Facemasks: the facts

17 Jul 2020 Nick Garbutt    Last updated: 17 Jul 2020

Pic: Unsplash

The controversy over facemasks is emblematic of the dangerously shambolic government response to Covid-19. And it's not just public health that’s at stake. 

It’s deeper than that, going right to the heart of the nature of rules and why we obey them or not.

First the facts. Facemasks do work. We know this from two types of study conducted during the pandemic: in the laboratory and real life experience.

For example a paper was published in the New England Journal of Medicine by a group of US scientists which used lasers to analyse the effectiveness of facemasks. When we speak we emit droplets of fluid from our mouths. These fluids can contain viruses. Whilst large droplets will fall to the ground, smaller ones can linger in the air, behaving like an aerosol. They found that the number of droplets was greater the louder people spoke and that the droplets produced were smaller than when people coughed or sneezed. It seems to follow from this that speaking to others is potentially more dangerous than coughing in their presence.

However when mouths were covered by a slightly damp cloth the droplets were suppressed.

Perhaps even more compelling are the emerging studies of real life experience. A study of 198 countries has found that those where facemasks are either the norm, or been legally enforced have emerged better from the pandemic than those where they are not.

There are also some compelling individual case studies like this from the  Canadian Medical Association Journal which tells of a man who flew from China to Toronto with a dry cough and subsequently tested positive for Covid-19. He wore a mask on the flight. All 25 people closest to him on the aircraft tested negative.

So why has the medical opinion of facemasks changed? The WHO amended its guidance on 5 June to recommend medical grade facemasks for settings where physical distancing can’t be achieved and three layer ones for everybody else. Up until then the chair of its relevant committee  was saying that there was insufficient evidence to argue for their use by the public. And England’s deputy chief medical officer was even suggesting they were “not a good idea” and  their use could be dangerous

We are learning more and more about Covid-19 as time passes, best practice in suppressing it is emerging, it is not immutable and will change as new evidence is published.

So if the evidence is hardening, why is it taking so long to introduce enforcement and why is there not a united approach across the UK?

First  if we were totally focused on eradicating the disease we would not have come out of lockdown until it had been eradicated. The lockdown at Wuhan worked because it operated as a cordon sanitaire around the affected area. The reason this is not being followed is because of the impact such measures would have on the economy which is in serious enough trouble as it is.

There is an urgent need to re-start economic activity. The retail sector is one of the most vulnerable and enforcing face masks in shops when they were deemed unnecessary during lockdown seems a difficult message to some politicians. And the management of Covid-19 is down to politicians, not experts, despite the rhetoric of following the science.

Second there are cultural concerns around wearing masks in this part of the world – a sense that people would refuse to wear them.

There has not been much evidence of what American commentators call Branch Covidians in the UK and Ireland – the sort of people who would risk death for “liberty”. However there are plenty of devotees of the 19th Century philosopher JS Mill who wrote: “Over himself, over his own body and mind the individual is sovereign”. We’ve heard plenty of that kind of comment during the face mask debate. The trouble with this is that the purpose of the mask is primarily to prevent you infecting others. So the argument is invalid.

Next there is the growing realisation that, even though this sounds counter-intuitive, imposing a strict lockdown is much easier than coming out of it. The UK government’s behavioural experts thought that people would not adhere to the restrictions. In fact they were wrong, compliance amongst the general public was high.

However as soon as the rules have become less universal they start to feel arbitrary. For example in the case of face masks, what is the logic behind imposing them in shops, but not in offices, pubs or restaurants, when those in the latter venues are likely to be in a confined space with others for longer?

We have entered an era where the individual liberties that Mill and others wrote about are being replaced by a kind of supervised containment with government is laying out ground-rules for every day life. All this at a time when clear messaging: stay at home, save lives as been replaced by the vague paranoia induced by “stay alert”. Classic Millsian thinking about liberty may no longer be appropriate to surviving a pandemic, but that does not make the experience comfortable.

This is compounded by the confusion arising from regional governments deciding to adopt different measures than those announced from Downing Street. Face masks are just one example. They are already enforced in Scotland, will come into force in England from July 24. There’s been no announcement in NI to date.  At a time when we need clarity of message most of us are confused. There’s no doubt that one time or another households have been following rules laid down by the wrong government!

Covid-19 is a global pandemic and for this reason the WHO’s Covid-19 special envoy David Nabarro has urged leaders of all nations to “find ways to collaborate for the sake of humanity quickly because the challenges are too great to be dealt with by countries pursuing separate agendas.” The UK can’t even achieve this between its constituent parts.

This is not just a matter of poor co-ordination it is also exposing serious weaknesses with devolution itself. Prime Minister Johnson might be purporting to make policy on Covid-19 for the whole of the UK. In practical terms he is only doing so for England, yet England does not have its own devolved institution. This might not matter so much when Tories are in power as they have a majority of seats there. But what if they had lost the election and a coalition of Labour and the SNP were in power? What mandate would it have for England? That would surely provoke a constitutional crisis.

Finally and crucially we get to the matter of trust. And trust in the UK government’s handling of the pandemic is in short and diminishing measure as all the polls demonstrate. And as trust diminishes it becomes harder and harder to impose rules. We need to believe that they are fair, and reasonable that they have some kind of moral purpose, and that they are universally applied.

During the pandemic there have been many instances where people in positions of power have chosen not to follow rules which they have applied to others. This undermines their moral authority. People are not fools and by exempting themselves from the precepts applied to others politicians are playing a very dangerous game. For without moral authority laws break the social contract between citizens and state. They are no more and no less than edicts backed by force. And with the police in England saying they will be unable to enforce compliance such measures will only work if the vast majority of people believe they will.

Perhaps that, as much as anything is behind the UK government’s reluctance to impose new ones.



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