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Face masks: A thread. There has been a lot of discussion about masks, this is not a rehash of the previous debates on evidence, rather a quick gallop through the changing Government and WHO advice and policies and the key issues they raise....
UK government: “Evidence suggests that wearing a face covering does not protect you. However, if you are infected but have not yet developed symptoms, it may provide some protection for others you come into close contact with. Face coverings do not replace social distancing”
Despite claims by some that ‘masks make us safe’ the guidance on this is clear that masks are not a standalone measure and that the evidence on their use in community settings is very limited and this has not changed ( https://www.gov.uk/government/publications/staying-safe-outside-your-home/staying-safe-outside-your-home#face-coverings)
WHO updated its guidelines on masks on (5/6/20): “the use of a mask alone is insufficient to provide an adequate level of protection or source control, and other personal and community level measures should also be adopted to suppress transmission of respiratory viruses”
New WHO guidelines here: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks (plus infographics and videos about mask use)
The UK government and proponents of homemade face coverings have suggested that masks can be easily made at home and that this is adequate: e.g. “Masks are simple, cheap, and potentially effective.” https://www.bmj.com/content/369/bmj.m1435
The Government instructions on making a face covering suggests two squares of cotton or a tshirt being cut down to create a covering and the Health Secretary referred to these instructions in his press conference on Thursday 4th June: https://www.gov.uk/government/publications/how-to-wear-and-make-a-cloth-face-covering
The updated WHO guidance is clear that 3 layers of material is needed, a waterproof outer, a polypropylene or polyester middle and cotton inner being advised (see page 10: file:///C:/Users/ehanna01/Downloads/who-2019-ncov-ipc-masks-2020-4-eng.pdf)
The UK government guidance is therefore at odds with the current WHO advice on this. Whether the three layer, multi-material covering can be easily made at home depends on access to the resources to produce such a garment....
Other governments who have mandated masks, e.g. France, Spain, Italy, Hong Kong have provided masks to the population to ensure access and uptake of them. The new policy on hospital visitors and outpatient appointments suggests masks will be provided to those without them
So what are some of the key issues we should consider now as we move into a new period of face mask use? (these are in no particular order and not an exhaustive list!):
Issue 1: Not everyone has access to a face covering or the resources to make one. This could cause further inequalities around covid-19 – especially if the WHO construction guidelines are to be followed
Hong Kong often used as example of value of face masks, the government provided universal access to masks: https://www.bmj.com/content/369/bmj.m1880 this can help reduce inequalities around access, especially as we know that health inequalities and Covid-19 are likely to be linked
Issue 2: There has been no full assessment of the implications (as far as we know!) before mandating. WHO is clear that decision makers must: “evaluate the impact (positive, neutral or negative) of using masks in the general population (including behavioral and social sciences”
This is particularly problematic when there has been no consultation or buy in from organisations where this will impact, e.g. https://www.bbc.co.uk/news/uk-england-london-52933840 policies cannot be implemented effectively without buy-in and information to all concerned.
This disrupts trust in the government and doesn’t allow for adequate preparation for such policies, especially as Masks have risks and negative implications. The WHO provides an extensive list of these on page 8 of its updated advice
Issue 3: The new policy around transport is London-centric. E.g. there is a pilot scheme for free masks which could help with issue 1 but this is just currently being done by Transport for London. Discussions of enforcement have also centred on London travel
e.g. https://www.bbc.co.uk/news/uk-england-london-52933840 We must ensure that transport in other parts of the country are considered, especially areas with socio-economic issues that could prevent use/cause further health or social inequalities (e.g. North East and North West) and where R rates are high
How will cross border travel be managed and what are the specific issues for rural populations and for those with long commutes by public transport. How can the risks be managed?
Issue 4: Exclusions about mask use must be made clear. The government have said that some groups, including the disabled wont have to wear masks. (dis)ability is not a homogenous group- therefore who will be exempt from masks and how will this be managed?
Clear information on how to keep disabled passengers safe during travel, including free from stigma if they are not able to use a mask must be provided. Disabled people are key workers/travel for work and they must not face further discrimination or inequalities due to policy
Issue 5: We must ensure we evaluate the policy. There is currently no details on how the government will monitor and assess the use. Covid-19 is a new emergent threat and we therefore must capture evidence, especially on things like where the existing evidence is very limited.
“WHO encourages countries and community adopting policies on masks use in the general public to conduct good quality research to assess the effectiveness of this intervention to prevent and control transmission” . Research strategy must be therefore considered now
The TL;DR? Face mask policy is changing and guidance has changed (e.g. WHO). Face masks could exacerbate inequalities between different groups and populations as well as places and must be carefully considered...
...Assessing all the aspects, including the risks is urgently needed and research on the effectiveness of masks must be the priority as we move into this next phase of mask use.
