Q&A on face masks: What is the latest advice?

Go into any supermarket/shop, or take any form of public transport in Ireland, and it is clear few people are wearing face masks.

It is hard to resist the conclusion that either they are utterly confused by changing public health messaging, or they don’t see the merit of wearing a mask.

Those in the latter camp may believe this Covid-19 pandemic is dealt with as Irish deaths and cases are close to zero – and wish to get back to normal as quickly as possible.

Or they are not prepared to put up with what they perceive as the hassle of wearing a mask with all the protocols about how to put it on and take it off correctly, not forgetting re-use procedure. There is social stigma too around wearing them.

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While the world for the most part agreed on the best way to deal with the Covid-19, ie lockdown, physical distancing and repeated handwashing, the same cannot be said about face masks.

There is huge variation between countries; in some they are mandatory in public places, in others they are worn routinely whenever there is risk of an epidemic. Differing advice from health authorities doesn’t help.

A lot comes down to interpreting research, evaluating risk and factoring human behaviour. So scientists don’t reach an absolute position and governments wrestle with what to tell their citizens who are demanding clarity.

What on balance is best advice?

Advice on whether to wear a mask has changed in line with emerging research about Covid-19. Evidence backing the wearing of masks in public, where there is community transmission, has strengthened – especially in confined spaces. They do not need to be worn in the open air or while driving a car.

When it comes to those over 60, whose immune system is weakening coinciding with ageing, and those with underlying conditions, the case is clear-cut. Moreover, this age group should wear medical-grade masks that, fortunately, are now more readily available, though not cheap.

What is the latest advice from the World Health Organisation?

In the past week, WHO has come out more strongly in favour of masks, with a variation of types recommended depending on circumstances. Its updated guidance says the public should wear masks where physical distancing is not possible.

It is firmly in favour of medical masks for the over-60s and those with pre-existing conditions. A cloth mask of at least three layers is best for the general public.

Initially, the WHO was almost anti-mask, insisting many people won’t wear masks properly, thereby risking infection. Masks give people a false sense of security and encourage risky behaviour, it contended. Compounding matters was the obvious shortage of masks for healthcare workers as cases rose rapidly.

WHO accepts growing indications that the more people use masks, the lower the transmission, notably from those who are asymptomatic or pre-symptomatic. Previously it recommended masks for people who are symptomatic, to prevent spread to others.

What research is persuasive in favour of face masks?

At the onset, scientific evidence on the effectiveness of face masks in slowing transmission of respiratory diseases was limited. There was no data on Covid-19 since it was a previously unknown disease.

However, there is a growing body of evidence favouring face masks and cloth coverings.

This week a UK study found population-wide face mask use could push Covid-19 transmission down to controllable levels, and prevent further waves of the virus when combined with minor lockdowns.

A US study found that if 80 per cent of a closed population were to don a mask, infection rates would statistically drop to approximately one-twelfth the number of infections – compared to “a live-virus population” in which no one wore masks.

Where does Ireland stand in light of revised WHO guidance?

NPHET’s expert advisory group is to review the latest WHO recommendations, but evaluation of current advice suggests Ireland is very much aligned with that viewpoint – though there may be a difference of emphasis.

The bottom line, however, is mask use is nowhere near the level warranted. There has been a failure of national advice to hit the target – understandable at a time of exponential rise in cases; less acceptable when easing lockdown.

Given such low usage in Ireland, the time has come to heed the strong recommendation of WHO special envoy Dr David Nabarro, who told the Oireachtas special committee on Covid-19 there needed to be a push from saying people “should” wear them to people “must” wear them.

This, he advised, was for the benefit of service providers, including drivers, attendants and security guards – it was a reasonable requirement that commuters wear coverings for the sake of people who look after them.

There is much catching up to do to ensure more specialist masks are available for those who are vulnerable to Covid-19 and those who cannot afford a mask or to make a cloth version. Supplying free masks to every household could make up lost ground.

What is the prudent way to proceed?

There is no going back to normal soon. Risk of contamination of surfaces and infection is ever present. Good hand hygiene and respiratory etiquette, while maintaining physical distancing where possible is still the winning formula. But "wear a mask" in the correct way has rightly been added to that mix.