“We should have waited to lift mask mandates”: A Q&A with Dr. Peter Juni, head of Ontario’s Science Advisory Table, about the recent surge of infections

“We should have waited to lift mask mandates”: A Q&A with Dr. Peter Juni, head of Ontario’s Science Advisory Table, about the recent surge of infections

Last month, the head of Ontario’s Science Advisory Table said it was too early to lift mask mandates. A few weeks, and more than 100,000 new daily infections later, Dr. Peter Juni says it’s still not too late to make a difference. After coming to Toronto, in 2015, to take a position at St. Michael’s hospital, the Swiss-born general internist and epidemiologist became one of the pandemic’s most recognizable faces, often coming up against the political powers that be and always sticking to the science. This spring, he’ll be vacating his seat to take a job at Oxford University in England. But first, he’d love to get this 0utbreak under control.

Earlier this week, the Premier said that Ontario is experiencing a “little spike” in Covid cases, but that it’s “manageable.” Agree or disagree?  
I would describe what we are seeing as a strong resurgence. We started to see change after March 1, when the province expanded capacity limits and got rid of proof of vaccination requirements. And then the resurgence became even more prominent after the lifting of mask mandates on March 21. By looking at the wastewater data, we’re able to triangulate the number of new infections per day, which is now between 100 and 120,000. That’s double from the beginning of the week, and more than we’ve seen at any other time in the pandemic. 

That doesn’t sound very comforting—or manageable. How worried should we be?
That really depends on where we go from here in terms of our behaviour. It’s important to remember that we have developed a lot of immunity, even compared to when Omicron first arrived. Thanks to the vaccine rollout, over 7.2 million people have three doses. And between four and five million people have been infected since December. These two factors, taken together, provide a lot of short-term protection against infection, and long-term protection against hospital and ICU admissions, which is good. But ​​there’s still a danger of overwhelming our hospitals.

The Premier has said hospitals are capable of ramping up if needed. 
Yes, I saw that, but the reality is that even if we do have enough ICU beds, staffing is a serious issue. When five percent of the population has COVID, it includes healthcare workers. The other potential danger is that we still don’t know about the relationship between this latest wave and long covid, so that’s something we’ll be watching. 

I keep hearing about this new variant…
The new sub-variant, BA2, is now the dominant variant. The key difference is that it’s even more transmissible than the previous Omicron variant, so that has contributed to the spread, but not nearly as much as the recent reopening steps, and the way information has been communicated. 

So if you were running the province, would we still have vaccine passports and mask mandates?
With vaccine passports, we came up against a situation in which they were no longer useful, because they only indicated two vaccines and that was not effective against the Omicron wave. And then with so many people getting Covid, but unable to show proof of that immunity, it was just too complicated procedurally. So keeping them around would not have helped. With the lifting of the mask mandates, my preference would have been to wait after the reopening step of March 1, and after kids came back to school following March Break. The data would have shown that we’re in the sixth wave, and maybe it would be prudent to wait until the end of the peak to lift mask mandates. But the other issue with masks was the way information was communicated. What should have been said was, “Yes, we are lifting mandates, but continue to strongly recommend masking.” Instead, the message was, “It’s your choice.” 

Were you surprised by how many people have chosen to stop masking? 
Yes. With our modeling, we assumed the change would be more moderate, but instead, behaviour changed very quickly and the growth has been explosive.

Just so we’re clear on the chain of command here: As head of the province’s Science Advisory Table, you make recommendations to the chief medical officer, Kieran Moore, and Dr. Moore makes recommendations to the Premier.
Yes. I communicate with Keiran Moore. Over the course of the pandemic, I have only briefed the Premier directly once. I don’t even remember what it was about, but it was quite a while ago. 

Is it fair to say your input on this latest round of openings was ignored?
Yes. I was very clear about what I was saying: “It’s too early. We need to wait for more data.” I honestly don’t know what happened. I was very surprised. In the last communication I had with Kieran Moore about masks, we talked about lifting mandates at the end of March. And then, instead, they did that in the middle of the month. I found out when a journalist asked me about it during a live interview.  

