The Decibel - A behavioural psychologist explains why Canadians aren’t wearing masks

Episode Date: December 9, 2022

Healthcare systems across the country are under strain yet again, and this time children seem to be bearing the worst of the combination of influenza, RSV, and COVID-19. Health officials would like people to voluntarily mask to help stop the spread, but people across Canada seem to have given up on them.Dr. Kim Lavoie is a psychologist at UQAM, Canada Research Chair in Behavioural Medicine, and co-director of the Montreal Behavioural Medicine Centre. She’s on the show to explain why people just aren’t masking the way they used to.Questions? Comments? Ideas? Email us at [e-mail]

More children in Canada are being admitted to hospital with influenza than at any point in the past decade. And the tripledemic of flu, COVID and RSV is straining health care. Ottawa's Children's Hospital is so overwhelmed that the Red Cross is stepping in to help. And this week, BC's Children's Hospital briefly issued a Code Orange, which is usually only called during natural disasters or mass casualty events. One of the easiest and cheapest ways to ease this strain on our healthcare system is masking. But three years into the COVID-19 pandemic, people just aren't wearing masks as much anymore. Dr. Kim Lavoie is a psychologist and the Canada Research Chair in Behavioral Medicine. She's here today to explain why so many people have stopped masking. I'm Maina Karaman-Wilms, and this is The Decibel from The Globe and Mail.

Kim, thank you so much for being here today. Well, thanks so much for having me. Just to start off, can you just explain to me what exactly is behavioral medicine? That's a great question. So behavioral medicine really is at the interface of behavioral science. So the study of normal human behavior applied to the context of medicine. So we use behavioral medicine to understand health behaviors. So why do people drink, smoke? How do we get people to quit smoking? What motivates different health behaviors? And so there's years and years of behavioral science and how to understand and change human behavior. And we can use that knowledge to better craft, for example, interventions that target behavior change at the level of individuals or communities

or populations. So as you know, in the context of the COVID-19 pandemic, you know, behaviors are everywhere and they've been critical to pandemic management. So that's roughly in a nutshell what behavioral medicine is. Thinking of behaviors as medicine. Yeah. Fascinating. OK. OK. So at this point, you know, our health care system is overwhelmed. Children especially are being hospitalized at unprecedented rates. We're facing this tripledemic of respiratory viruses. Why aren't we seeing more people mask at this point of the pandemic? You know, that is the sort of the money question, I think, of the month. One of the things we've

suffered from is that we haven't really empowered people to make informed risk assessments, really teaching people how to assess situational risk and when and how masks should be used. So, you know, back when we had mandates, it was really all or nothing. It wasn't as strategic as I think it needs to be. So I don't think we're empowering people to know if and when they should wear a mask. And I don't think it's everywhere. So it's kind of like that people need that knowledge to make decisions themselves then. Exactly. We need decision tools and helping people make risk assessments. So, for example, I brought my son to a chess tournament over the weekend.

He's 11 years old and we brought them to a local college, big college. There were about 500 parents and kids jammed into this cafeteria. And if maybe 10 people out of the 500 wearing masks, that is a lot. So this to me, I mean, we obviously went with masks. My son attended the tournament with a mask. But I was at a loss as to understand how people weren't independently assessing the situation as high risk, not just in general, but in particular right now. So there is a lack of, I think, knowledge and understanding what situations are high risk and what are the consequences if you don't protect yourself and others right now.

And what we're seeing in the hospitals, as you said earlier, is that the pediatric emergencies are overwhelmed. Kids are struggling to breathe and not just because they're catching COVID, but because they're catching a whole host of other things. Another reason is what I would call the consequences of really a vaccine-only or vaccine-heavy pandemic management strategy to the detriment, I think, of really promoting other behavioral prevention measures like masking. And thirdly, and perhaps most importantly, I don't think we ever really created a social norm of mask wearing. Can I ask you about that in a little more detail then?

Like, what would that social element, what would that actually look like? Like, what are we lacking and what would we need in order to have it? So the first thing is we need to go back and help people evaluate risk in which places, conditions, and what times of years do we need to be wearing a mask, for example. So we really need to go back to basics. The second thing, we need to promote masks as being accessible, low cost, non-intrusive prevention tools for everyone to wear in these high risk situations. Okay. So we've never really promoted them as these fantastic prevention tools. And we need to make mask wearing what I'm going to call a symbol of community unity and values. So our resilience, solidarity with each other, the fact that it

