Time to grow up and face the simple truth about protective masks

There has been little as divisive in this pandemic as the debate over face masks. It’s a battle that raises not only thorny issues about identity politics and the culture wars that plague us but important questions about the way in which we weigh and act as a society on scientific evidence.

As the winter approaches and we are pushed indoors, expect the battle to intensify as we look for ways to mitigate transmission of the virus in offices, and even our homes.

The history of face masks should provide all sides with a degree of perspective, perhaps solace. We can surely all agree that it is amusingly appropriate that the first person to study the airborne dynamics of mucous droplets was a chap called Carl Flügge. And we should note that ours is not the first generation to squabble over masks.

“Three Shot in Struggle with Mask Slacker,” the San Francisco Chronicle reported during the 1918 Spanish Flu pandemic after James Wisser, a blacksmith and mask refusenik, got into a drunken tangle with a local “flu squad” whose job it was to enforce what was then law.

Mr Wisser had no doubt been incensed by the likes of the Red Cross and others who had called for “openface sneezers to be arrested” while peddling uncompromising slogans including: “Obey the laws, And wear the gauze! Protect your jaws, From septic paws!”

In this first great clash, the antagonists were much the same as today but there are differences. The libertarians of the early 1900s were drawn, in spirit at least, from the Wild West; the heirs of cowboys who were happy to wear bandanas to herd cattle or rob banks, but not when they were directed to do so.

This time around, in Britain at least, it is the other side – the health authorities – who were conflicted at the start. The Department of Health and Social Care has long opposed the use of masks by the general public as a matter of orthodoxy.

It has sought to frame the question around whether masks protect the wearer rather than others. And by adopting the mantra of evidencebased medicine in which nothing is actionable until it is proven, it has been able to endlessly repeat that there is “no reliable evidence” that they work to contain viral transmission.

This is why Britain did not have enough masks stockpiled and why decisions mandating their use in trains, buses, shops and other indoor public spaces have all been taken begrudgingly, and late.

Even now senior officials insist that the only reason they have changed their tune is to mollify us dimwits.

“The evidence on face coverings is not very strong in either direction,” said England’s deputy chief medical officer Dr Jenny Harries this week. “But it can be very reassuring in those enclosed environments for children and for teachers to know that people are taking precautions.”

While most experts have been keeping their heads down, Trisha Greenhalgh, professor of primary care at the University of Oxford, has taken up the fight, pulling together countless studies that point to the efficacy of wearing masks.

“Just look at the Covid transmission rates in Vietnam and other south-east Asian countries where everyone wears a mask and its obvious they have an impact”, she said.

This week Prof Greenhalgh and colleagues published a paper in the

British Medical Journal on social distancing and droplet transmission. At its core is a grid you can cut out and stick on your fridge as a guide to averting the risk of contagion, and in less than a week it has had more downloads than any other paper the BMJ has ever published.

The great merit of Prof Greenhalgh’s approach is it treats us all as adults.

For instance, she would never “shame crowds on a beach” because they are outside and “that’s a million times less dangerous than going to a busy pub”.

She recommends masks in smaller crowded spaces, especially loud ones, but not necessarily in well-ventilated offices. A school might ask its students to wear masks in the corridors where there is bustle and chatter but not in a library that is quiet.

She says there is no need to wear masks outside, as now mandated in Paris, but you might consider it if you were having a loud conversation with a stranger on a noisy building site. As winter sets in, she notes there will be growing need to wear masks inside.

“There are common sense things you can do once you know the broad parameters of risk and I think we can trust people to do that”, she said.

Now let the battle begin.