Cloth masks, scarves and bandanas to be 'encouraged' with no compulsion

[mpthomson]

This is likely to be the reason why they are not being encouraged, as with the current manufacturing and supply chain in place we can barely provide the right PPE as it is.

But I think the government should recognise the importance of wearing face masks for the wider population and make plans their wider use.

Why is it important for the wider population, given that there's fundamentally no peer reviewed evidence to support their use in the general population?

Your BMJ link deals exclusively with medical settings for masks, not walking round town or getting on a train and the research is totally irrelevant for the general public.

 

[mpthomson]

I struggle to see why there should be a significant reason why an ill-fitted mask worn by a healthcare professional in a busy hospital should have substantially more (or less) efficacy than an ill-fitted mask worn by a commuter on a busy train.

Because medical professionals have to get very close to patients to carry out their roles, within inches often. The two sets of circumstances are wholly different. No-one is going to propose NHS grade facemasks for the general population as a) there aren't enough of them anywhere in the world at the moment and b) the public wouldn't use them properly, at which point they are more of a risk than if you didn't wear one.

 

[Bletchleyite]

Because medical professionals have to get very close to patients to carry out their roles, within inches often.

A bit like passengers on the Tube, then?

You could "social distance" mainline trains via compulsory reservations and blocking out of some seats. You can't do that on the Tube once usage goes back up.

 

[yorksrob]

So in other words we’re still at the whim of others, and can’t fully control and mitigate the risk down to as low as reasonably practicable. Knowing how disgusting an element of the population is, how can we guarantee that everyone buys-in to wearing masks for the benefit of others? Sadly I think I know the answer to this one...

Then fine people for not wearing one. Make sure there are a few high profile cases then most people won't bother with the hassle.

 

[Huntergreed]

Then fine people for not wearing one. Make sure there are a few high profile cases then most people won't bother with the hassle.

Problem then is people with conditions like Autism or Asthma that can't wear masks are then essentially a prisoner in their own home.

 

[yorksrob]

Problem then is people with conditions like Autism or Asthma that can't wear masks are then essentially a prisoner in their own home.

I suspect it would be possible to provide some sort of a medical note in those circumstances.

 

[Bletchleyite]

Problem then is people with conditions like Autism or Asthma that can't wear masks are then essentially a prisoner in their own home.

Autism I'll give you (this whole thing is going to be horrible for people with serious autism in particular).

In what way (I am one, by the way) can't an asthmatic wear a mask?

 

[westv]

A bit like passengers on the Tube, then?

I can't I'm imagine a tube train being full of people infected with Covid19.

 

[Bletchleyite]

I can't I'm imagine a tube train being full of people infected with Covid19.

Because everyone's packed in it'll spread.

 

[MarkyT]

A new paper on public mask wearing written by Trish Greenhalgh
PROFESSOR OF PRIMARY CARE HEALTH SCIENCES
The Nuffield Department of Primary Care Health Sciences, University of Oxford
Masks for the public: laying straw men to rest

Masks for the public: laying straw men to rest

This paper responds to one by Graham Martin and colleagues, who offered a critique of my previous publications on masks for the lay public in the Covid-19 pandemic. I address their charges that my co-authors and I had misapplied the precautionary prin

www.authorea.com

Abstract
This paper responds to one by Graham Martin and colleagues, who offered a critique of my previous publications on masks for the lay public in the Covid-19 pandemic. I address their charges that my co-authors and I had misapplied the precautionary principle; drawn conclusions that were not supported by empirical research; and failed to take account of potential harms. But before that, I remind Martin et al that the evidence on mask wearing goes beyond the contested trials and observational studies they place centre stage. I set out some key findings from basic science, epidemiology, mathematical modelling, case studies and natural experiments, and use this rich and diverse body of evidence as the backdrop for my rebuttal of their narrowly-framed objections. I challenge my critics’ apparent assumption that a particular kind of systematic review should be valorised over narrative and real-world evidence, since stories are crucial to both our scientific understanding and our moral imagination. I conclude by thanking my academic adversaries for the intellectual sparring match, but exhort them to remember our professional accountability to a society in crisis. It is time to lay straw men to rest and engage, scientifically and morally, with the dreadful tragedy that is unfolding across the world.

