi, G., Elson, P., Andreini, M., Tarocco, N., Vasselia, C., Keiser, O. (2022, May 23). SARS-CoV-2 aerosol transmission in schools: The effectiveness of different interventions. Swiss Medical Weekly. https://doi.org/10.4414/smw.2022.w30178.

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