shows that we care for others in our population who are more vulnerable. This is, of course, something we see all over Asia, and they've done a fantastic job of this. Even pre-pandemic, a lot of Asian communities, particularly in Japan, for example, would wear this in crowds, irrespective of, you know, pandemic situations. So we can create a social norm, but we need to stop demonizing the mask. And I think one of the problems is, is that, you know, masks have become a symbol of oppression. They become a symbol of a pandemic we all want to forget. Some people think people who wear masks are sheep, are weak in some way. They're the scaredy cats. But why does it have that? How did it get that association? Well, I think it's back to the fact that we had a very authoritarian policy around masking. And this is really important from a behavioral standpoint. So bear with me. So what is an authoritarian policy? Authoritarian policies are really do it and be compliant to what I say that you should be doing. So it's very top down, very hierarchical, do as They said, listen, you must wear masks or get vaccinated or whatever else. And if you don't, we're going to punish you. We're not going to give you access to

flying. We're not going to give you access to shops and restaurants. I mean, you must wear masks. Otherwise, we're not going to let you go. Okay. You must get vaccinated otherwise and have your passport. Otherwise, you can't access these spaces. So this is a model of punishment if you do bad. It wasn't a model of reward or reinforcement if you do good. So what the government and public health has done across the country is the opposite of what behavioral science would have advised them to do. And the problem is when you essentially train the population to wear masks to avoid punishment, and then fast forward to now you remove the punishment, no more mandates, you can go anywhere you want, no requirement to wear a mask. If that was your motivator, and you remove the motivator,

what's going to happen to the behavior, it's going to go away too. So we never really built a culture of wearing masks and really showing the population not only how and when they should be used, but what are all the benefits? What are all the pros? And what are the non-negatives? We're still hearing rhetoric, even from pediatricians, and it just drives me crazy to hear pediatricians and other physicians say it's harmful for kids to wear masks in school. It affects their development. It affects their learning and socialization, there is absolutely, and I'm going to say it really loud, absolutely no evidence anywhere in the world of this. Absolutely none. But right now across Canada, there are thousands and thousands of kids that

are homesick, missing school entirely, and God knows what else in terms of long COVID and other respiratory symptoms, not able to get the care that they need. And there is evidence that getting sick is bad for kids and families. We'll be back after this message. I want to ask you, too, about, I guess, the way that we were introduced to this idea of mask wearing, because I remember at the very beginning of the pandemic in early 2020, we were actually told not to wear masks because health care workers needed the masks. Can you talk about, I guess, how being introduced to masks in this way maybe shaped how we think about them? Absolutely. I think that that early talk about, you know, when governments and public health were saying, well, we're not really sure if you need them, you know, there's not a lot of

evidence of that. In fact, we did have a lot of evidence from previous pandemics and certainly flu virus seasons that masks were helpful. But in fact, it wasn't that masks weren't important and shouldn't be used. But there was a supply problem, not just in Canada, but all over the world. And governments knew and public health knew that if we create, sound the alarm at the level of the population, we're not going to be able to have enough supply for our healthcare workers who should be prioritized for this equipment. So I think that really sowed the seeds of doubt in many minds and that and we're still sort of living the legacy, the negative legacy of that today. Yeah, because what kind of impact does that have on our

our trust, essentially, in public health figures? It completely undermines it. And the government has repeatedly, in my view, really lacked transparency. It's fair to say early in the pandemic, we didn't know everything we know now, and we're still learning new things every day. But be transparent about the things that we don't know. And certainly, certainly err on the side of caution. How I would have liked the mask question to be handled early in the pandemic and say, listen, there's good theoretical evidence to suggest that this could be good for us. But as a society, we need to prioritize this equipment for people that really need it. And right now, that's our health care workers. But we're ramping up supply, hold tight. And in the meantime, this is what you should do in lieu of not having access to masks as you wish. Stay home, minimize your contacts. That could have been something to do for a short period of time while we ramp up production and then make it accessible. We often talk about the importance of modeling certain behaviors too, right? And the thing is,

we've seen a lot of contradictory behavior from government officials too about masking. I'm thinking specifically of Ontario's chief medical officer, Dr. Kieran Moore, who strongly suggested people should start masking a few weeks ago and then was photographed just days later at a large indoor party without a mask. So I guess what I'm wondering is how much of a difference would it make if we did see government and public health officials wearing masks? A huge difference. And I cannot underscore this more. So I think one, from a behavioral standpoint, OK, it's completely predictable that people would resist what I would call a top-down being told what to do kind of policy and then not have those same leaders sort of walk the talk. So, you know, we've seen it not only in Ontario, we've seen this in Quebec as well. As recently as last week, our premier, François Legault, tweeted a picture of himself and his wife dancing at their party's

annual ball. And so you see them dancing on the dance floor in front of a crowd of what's probably 100 people all unmasked. Okay, very crowded. So you have these images and people say, well, wait a minute, your own health ministers are advocating for the use of wearing masks, your public health officers are telling the rest of us to wear masks or avoid those situations at this time, because it's, you know, we're in the middle of a surge. And yet, seemingly, this recommendation doesn't apply to you. So how do you expect a population to react? It really undermines their credibility, it undermines the perception of the real importance of wearing masks when we see our leaders not following those recommendations. And it builds,