Conclusion
In conclusion, I congratulate Martin et al for rising to my challenge to produce a critique of my publications on face masks for the public. But whilst academic sparring can keep a few sociologists amused during lockdown, we also need to remember our moral accountability to a society in crisis. I myself trained as a doctor. The relentless, day on day stories of avoidable deaths from this dreadful disease sicken me. I will do whatever I can, as an academic, a doctor and a citizen, to reduce that death toll and help get society back running again.
As Gandhi et al concluded in their NEJM editorial: “This unprecedented pandemic calls for unprecedented measures to achieve its ultimate defeat”.19 It is time to put the straw men to rest and take a less mischievous perspective on the evidence.

Peer Review Status: UNDER REVIEW
28 Apr 2020Submitted to Journal of Evaluation in Clinical Practice
28 Apr 2020Assigned to Editor
28 Apr 2020Submission Checks Completed
28 Apr 2020Reviewer(s) Assigned

 

[DynamicSpirit]

A new paper on public mask wearing written by Trish Greenhalgh
PROFESSOR OF PRIMARY CARE HEALTH SCIENCES
The Nuffield Department of Primary Care Health Sciences, University of Oxford
Masks for the public: laying straw men to rest

Masks for the public: laying straw men to rest

This paper responds to one by Graham Martin and colleagues, who offered a critique of my previous publications on masks for the lay public in the Covid-19 pandemic. I address their charges that my co-authors and I had misapplied the precautionary prin

www.authorea.com

Interesting paper. To go off at a slight tangent, this statement in it caught my eye.

Sars-CoV-2 has a lipid membrane which is destroyed by soap or detergent (this, of course, is why hand-washing works).

That seems to imply that you don't necessarily need 'proper' handwash to wash your hands, because any soap or detergent would work just as well if your aim to neutralise any Covid-19 particles. Does anyone know if that is correct?

 

[6862]

That seems to imply that you don't necessarily need 'proper' handwash to wash your hands, because any soap or detergent would work just as well if your aim to neutralise any Covid-19 particles. Does anyone know if that is correct?

Yes, normal soap should be enough. The soap interacts with 'greasy' parts on the outside of the virus and increases its solubility, which will allow.it to be washed away, as well as disrupting the outer structure of the virus. Alcohol hand sanitiser does destroy the virus, but I think hand washing is supposed to be preferable because using hand sanitizer doesn't wash it away (i.e. it's more likely to leave some virus behind). Obviously the advantage of hand sanitizer is that you don't need running water.

 

[Meerkat]

A new paper on public mask wearing written by Trish Greenhalgh
PROFESSOR OF PRIMARY CARE HEALTH SCIENCES
The Nuffield Department of Primary Care Health Sciences, University of Oxford
Masks for the public: laying straw men to rest

Masks for the public: laying straw men to rest

This paper responds to one by Graham Martin and colleagues, who offered a critique of my previous publications on masks for the lay public in the Covid-19 pandemic. I address their charges that my co-authors and I had misapplied the precautionary prin

www.authorea.com

Peer Review Status: UNDER REVIEW
28 Apr 2020Submitted to Journal of Evaluation in Clinical Practice
28 Apr 2020Assigned to Editor
28 Apr 2020Submission Checks Completed
28 Apr 2020Reviewer(s) Assigned

I couldn’t see links to the sources.
it mentions 12 studies of asymptomatic transmission- I want to know if they proved that was airborne.

 

[Bantamzen]

I couldn’t see links to the sources.
it mentions 12 studies of asymptomatic transmission- I want to know if they proved that was airborne.

Hopefully those peer reviewing the paper are asking the same questions.

 

[Meerkat]

Hopefully those peer reviewing the paper are asking the same questions.

Particularly the aircraft carriers. It could be airborne......or could be contact - it is a building made of hard surfaces! All those ladder handrails, compartment doors, shared toilets and showers, shifts using the same tools and buttons.....

 

[Bantamzen]

Particularly the aircraft carriers. It could be airborne......or could be contact - it is a building made of hard surfaces! All those ladder handrails, compartment doors, shared toilets and showers, shifts using the same tools and buttons.....

