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expert reaction to mandatory face masks on public transport

It has been announced today that from June 15th fabric face coverings will be required on all public transport in England.

 

Prof Dame Til Wykes FMedSci, Vice Dean Psychology and Systems Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, said:

“The plan to introduce face coverings for public transport will provide the public with some confidence for a return to work. But these need to be an addition not an “instead of” other anti-Covid-19 measures like handwashing. So the strategy should be – wash your hands then wear a face mask while travelling then wash your hands after you leave the transport. Holding the support pole on bus or train or even pressing the button to open a door is a potential hazard.

“Face covering introduced in other countries has been hard to remove. We need to have a plan for removal at a point when the current heightened risk has reduced. Without a clear plan on their removal, the public will continue to feel at risk. Continuing to wear a face covering will have negative effects for some groups e.g. those who lip read and for understanding non-verbal cues in social situations.”

 

Prof Robert West, Professor of Health Psychology, Department of Behavioural Science and Health, UCL, said:

“Grant Shapps is probably right to suggest people will comply with this.  What we’ve seen in the pandemic so far is an exceptionally high level of adherence to the various social distancing measures and other guidelines – even to the detriment of people’s wellbeing in the short term – because everyone has recognised how important it is.

“However, it is important to understand that with face masks the evidence is equivocal so the policy is based on opinion. This is fine because policy often has to be formed in this way. However, normally when you introduce a mandatory measure like this you have to go through a process of consultation, then you have to do an impact assessment.  It is in this impact assessment that you would assess the likely benefit and unintended consequences. In this case it could be counterproductive if face masks become ‘fomites’ or people end up closer to each other for longer than would otherwise be the case.

“It would be unfortunate if use of face coverings was used as a way of supporting an easing of social distancing. You wouldn’t want to allow a greater density of people on public transport because people were wearing face masks.

“It is absolutely right to stress, as Grant Shapps did, that people who can work from home should continue to do so and that those who have to go to work should avoid using public transport, especially at peak times. The problem is the interpretation of this, and who makes thedecisions.  If you as an employee are free to make thedecision that you don’t feel safe coming into work and that the only way you could do it is through public transport, then that’s your decision.  However, if your employer is saying that in their opinion it is okay for you to go in and puts pressure on you to do that then that is obviously problematic.”

 

Prof Nicola Stonehouse, Professor of Molecular Virology, University of Leeds, said:

“The World Health Organisation’s advice is clear. Although a medical mask can offer some protection, the use of masks in a community setting is not supported. Furthermore, mask wearing can result in a false sense of security, and enhanced risks that come from touching the face. This seems to me to be another political decision, rather than one based on scientific evidence.”

 

Dr Leandro Pecchia, School of Engineering, University of Warwick, said:

“Making the use of masks compulsory could be a good idea. However, we must remember that cloth face-masks are meant to protect those around me from my saliva drops and breathing. Only filtering facepiece masks (e.g. FFP2 or FFP3) protect wearers from others.

“To be clear, this is a novel hygiene measure, which will become more and more diffused in the UK, as it is already in many Asian countries. Over the past centuries we learnt to increase our hygiene measures such as washing hands, eating with cutlery, avoiding sharing glasses. Now, we have to learn to wear cloth masks in closed, crowded places. Making this compulsory will accelerate this process.

“If we are just talking about local transport, yes, to be consistent, I personally believe that other measures are also needed, including extra cleaning, solutions to minimise touching surfaces (e.g. an open bus door), thermo-scanners… If we are talking about international flights, probably it would be better to wait till the UK fatalities get below the total numbers of COVID fatalities in the whole of the rest of the EU…”

 

Dr Antonio Lazzarino, Department of Epidemiology and Public Health, UCL, said:

“The issue of face coverings in the context of the COVID-19 pandemic is very controversial. While no ad-hoc studies with a correct design have been carried out, it is now commonly accepted that face coverings provide very little protection, if any.