as you said, mistrust, cynicism, and anger. So one of the big things that everyone's worried about now, and I think one of the reasons why many governments don't want to reimpose any mandates is because they're afraid of what happened around the convoys. But the convoys didn't happen overnight. I think they slowly built and I don't think the convoy message is really what reflects, you know, how all Canadians feel. But it's the kind of thing that you can that can happen when you have, you know, recommendations for the public that don't seemingly apply to those making the rules. So this is the kind of I guess the result of this anger that you're talking about here, right? When we're talking about the convoy in Ottawa that was occupying the downtown there,

or the border blockades, this is maybe how that anger kind of manifests then in a way. Of course, because people are smart. People see that, I mean, it's and it's not just Canada, we all heard the stories about Boris Johnson, England was in lockdown, was having parties, you know, at 10 Downing Street. So this is incredibly infuriating because it stokes our perceptions of fairness. OK, people have made so many sacrifices throughout the pandemic. Think about people who had to say goodbye to loved ones during the pandemic over iPads, okay, over the phone, who couldn't be at the bedside of those who were dying and sick in hospitals. There were so many restrictions. Then now, in reality, if you look at the figures, the pandemic has never been worse

than it is right now. And yet now we have zero policy, zero prevention measures in place of any kind. We have more deaths in Canada in 2022 than in 2020 and 21 combined. So what does this say to all those people who made all those sacrifices? It kind of suggests like, well, did we even really need to make them back then? We're not really hearing or the governments aren't really sharing the data on which they made many of those decisions. We're not seeing what were the benefits of having made all those sacrifices. And so when you're saying like we don't see the benefits to those sacrifices, I guess

in terms of, again, coming back to these ideas of behavioral psychology, kind of that positive reinforcement, like would that help to know that all those sacrifices actually did make a difference? The thing about prevention, the challenge, I guess, is that when you prevent death or illness, you don't see it, right? You're preventing it, so it doesn't show up in any statistics. And so, it's hard to show if you've been successful in preventing things. But we have very sophisticated modeling techniques, and there have been estimates that the number of people that we've saved through implementation and adherence to all these health measures is in the millions. OK, but we don't see that on billboards. We don't see that on our TVs. You know how many millions of people could have perished as a result this pandemic if we hadn't implemented all of those strict measures early on. So all this being said, Kim, before we wrap up here, is there anything that can be done to get

people to change their behavior of their own accord and start masking? I think we have to go back to basics. I think we need better, not just education, but we need to show the public, look at what masks have done for us. Look at what they can do for you. Present clearly what are the benefits of masking. Promote masks as one of the most essential prevention tools that we have. It is also the least expensive, the most accessible, and the least intrusive. And I'm not calling for a widespread all or nothing mask mandate. What flies in the face of common sense right now, and I think it's another thing that's undermining why people aren't wearing masks, is that right now, you tell me, what is the most important

place of transmission right now across Canada? It's in which sector or which situations? We're talking about kids, right? So schools, daycares. Exactly. So what I've heard is that the one place they're not recommending masks is schools and daycares. So if we don't need to wear masks in the place that's the highest risk for transmission right now and is the cause of the overloading of the health care systems right now across Canada, if we don't need to wear masks there, why do we need to wear one to go to work? Why do we need to wear one to go to the theater? Why do we need to wear one to go shopping? It doesn't make sense. So we would need mandates in schools and daycares then is what you're saying. That's where we need to mask. If you want to go to a bar and a restaurant, that activity is incompatible with mask wearing, but it's not an essential place to go. You can order in, you can skip going to a restaurant,

it's no big deal. Okay. And people can individually risk assess for those things. But for places that people have to go, pharmacies, stores, school, work, you mandate masks in places where actually wearing a mask doesn't interfere with what you're doing. Okay. And it doesn't mean you have to wear it for 24 hours. You can wear it a couple, you can wear it during the meeting and then you go back to your office, you take it off. It's about teaching people where and when to wear it. And it's not all or nothing. But in the meantime, I do think we need a strong recommendation, even mandate for certain

targeted spaces. And I think schools is definitely one of them. Kim, thank you so much for taking the time to talk to me today. It's really my pleasure. And I think I want to wish everyone a happy holidays. And I think we have a good chance if we all pull together now. That's it for today.

I'm Mainika Raman-Wilms. Our producers are Madeline White, Cheryl Sutherland, and Rachel Levy-McLaughlin. David Crosby edits the show. Kasia Mihailovic is our senior producer, and Angela Pichenza is our executive editor. Thanks so much for listening, and I'll talk to you next week.