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About Face: The Great Coronavirus Mask Debate

When the novel coronavirus started to get stroppy and make its now global impression, one theme seemed to be common. Face masks were, at least initially, a conceit, a sort of fashion or extra-medical accessory. To use it was a mark of vanity. Rushing out to stock up on such masks was also selfish: you were taking them from the medical profession who needed it more than you.

From vanity and selfishness, masking up has become a necessity. Whole countries have been given the spanking of a lockdown, with consequential economic contractions. With the details of opening up and easing restrictions being put to paper, the collective, public use of face masks is being encouraged and, in some cases, mandated.

Many of Germany’s federal regions have made wearing masks mandatory on public transport and when shopping, though the regulations vary. Austria has decided to make them compulsory when shopping. But confusion and inconsistency reigns in some quarters. Prime Minister Winfried Kretschmann of Baden-Württemberg has suggested the use of scarves and cloth covers for the general citizenry while reserving medical masks for health workers.

Kretschmann’s qualification revisits old concerns about hogging the necessary equipment and taking from the health warriors who are engaged in the battle. This is a concern facing those in Britain’s National Health Service. Will such encouragement incite a stampede that will outstrip supply?

The science behind wearing a mask remains a question of dispute. Then again, much of the policy weapons deployed against COVID-19 could be bracketed that way. Hilda Bastian spouts irritably in Wired against the “double standard” on wearing face masks, which receive a scholarly, hyper-rigorous attentiveness. “We don’t see op-eds that ask whether people really need to keep 6 feet away from each other on the street, as opposed to 3 feet, or that cast doubt on whether it’s such a good idea to promote bouts of handwashing that are 20 seconds long.” Infectious diseases consultant Babak Javid says much the same thing, claiming that the results from laboratory tests on handwashing are, at best, disappointing, while there have been none to speak of regarding physical distancing.

The trials on face masks have, for the most part, been unrewarding in their results. There are issues about adherence, problems about whether the masks are even worn properly and even whether wearing such masks conveys a false sense of security. Consider, for instance, a recent letter of waning by ear, nose and throat surgeon Guy A. Vernham to the editor of the BMJ. “I would argue that incorrect mask wearing in particular, is a serious concern which might result in an increased risk of spread: Incorrect fitting and removal, failure to understand associated hand hygiene and touching/adjusting the mask during use do run a risk of contagion which could outweigh any benefits.”

When teased out, the existing complement of trials suffer from methodological pitfalls. A US study examining 1437 young adults in university residence halls during the 2006-7 influenza season found that the use of face masks and an attentiveness to hand hygiene “may reduce respiratory illnesses in shared living settings and mitigate the impact of the influenza A(H1N1) pandemic.” Despite this effort being commended, the findings had to be seen in light of the following: that the trial took place during a mild flu season; there was a chance that some students were infected prior to the trial’s commencement; and the study was not designed, according to Titus L. Daniels and Thomas R. Talbot, “to detect small differences that may be demonstrated by the incremental use of face masks to hand hygiene”.

Reviews on the published studies throw up similar methodological problems. A survey of 31 eligible studies, including 12 randomised controlled trials (RCTs) on the use of facemasks, found that the latter “often suffered from poor compliance and controls.” Such RCTs were expected “to under-estimate the protective effect” of the masks, with observational studies having an opposite, exaggerating effect. Participants who were tasked with wearing masks often did not; those who should not have, did.

According to Julii Brainard, a senior researcher in modelling public health threats, “Part of the reason why the research has been so difficult is that what should be our best-quality experiments aren’t very good. So we’re stuck with what are called observational studies where researchers ask what people did.”

The argument for face masks has now pivoted away from the healthy wearer who is concerned about infection; the current focus is on the one who is already infected, exhibiting asymptomatic or mild symptoms. This chimes with the message that you are doing your bit to prevent transmission, while injecting a moral sting into matters. And if all else fails to convince, the precautionary principle – that such masks be worn, according to a study in the BMJ, “on the grounds that we have little to lose and potentially something to gain from this measure”, comes into play.

As with much in the realm of public health, policy is often made on the hop, done to cope with panic and calm troubled waters. With interest now on returning some blood into the arterial streams of the global economy, the scientific equivocality behind the length of time one washes hands to the nature of mask one wears, will take second place to the expediency of reassurance.

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15 comments

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  1. Jack Cade

    I have just returned from a supermarket in Golden Grove, SA. The checkouts were crowded like a footy queue. No attempt to keep the distance…You have to wonder.

  2. Michael Taylor

    Jack, Golden Grove is in Crows’ territory. No wonder it was a rabble.

  3. Jack Cade

    Michael Taylor

    Reading your comment – my heart soared like an eagle (Magpie, actually).