Indeed, especially where people are in the space for very long periods of time, like you say places like carriers, cruise ships, hospitals, care homes. There still doesn't seem to be a huge amount of evidence for airborne transmission yet. That's not to say there won't be, but the findings coming in do seem to point more & more towards direct or indirect physical contact, rather than airborne spread. If this were to be found to be the case, then masks would only offer a very small amount of protection versus maintaining an elevated hygiene regime, both on a personal level & in terms of regular cleaning of enclosed spaces regularly used by many.

 

[MarkyT]

Romania just became the 65th country to announce mandatory nationwide mask laws. Joining Germany, Indonesia, Argentina, Thailand, Singapore, Israel, Vietnam, and many others.

 

[MarkyT]

A report stating that many infected people may be contagious for at least a few days before they show any symptoms.

Coronavirus (COVID-19) Overview

COVID-19 is a new type of coronavirus that causes mild to severe cases. Here’s a quick guide on how to spot symptoms, risk factors, prevent spread of the disease, and find out what to do if you think you have it.

www.webmd.com

How Contagious? Likely Before You Know You’re Sick
...
April 28, 2020 -- Scientists know that people are contagious in the early stages of infection with COVID-19, but just how contagious and for how long remains unclear.

Although a lot of emphasis has been placed on the need to stay home if you feel sick, many studies have shown that people are often contagious before they know they have been infected, making the virus that causes the disease much harder to contain.

In one recent study, researchers from China tracked 94 COVID-19 patients and found that they shed the most virus -- and were likely the most contagious -- just before or as they developed symptoms.

Infected people with no symptoms are likely to be just as contagious as those with symptoms, such as a dry cough, fever, and aches, according to very early research, says William Hanage, PhD, an epidemiologist at the Harvard T.H. Chan School of Public Health.

In a new study from The Lancet, which looked at the outbreak as it spread from Wuhan to Shenzhen, China, researchers showed that cutting down the time people with the virus interacted with others reduced its spread -- in other words, social distancing worked. This study also found that 5% of infected people took at least 2 weeks to develop symptoms, suggesting they may have been infectious for a long time.

Evidence from a nursing home also supports the idea that people are contagious before they get symptoms or even if they never develop obvious symptoms, according to a New England Journal of Medicinestudy. More than 70% of residents who hadn’t yet gotten symptoms were shedding the virus, the study showed.

 

[Bantamzen]

@MarkyT as glad as I am that you've stopped using 100 year photos to try to prove your case for everyone being forced to wear masks, these additional studies you offer still don't actually seem to point at the method of transmission, just that the virus starts to shed potentially a few days before symptoms start to show. But the shed viruses still have to have a way to move from the person infected to an uninfected person, and there is still nowhere near enough evidence to suggest that it can be spread easily through people breathing normally.

And herein is the point. It doesn't matter how many governments decided to enforce mask wearing, governments do not dictate how & when the virus spreads. That is the key part of the data, and so far from what I can see you haven't brought anything new to the table to enforce your desire to force people to wear masks.

 

[DynamicSpirit]

@MarkyT as glad as I am that you've stopped using 100 year photos to try to prove your case for everyone being forced to wear masks, these additional studies you offer still don't actually seem to point at the method of transmission, just that the virus starts to shed potentially a few days before symptoms start to show. But the shed viruses still have to have a way to move from the person infected to an uninfected person, and there is still nowhere near enough evidence to suggest that it can be spread easily through people breathing normally.

And herein is the point. It doesn't matter how many governments decided to enforce mask wearing, governments do not dictate how & when the virus spreads. That is the key part of the data, and so far from what I can see you haven't brought anything new to the table to enforce your desire to force people to wear masks.

I think the problem with this argument is that you seem to be looking for strong, peer-reviewed, robust, evidence that wearing masks works before mandating them anywhere in public. In normal circumstances, waiting for that kind of evidence would be a good approach. But we're in an emergency situation in which action needs to be taken quickly to stop people dying and, because it's a new virus, we don't have that body of carefully researched science and peer-reviewed findings about Covid-19 to tell us what to do. If we wait for that research to appear and be sufficiently robust before we take any action, then it would be too late, and potentially millions of people around the World will have died. So we have to do the next best thing, and take action based on what the relatively new science, combined with established knowledge about other virus and pandemics in general, appears to be telling us is likely to be a good move. That's why lots of countries imposed hugely disruptive lockdowns NOW, without waiting for robust peer reviewed research to tell them whether or not lockdowns would work. Governments and scientists had to make educated guesses based on what we know so far. And it's why the advice we are getting is fairly quickly evolving.