With the election coming up, do you think certain leaders are keen to put masking behind us?
I’m not a political scientist, so I’m not qualified to say what might have happened on that end. I would say that, in general, when we look at what’s happening in other provinces, and the US and countries in Europe, there’s a tendency from leaders to want to signal that the pandemic is over. I think that might be based on a social pressure that’s felt most acutely by politicians and policymakers. When you look at the polls at the time when mask mandates were lifted, most Ontarians were still okay with masking.

Should we be reinstating mask mandates?
I think, at the very least, the message from leadership needs to be a very strong recommendation to continue to wear masks, and this needs to be done very swiftly. 

Is it not fair to say at this point in the pandemic that people don’t necessarily respond to “strong recommendations”?
That’s more of a political question. 

Okay, here’s a scientific question: Will people die because we are abandoning mask-wearing too quickly? 
Yes. At this stage, we can hope that more people get vaccinated, but that will not take effect soon enough to blunt this wave. Masking and other public health interventions are the only measures we have. If we hold off just a couple of weeks, we could make such a difference. 

What about the idea that we need to learn to “live with COVID”?
I hate this expression. To me, that sounds like admitting defeat. 

I think there are a lot of people who have bought into this idea that masks aren’t all that effective. 
Yeah, yeah. The problem is that we’re in the middle of a pandemic, so we don’t have the highest level of evidence to support mask-wearing—just a couple of randomized trials. So you have some people abusing the principles of evidence-based medicine to argue against masks. They’re basically saying that the absence of high-level evidence is the same as evidence of absence, which is very dangerous in a situation where we have a highly transmissible airborne variant. 

So in your over-300-research-papers-published opinion, masks are an effective form of protection? 
When we look at the observational data that I’ve accumulated, it’s all compatible with masks working. And if you want proof of concept, just look at our wastewater, look at infection rates! This is because we lifted mask mandates. 

If you look into your science-informed crystal ball, what does summer  2022 look like? In a worst-case scenario, could we see more lockdowns?
No. And that’s because of the level of immunity we have built up. What summer looks like really depends on whether a new variant is coming and the nature of the variant. It’s possible we could need an additional vaccine effort or to mask up again. Of course, there are no guarantees, and the other factor is the weather. The more we can be outside the better things will be. 

Speaking of the summer, you are leaving us to take a new position at the University of Oxford. You announced the move shortly after the province announced the loosening of restrictions. Were you just like, Screw this—I’m outta here!
No, no. That’s really not the case, and, honestly, the offer from Oxford—combined with the opportunity to be closer to family—was too great an opportunity to pass up. But I have loved my time here and I’m sad to be leaving. I will miss my colleagues and so many other people. My children will miss their friends. And we will miss the diversity. In Toronto, people feel at home irrespective of where they have come from. I don’t know anywhere else in the world that is like that. Can I share a story?

One of my colleagues, the acting director of my centre, came here to do an interview and when he was in the cab on the way back to the airport he was chatting with his driver who had a heavy accent—he had come here from India fairly recently. My colleague said to him, “Canadians are really friendly,” and the driver said, “Thank you.” Maybe if you are from here that story doesn’t mean as much, but it blew both of us away. You have people in Europe who live somewhere for their whole adult lives, but still don’t feel like they are of that place. 

That’s wonderful.
Yes, and you know it’s something that maybe people who live here all their lives don’t notice, but it’s very unique. This is a wonderful place, and I’m so proud to have been part of the amazing effort we’ve made in fighting Covid. It hasn’t been perfect, but I think we should all be very proud. And you know, someone like me, If I did what I did here in my home country of Switzerland, I would have to travel with a police escort. 

Because you have spoken out against government policy?
No, because I have been very vocal about the need to work together and to give up certain freedoms in order to protect ourselves and each other. This is not an idea that would have been accepted in Switzerland, or many other countries. 

You have frequently spoken out against the government policy though. Has that part of the job been hard? 
Not for me. When I took this job I said, “I won’t lie.” You can only have a trustful relationship between two people—or in this case, myself and the public—if they know they can trust you. There have been some very difficult messages, but my belief is that you can be truthful and soft at the same time. Things have definitely gotten tense at times, but I try to keep in mind something my colleague Steini Brown said to me early on, which was, “It’s not about making a point, it’s about making a difference.” That has really guided me throughout the pandemic, and still today.