  4. Michael Taylor

    Jack, I’ve been a Port supporter for over 50 years, since I was a wee tacker on the KI farm. And I hate them damn Fruit Tingles with a passion. 😀

  5. Keitha Granville

    Surely the mask wearing decision should be made on some scientific basis. If the wearer has the virus they shouldn’t be out anywhere, with or without a mask. If a mask wearer isn’t wearing gloves, the mask won’t stop the virus getting on to their hands. They will have to have gloves too, or be incredibly fastidious about not putting hands near faces at any time after the mask comes off.

    It seems to me that without every mask wearer being very well informed about the use and precautions around masks, it will simply lull them into a false sense of security. Like the phone app. If you have it you’ll be protected says the govt. How ?????

  6. Jack Cade

    Michael Taylor

    I’ve been a Port fan since I arrived in Australia with my family – parked on the Finsbury hostel, about a mile from Alberton Oval. Although a soccer player and fan, the Port people were like my native Liverpudlians, my kind of people. Couldn’t support any other team.

  7. Michael Taylor

    Jack, I looooove Liverpool (and yes, I’m a Beatle tragic).

    Would go back there tomorrow if I could just to get some chips from the Red Lobster Cafe (near the top of the mall). To die for.

  8. Jack Cade

    Michael

    Just beware of Penny Lane chippies selling Fish and Finger Pie. That’s possibly the dirtiest line ever in a song.

  9. Jack Cade

    Michael

    Just beware of Penny Lane chippies selling Fish Finger Pie…
    It’s possibly the dirtiest lyric in any song!

  10. Michael Taylor

    The barber shop is thill there, but I don’t think he was selling photographs.

  11. paul walter

    Doesn’t take long to grasp that Binoy Kampmark is onto a social disciplining aspect that has some including myself concerned.
    It is wrong to see masks and some other devices involving the lockdown including excessive policing of very minor breaches as conspiracy theory material, but many of the tactics to cope with the virus, eg “the app”, combined with monotonous so called “messaging” from the Media, make it difficult to avoid observing conditions created in tandem now would allow for an even more authoritarian society, post-pandemic.

    This particularly when a person considers the untrustworthy and paranoid state of the ignorant and arrogant leadership in most places on god’s earth. A person could be forgiven for thinking we are at a stage of further roll-out of surveillance and dumbing down occurring for all of this century.

    You could further ask if organisation like the deleted ABC are somehow so intent on “messaging ” that this has usurped the usual role of journal of record for former broadsheet media and press, or what has remained of it.

    I marvelled at the single IQ stuff throughout last week while the remarks by the relatively conservative Senator Rex Patrick on a possibly “designed” surveillance window with the tracking app and censorship of information on yet another fishy and expensive defence procurement deal went virtually unremarked.

  12. paul walter

    Just quickly, on other issues brought up here, I think I mentioned previously that many of the mates I grew up, living in working class Elizabeth SA, whilst at school in the sixties, tended to be folk from the British Isles, who suffered at the unpleasant Smithfield migrant hostel before being let loose into the dreary canyons of HousingTrust, dusty Elizabeth.

    Most of us got by in a self sufficient sort of way, but it was rough for those at the bottom of the heap there.

  13. Old bloke

    Silly me, and I thought the article was about wearing face masks. Anyway, when in a shopping centre where there are a number of people I wear a face mask. Don’t care about the efficacy of experiments done, I’m into the precautionary principle. I’m doing no harm to anyone nor myself, but if the masks work then I just might be doing something to protect myself and others. And when I get back to the car I whip out the disinfecting wipes, go over my hands and what I have touched on the car. Over zealous…or playing it safe, I’m in good health, but 77 years of age. By the way I have few N95 masks, the ones worn by medical staff. I got them from China from a friend and apart from hold ups at customs, arrived in time. I just wonder that if I could get some so easily, why couldn’t the government do the same? Well, maybe the problem is that we have no government politicians who are on good enough terms with the Chinese to be able to pick up the phone and ask for supplies.

  14. Old bloke

    Could I also add that on casual observation of the news, those countries that seem to have suffered less from the pandemic are those where the people have the habit of wearing masks during periods of infectious disease threats. The wearing of masks might also suggest that people are more aware of the risks involved in being out amongst other people. Spoke to another old fella wearing a mask at the shops the other day. I complained that I didn’t like wearing the thing because it was uncomfortable, but he was worried by the way people looked at him. I’ve had different reactions, usually a nod of acknowledgement.

  15. paul walter

    Old Bloke, it is like dunny paper a month ago- you can clean up on the black marke a motzaht for a premium if you have a source….those who hoarded up on masks in the free air air era now nod wisely and pat themselves on the back for their wisdom and foresight in predicting the coronavirus.

    Truth is, no one saw this of all things coming, but every cloud has a silver lining, even in the worst of times some count their blessings.

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