In the case of masks, we have something that isn't massively disruptive - certainly, nothing like as disruptive as social distancing - that looks likely to help prevent virus transmission at least a tiny bit, and quite possibly a significant amount. Given the urgent need to reduce transmission, it seems sensible to me to go ahead and mandate masks in some situations (such as public transport) even in the absence of stronger evidence. If we mandate masks (assuming we can actually produce enough of them - not much point otherwise) and it turns out that masks didn't work after all, then the only harm is a bit of inconvenience, and wasted expenditure buying them. If we don't mandate masks, but in 6 months time evidence shows that they actually are quite effective with Covid-19 (which is not certain, but a strong possibility) , then we've just caused quite a few thousand deaths and very likely resulted in the lockdown having to last a lot longer, with all the economic damage that entails.

Which way would you rather be wrong?

 

[Mag_seven]

If we mandate masks (assuming we can actually produce enough of them - not much point otherwise) and it turns out that masks didn't work after all, then the only harm is a bit of inconvenience, and wasted expenditure buying them. If we don't mandate masks, but in 6 months time evidence shows that they actually are quite effective with Covid-19 (which is not certain, but a strong possibility) , then we've just caused quite a few thousand deaths and possible resulted in the lockdown having to last a lot longer, with all the economic damage that entails.

The flip side of that is that masks give people a false sense of security and they end up disregarding far more effective things such as social distancing. Its not quite a simple as put a mask on and you will reduce the infection rate - the full implication of mask wearing, including the behavioural consequences has to be taken into account.

 

[Domh245]

If we mandate masks (assuming we can actually produce enough of them - not much point otherwise) and it turns out that masks didn't work after all, then the only harm is a bit of inconvenience, and wasted expenditure buying them.

Except that isn't quite the case. They aren't "worst case - no impact", there are very real risks that they increase the rate of transmission and other issues as detailed by the WHO. It's why going enforcing masks without fully assessing them is a risky strategy

• self-contamination that can occur by touching and reusing contaminated mask
• depending on type of mask used, potential breathing difficulties
• false sense of security, leading to potentially less adherence to other preventive measures such as physical distancing and hand hygiene
• diversion of mask supplies and consequent shortage of mask for health care workers
• diversion of resources from effective public health measures, such as hand hygiene

 

[MarkyT]

Boris Johnson now says "mask-wearing will be useful"

https://www.bbc.co.uk/news/live/world-52481788

Posted at 17:4517:45
Johnson: Face masks will be useful after lockdown
Asked what a manageable R infection would be, Boris Johnson says the "crucial thing" is to stop the national rate going above 1 again.
He adds the UK is getting more reliable data - for instance on how it is varying region by region - and the government will thus be more "sophisticated" in its response in future.
Asked about government advice on the wearing of face marks, he says mask-wearing "will be useful" as the UK comes out of lockdown.
He says this will not just be to do with managing the spread of the disease, but giving people "confidence they can go back to work".

 

[Bantamzen]

I think the problem with this argument is that you seem to be looking for strong, peer-reviewed, robust, evidence that wearing masks works before mandating them anywhere in public. In normal circumstances, waiting for that kind of evidence would be a good approach. But we're in an emergency situation in which action needs to be taken quickly to stop people dying and, because it's a new virus, we don't have that body of carefully researched science and peer-reviewed findings about Covid-19 to tell us what to do. If we wait for that research to appear and be sufficiently robust before we take any action, then it would be too late, and potentially millions of people around the World will have died. So we have to do the next best thing, and take action based on what the relatively new science, combined with established knowledge about other virus and pandemics in general, appears to be telling us is likely to be a good move. That's why lots of countries imposed hugely disruptive lockdowns NOW, without waiting for robust peer reviewed research to tell them whether or not lockdowns would work. Governments and scientists had to make educated guesses based on what we know so far. And it's why the advice we are getting is fairly quickly evolving.

