Few things are as instantly symbolic of the pandemic – or have been as hotly debated – as facemasks.
But from tomorrow, after more than a year of being legally required to wear one in many public spaces, Britons will finally be free to ditch them for good.
Except that it’s not going to be quite as simple as that.
You’ll still be required to wear one on public transport in many places. Hospital visitors will still need one.
Supermarkets and shops have indicated they’ll ‘encourage’ customers to put one on, and workers in many restaurants and bars will still be wearing them.
Oh, and the Scottish and Welsh governments have opted to keep their mandatory mask laws for the time being.
Few things are as instantly symbolic of the pandemic – or have been as hotly debated – as facemasks. But from tomorrow, after more than a year of being legally required to wear one in many public spaces, Britons will finally be free to ditch them for good
While Prime Minister Boris Johnson said earlier this month that he will continue to wear them in crowded places, he and other Ministers have indicated it is very much up to individuals to decide.
Last month it emerged that Israel, where more than 70 per cent of the population are vaccinated, was reintroducing mask laws as it attempted to tackle a third Covid wave.
What one should do – and think – about masks still feels as unclear as it was back in March 2020.
Writing in these pages earlier this month, The Mail on Sunday’s GP columnist Dr Ellie Cannon said she would continue to wear one in her clinic, no matter what.
In medical settings, masks could reduce transmission of many infections, not just Covid, she reasoned.
Since then we’ve been flooded with emails and letters, with the overwhelming majority of readers agreeing with her stance.
Many said they had long been frustrated by people who refused to wear them in places that required them to be close to others.
But there were those who asked, after more than a year since mask laws were controversially introduced, where’s the evidence they actually work?
In an effort to find a definitive answer, and help you come to a decision about whether you should be putting one on come Freedom Day and, more importantly, when and where, we spoke to some of Britain’s leading experts.
Scepticism about masks is, to some extent, rooted in the messages publicised last spring by all of the major public health bodies in the West.
In March 2020, Dr Mike Ryan, executive director of the World Health Organisation Health Emergencies Programme, said there is no ‘specific evidence to suggest that the wearing of masks by the mass population has any potential benefit’.
The same month, England’s Chief Medical Officer Professor Chris Whitty said: ‘Wearing a mask if you don’t have an infection reduces the risk [of being infected] almost not at all. So we do not advise that.’
Instead we were told to wash our hands for the amount of time it takes to sing Happy Birthday.
In America, Dr Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases, said: ‘There’s no reason to be walking around with a mask. [It] might make people feel a little bit better… but it’s not providing the perfect protection that people think that it is.’
Of course, all rapidly changed their stance as scientists gained better understanding about how Covid spread. But the perception that masks don’t work has stuck.
Videos of Dr Fauci’s comments continue to circulate on social media, despite him now endorsing double-masking – wearing two masks for greater protection.
Dr Trish Greenhalgh, Professor of Primary Care at the University of Oxford, said that the UK ‘got off on the wrong foot’ when it came to mask-wearing.
Health chiefs were initially fixated on finding definitive evidence from studies that masks worked to stop Covid transmission – which, of course, at the time did not exist.
‘We became obsessed with the Holy Grail of definitive randomised control trials that would quantify both the benefits and harms of masks, just as you would for a drug,’ she said.
Randomised control trials are often considered the best way to test medicines, involving two groups of participants, one given the real treatment and the other who are not, monitored under strict scientific conditions.
These are necessary to ascertain the safety of drugs, which can have significant side effects.
But, as Prof Greenhalgh points out, for an intervention that has few if any potential downsides, such as mask-wearing, it’s simply not necessary.
Except that it’s not going to be quite as simple as that. You’ll still be required to wear one on public transport in many places. Hospital visitors will still need one
Researchers have now shown that regions which adopted a precautionary approach, introducing mask mandates in the first days of the pandemic – including Japan and Hong Kong – had six times fewer Covid-19 deaths by the end of 2020 compared with countries that delayed the ruling, such as the UK.
Dr Monica Gandhi, Professor of Medicine at the University of California, San Francisco, agrees.
Speaking on The Mail on Sunday’s podcast, Medical Minefield, Prof Gandhi, an expert in public health, said a common-sense approach to masks would have been more appropriate: ‘Masks are like a condom, frankly, in sexually transmitted infections.
‘There isn’t actually a great study that shows condoms work. But they do work – they provide a physical barrier. And it’s the same thing with masks.’
Another misconception that’s hung about is that masks could do more harm than good.
In a television interview in March 2020, Dr Jenny Harries, England’s then Deputy Chief Medical Officer, said: ‘What tends to happen is people will have one mask.
‘Or they will be out and they haven’t washed their hands, they will have a cup of coffee somewhere, they half hook it off, they wipe something over it.
In fact, you can actually trap the virus in the mask and start breathing it in.’
There was a genuine concern about infection-by-mask, possibly due to a handful of small, pre-pandemic hospital-based studies of healthcare workers that suggested that, in high-risk situations while treating very unwell patients, this could occur.
But Prof Greenhalgh said this ‘never made sense’ when it came to Covid, adding: ‘There was never any evidence that people touch their faces more when masked.’
Initially it was believed the virus travelled mainly via droplets expelled from an infected person’s mouth and nose when they coughed or sneezed, with these droplets landing on surfaces that are then touched.
However, it was quickly shown, in numerous studies, that the virus didn’t survive on surfaces for any significant amount of time.
Today, experts agree these droplets are a risk if we are in close proximity to someone who is infected.
Masks have been shown to trap these, meaning if a person is carrying the virus, wearing one will limit the spread.
A University of Edinburgh study, published in April, showed the number of droplets expelled from an infected person’s mouth was 1,000 times lower when wearing a single-layered cloth mask.
