It is a matter of orthodoxy at the UK Department of Health and Social Care (DHSC) that surgical facemasks are a no-no as far as the public are concerned. Officials have long taken the view that paper masks do not protect against viruses and do not hold emergency stocks of them.
That thinking, like so much else, is now being tested. Last week, the US Centers for Disease Control (CDC) – a long standing ally of Whitehall in the no-mask camp – was reported to be about to change its advice. Surgical masks should be used, not for personal protection, but to protect others from Covid-19, it was expected to announce.
It’s another virus-fighting lesson that has been borrowed from the east and raises important questions. Might population-wide use of face masks have slowed the spread of the pandemic in the west? And were our public health officials asking the wrong question all along?
I first thought about face masks at around 4pm on Wednesday, November 28, 2007, when a small but agitated civil servant flung open the door of my office shouting, “Take it down! Take it down!”. I was editing the NHS website and we had just published a story which suggested that face masks had helped bring the 2003/4 Sars epidemic under control in south east Asia.
The official was part of the DHSC’s pandemic planning team. She was very angry and wanted the story taken down immediately. She had just been to see the then Prime Minister, Gordon Brown, and had explained to him, “in terms he could understand”, that there was really no need for the UK to hold a stockpile of masks, she said. The story we had just published threatened to undo all of that by giving credence to an “minor academic paper” which said the opposite. I told her to hop-off.
The issue came up again two years later at a meeting of officials in the early stages of the 2009 H1N1 swine flu pandemic. The virus was breaking out of Mexico and heading our way fast and no one was sure how lethal it was. There were officials from across the UK dialled into the meeting and someone from Scotland noted there was no stockpile of surgical masks south of the border and wondered if “colleagues in London” might like to borrow some of theirs. “That won't be necessary,” they were told.
The DHSC, like most western health authorities, have always approached the question of surgical masks from the perspective of the individual. The question has always been, do they protect us individual citizens from infectious droplet borne diseases?
Approached from this angle, the evidence is clear – they provide little protection from viruses and may create a false sense of security as well as wider public anxiety. They are ill-fitting and need regular adjustment, causing wearers to touch their hands to their faces. Worse, they quickly become moist, creating a potential magnet for germs. It’s for these and other reasons UK doctors and nurses are so angry about not being provided with enough proper FFP3 respirators.
But what if you turn the question around, focusing not on the individual but on society; do surgical masks slow the progression of droplet spread viruses if issued to people in their millions, as we are seeing in China, South Korea and Taiwan?
A couple of days ago Science magazine ran an rare interview with George Gao, director-general of the Chinese Center for Disease Control and Prevention.
“The big mistake in the US and Europe, in my opinion, is that people aren’t wearing masks,” he said. “This virus is transmitted by droplets and close contact. Droplets play a very important role – you’ve got to wear a mask, because when you speak, there are always droplets coming out of your mouth. Many people have asymptomatic or pre-symptomatic infections. If they are wearing face masks, it can prevent droplets that carry the virus from escaping and infecting others.”
There are few western experts who would disagree when put this way round. This is exactly what surgical masks are designed for – to keep droplets in rather than out, to stop them from spreading to others. It is just that in the west, with our focus on the individual, officials may not have given their society-wide use enough attention.
There is also an element of paternalism. "Masks are not only an instrument of protection but also a symbol of fear,” notes Yanzhong Huang, a senior fellow for global health at the US Council on Foreign Relations.
No doubt the DHSC will take some time to come round to this view, even if their colleagues at the US CDC pivot.
British officials will demand hard evidence that the mass-issuing of face masks can slow the spread of a virus before acting. They would add that the systematic review they didn't want Gordon Brown to see doesn't amount to that. And they would point out that China sits outside the cluster of mask-wearing Asian countries in the chart above which is doing the rounds on the internet.
All of this is no doubt correct but it is also academic. We don't have a stockpile of surgical masks in Britain even if we wanted one.
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