The public should be wearing face masks

The failure to recommend them in the UK is evidence of the hubris of scientific advisers in Government

Arecurring theme of the handling of the Covid-19 emergency has been the apparent unwillingness of the Government and its advisers to recommend interventions that have been tried and found to be useful in preventing, containing, mitigating and otherwise responding to the enormity of this threat to life and health. Whether it be screening and systematic population testing, triaging, isolating or quarantining, our attitude seems always to be at best sceptical or at worst half-hearted.

Nowhere has this been more in evidence than in our policy towards the wearing of face masks by the public, a practice that is widespread in many parts of the world – notably in nations that have been more successful at suppressing Covid-19 – and which is now gaining support in previously sceptical countries. But not seemingly here in the UK, where the deputy Chief Medical Officer for England has again spoken out against any change in policy.

To be fair to the Government, a systematic review of the English language literature on the prevention of the transmission of the influenza virus by Cambridge Core in 2009 did find that, while there was some evidence to support the wearing of masks during illness to reduce virus transmission, there was little data to support the use of masks or respirators to prevent becoming infected. The review argued that further studies were needed.

But that was more than 10 years ago, and no evidence of effect is not evidence of no effect. In recent days, the Center for Disease Control in the United States has issued new guidance to the effect that everyone should wear a cloth face cover when they go out in public, a measure that is intended to protect other people in case you are infected. The World Health Organisation is currently reviewing its own position on the matter.

The emerging knowledge that corona sufferers may be able to infect others in the preclinical stages of the disease makes such moves all the more logical. Furthermore, new research published in Nature Medicine last week concluded that surgical masks may help prevent infected people from making others sick with seasonal viruses, including coronaviruses. During the 1918/19 Spanish flu pandemic, meanwhile, Hobday and Casons in Boston demonstrated lower case fatality rates in open-air hospitals with natural ventilation and gauze masks and our own Dr Hood, the medical superintendent at the Marylebone hospital, showed a similar effect with lint masks.

Why is the UK, then, so resistant? Sadly, a rigid and inflexible approach to science has seemed to dominate thinking and specialist advice, with constant rhetoric about us having the best science in the world when a bit of modesty might have served us better. Indeed, the narrow range of intervention options offered by Cobra, seemingly based on a narrowly drawn coterie of advisers, including the increasingly challenged group of Imperial College academics, is being questioned by front-line practitioners.

But our failure to change tack on this issue could also have something to do with our lack of preparedness for pandemics in general. Given our well-publicised problems with regard to other capacity issues, including testing kit, reagents and swabs, personal protective equipment and potentially oxygen, could it be the case that the Government is avoiding another embarrassing failure that would be brought about by large-scale public demand for face masks?

It seems likely that in the days to come we will witness a U-turn on this issue, something which can’t come soon enough for those such as bus and taxi drivers, who may already have become victims of the coronavirus.

As we hopefully move towards a more pragmatic package of measures, we must remind ourselves of the importance of a rigorous approach to even the humble face mask, which must be worn properly and changed or washed regularly. Perhaps when all this is over, standards of British personal hygiene will have been permanently improved – something that even the Roman occupation failed to achieve.