In the case of masks, we have something that isn't massively disruptive - certainly, nothing like as disruptive as social distancing - that looks likely to help prevent virus transmission at least a tiny bit, and quite possibly a significant amount. Given the urgent need to reduce transmission, it seems sensible to me to go ahead and mandate masks in some situations (such as public transport) even in the absence of stronger evidence. If we mandate masks (assuming we can actually produce enough of them - not much point otherwise) and it turns out that masks didn't work after all, then the only harm is a bit of inconvenience, and wasted expenditure buying them. If we don't mandate masks, but in 6 months time evidence shows that they actually are quite effective with Covid-19 (which is not certain, but a strong possibility) , then we've just caused quite a few thousand deaths and very likely resulted in the lockdown having to last a lot longer, with all the economic damage that entails.

Which way would you rather be wrong?

In terms of the scientific point of view, evidence that wearing masks makes a difference is really important. It really doesn't matter how bad a situation is, bad advice will always be bad advice. So if for example it turns out that encouraging people to wear masks in public does little to slow the spread of the virus because it's primary method of spread is not aerobic but through direct or indirect contact, then unless the entire population is trained in how to properly put on, maintain and remove a mask, & engages in a through hand washing / glove wearing regime then they it is more or less useless. And here's the thing, we don't yet know for sure where the virus is able to spread the most, although there is an increasing view that prolonged contact in enclosed spaces may be the prime source.

As for masks not being disruptive, here is a simple observation. We live in one of the most heavily observed via CCTV nations in the world, and for a reason. CCTV is very effective when it captures a criminal's face, but not so much when they have a mask on. I'll leave it here and let that thought sink in.

 

[Qwerty133]

Boris Johnson now says "mask-wearing will be useful"

https://www.bbc.co.uk/news/live/world-52481788

Although he says it'll be more for providing confidence to the public. To me that makes wearing masks compulsory to rely on the same arguments as that for banning the burqua and therefore the freedom of expression has to win out in both or neither case.

 

[MarkyT]

Although he says it'll be more for providing confidence to the public. To me that makes wearing masks compulsory to rely on the same arguments as that for banning the burqua and therefore the freedom of expression has to win out in both or neither case.

He does not use the 'more for' qualifier and states beforehand: '...will not just be to do with managing the spread of the disease' so that is acknowledging at least some positive effect.
Check this graph for relative population-adjusted cases and deaths across a range of European nations and US states. Note Czechia and Austria, the first European countries to mandate public mask-wearing (among other measures clearly):

 

[HH]

Romania just became the 65th country to announce mandatory nationwide mask laws. Joining Germany, Indonesia, Argentina, Thailand, Singapore, Israel, Vietnam, and many others.

People do like to jump on bandwagons and politicians like to be seen to be doing something, even if it's a placebo.

Check this graph for relative population-adjusted cases and deaths across a range of European nations and US states. Note Czechia and Austria, the first European countries to mandate public mask-wearing (among other measures clearly):

Interesting choice of countries. No Norway, no Greece, etc.

 

[Bletchleyite]

With regard to data, there was a substantial upgrade in the press conference slides today, so there is clearly more thinking on the data approach now.

 

[david1212]

Today I found that one of my employers customers has ordered £250,000 worth of PPE with a view to at least partly increasing current operations beyond a skeleton staff level. The business is industrial and overall there will have been and continue to be a huge drop in demand although some items produced will ultimately be supporting essential services. I'm unsure how many are employed on the site, perhaps 200. Generally employees on the shop floor do not work close together and can easily maintain 2m or more distancing. Offices are not densely packed either but may need rearranging plus perhaps on a rota some could work from home. ( I presume currently most shop floor workers are on furlough but at least some office staff are still working even if from home ). Major movement at start & finish times plus breaks could be reduced by staggering them, of course the unions would have to agree.

While the items ordered could be industrial grade rather than medical they will still be diverted from key workers e.g. packing & distribution to those who are vulnerable so self-isolating, public transport, refuse collection etc.

 

[MarkyT]

bandwagons...placebo

These are very loaded terms.

Interesting choice of countries. No Norway, no Greece, etc.

I think the chart was prepared from a US perspective to compare a range of states over there with a range of European nations.