The researchers concluded masks can block 99 per cent of Covid-infected droplets.
Other studies have shown less promising outcomes, with home-made cloth masks often failing to trap smaller droplets.
Other studies have found mask efficacy drops the more a person sneezes and coughs, as it makes the fabric wet.
But, on average, studies suggest even loose-fitting masks reduce the number of droplets sprayed by at least half.
Experts also now agree that Covid isn’t primarily being transmitted via droplets anyway – the virus is airborne, exhaled by those who are infected, and travels in smoke-like clouds.
Towards the end of last year a series of real-world studies found the virus could spread this way between individuals at least seven metres apart.
This is why a single passenger on a flight could infect dozens of others.
Dr Gabriel Scally, Visiting Professor of Public Health at the University of Bristol, said: ‘Droplet transmission is not a major problem – the virus travels in the air.
‘That’s why wearing a plastic face shield, where the air just goes out and around them, is pretty useless. The same goes for obsessive surface cleaning.
‘We should be concentrating on ventilation. And when we’re not outside, and in a place that can’t be ventilated properly, we should be wearing masks.’
He added there is now a wealth of evidence that shows masks are very effective at trapping these airborne particles.
US researchers have found during studies that, even if the mouth and nose are covered with a simple cotton T-shirt, up to 80 per cent of air particles exhaled from the mouth are blocked.
Other German studies found similar results with home-made cloth masks, reducing the amount of travelling particles and droplets by roughly 70 per cent.
There is also precedent: a 2013 study by Harvard University researchers found mask-wearers infected with flu expelled three times fewer droplets from coughs and splutters than non-mask-wearers.
The most comprehensive review of more than 170 studies, published in The Lancet medical journal last June, concluded that even with some gaps around the nose and mouth, multi-layered cloth and single-use masks blocked at least 60 per cent of infected particles.
Then there’s proof from real-life scenarios.
In July 2020, the Centers For Disease Control (CDC) in the US reported a case of two hairstylists with Covid in Missouri who had interacted with 139 clients – and not one of them became infected.
Both stylists and clients had been masked. The CDC concluded: ‘Adherence to face-covering policy likely mitigated spread [of the Covid virus].’
Similar scenarios have been reported in studies looking at Covid outbreaks in Beijing households, Swiss hotels and British hospitals in which those who wore masks were not infected while those who didn’t wear masks were.
More convincing proof comes from a global analysis published earlier this month by a group of researchers from the US, the UK and Denmark.
Scientists looked at self-reported adherence to mask-wearing in more than 20 million people across 92 regions, alongside other Covid safety behaviours, such as social distancing and working from home.
The authors concluded epidemics grew three times faster in regions where the majority of the population were not wearing masks.
Perhaps the biggest drawback to masks as an effective intervention is more predictable: they work only if enough people wear one.
Surveys indicate that, once the legal obligation to wear a mask is removed, at least a third of Britons plan to ditch them.
Government adviser and top epidemiologist Prof Graham Medley said earlier this week on BBC Radio 4’s Today programme that mask-wearing ‘probably won’t do any good’ without legal backing.
Some studies have suggested that, on a population level, to have an impact on transmission, between 70 and 80 per cent of people must wear a mask in public.
Prof Medley added: ‘I think that, without a mandate, we end up with a situation where even if the majority of people wear a mask, will that actually do any good because of [those] who don’t? That is something that still needs to be determined.’
But Professor Julian Tang, virologist at the University of Leicester, points out that, regardless of what others do, masks still provide protection to each person who is wearing one.
Lab experiments that involve putting masks on mannequins and spraying their faces with water, designed to mimic respiratory droplets, have shown the masks block 60 per cent of them.
This may prevent infection, or mask-wearers may get less unwell if particles do slip through because they receive a lower dose of the virus.
A report by University of California scientists found mask-wearers are less likely to be symptomatic than their unmasked counterparts when exposed to the same infected person.
‘Everyone can reduce their personal risk of becoming ill from this virus by wearing a mask,’ said Prof Tang.
‘There will always be roughly ten per cent of people for whom the vaccine doesn’t work, for one reason or another.
‘No one knows if they will be one of the unlucky people in that group.
‘So if you want to reduce your risk, if you’re in a crowded place indoors, or somewhere with little air flow, wear a mask.’
Supermarkets and shops have indicated they’ll ‘encourage’ customers to put one on, and workers in many restaurants and bars will still be wearing them. Oh, and the Scottish and Welsh governments have opted to keep their mandatory mask laws for the time being
This applies, Prof Tang said, even if no one else is wearing one. He added: ‘If there is a speed limit of 60mph on a road and everyone else is going 100mph, would you be safer driving at the same speed as them? No. It’s the same here.
‘Even if no one else is masking, if you are then you are more likely than them to be protected.’
Of course, there is a compelling scientific argument that vaccination negates the need for masks.
Given how many Britons have now been jabbed, Prof Gandhi said she felt it was ‘right’ that the Government was ditching the mandate.
‘In the US, people who have been vaccinated aren’t required to wear a mask,’ she said.
‘The UK has managed to keep Covid-19 hospitalisations low, even with increased cases, because you have done a great job in vaccinating your adult population.
‘People who are vaccinated are safe, and people who are unvaccinated are safe from other people’s vaccination. So easing restrictions makes sense.’
Prof Scully is unconvinced. ‘We know that people who have been vaccinated can still be infected by the virus.
‘Happily, very few of them go to hospital, but some do, and even fewer again die.
‘So the vaccination has been great at preventing deaths, but it’s not a guarantee. And we know that the variants are eating away at immunity.
‘That’s why people should keep themselves safe and others safe by wearing a mask when they’re in a situation that calls for it.’
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