“However, there are many potential side effects of face coverings from a clinical and epidemiological point of view, although none of them has been studied. But one clear, logical, widely-accepted side effect is that face coverings may give an excuse to easing other more important measures. Even the advocates of face coverings admit that measures such as hand washing and social distancing are more effective, although, again, there is no evidence for this. So the questions for public transport are:

  • Will more people use the tube/buses because they will feel more secure given that everybody wears a face covering? This will increase the risk of transmission.
  • Will people be able not to contaminate their hands and the handrails by not touching their face coverings and not touching the handrails while standing inside buses and trains? This seems to be impossible to me. Face coverings can therefore be a vehicle of infection, rather than a barrier.”

 

Prof Trish Greenhalgh FMedSci, Professor of Primary Care Health Services, University of Oxford, said:

“The UK is still seeing a daily death rate from COVID-19 that’s in the hundreds. We’re all bored with this disease. We all want to get back to work, back to our leisure activities and back to seeing our loved ones. But unlike in many other countries which have successfully contained the virus, it’s not yet safe to go “back to normal”. 

“This SARS-CoV-2 virus is spread mainly by droplet infection and possibly also by tiny aerosolised particles emitted when we cough, sneeze, shout, sing or even just speak in close proximity to other people. Up to now, the government’s policy on prevention has rested on two measures: hand washing and social distancing. If we wash our hands thoroughly and regularly, and stay 2 metres away from others, the chance of passing on the virus (or catching it from someone else) is small.  But we can’t always do that. It’s virtually impossible to stay 2 metres away from other people on a bus in rush hour, for example. This recent paper in Science explains why we need to add a third measure (face coverings) to handwashing and social distancing. Temperature taking isn’t going to help. People can be contagious with a normal temperature.

“Face coverings aren’t 100% effective, but they’re not zero percent effective either. I’ve seen evidence that a double layer of cloth is between 60 and 90% effective in stopping the spread of viral-laden droplets coming from the wearer, and also that the same mask is also 30-50% effective at stopping virus particles getting to the wearer. You can argue about the exact percentages, but overall, if everyone wears a face covering when they’re at close quarters, transmission is going to go down dramatically.

“Some time ago I suggested to the government to put out a clear message that face coverings are effective and unambiguously recommending wearing them in public places. I felt if they do that, most people will choose to wear one voluntarily like they do in many Asian countries. Up to now, the government’s message has struck me as somewhat unclear, and I know many people remain confused about whether there is any benefit. In order to support this change in policy, we need also to have a public information campaign to make the message much clearer:

COVER YOUR FACE

IN A PUBLIC PLACE

ITS EVIDENCE-BASED

IT MAKES US SAFE

“One final point. The government was initially reluctant to recommend face coverings partly because they worried that there would be a run on medical masks and there wouldn’t be enough for healthcare workers. You don’t need a medical-grade mask.  Make your own from cloth, personalise it and make sure it’s comfortable. You’ll find it easier to keep on for extended periods, and you’ll also contribute to a sustainable community response. Finally, some advisers to government were suggesting that if people wear masks or face coverings they’ll think they don’t need to wash their hands or maintain social distancing. We do, of course, need to keep going with these measures as well.”

 

Prof Sian Griffiths, Emeritus Professor, the Chinese University of Hong Kong, and co-chair of the Hong Kong government’s SARS inquiry, said:

“The evidence for the use of face masks or face coverings has been accumulating and it is now widely accepted that, along with other social distancing measures and hygiene measures, the science shows they can contribute to decreasing the risk of transmission in the community. 

“Many other countries are already mandating mask wearing in a variety of higher risk situations. Travelling on public transport, particularly once it gets busier, will make social distancing very difficult so the recognition by the government of the contributory role of masks/face coverings is welcome from a public health perspective. 

“Many scientists have been pointing out for some time that mask wearing fits the precautionary principle – above all do no harm, and the evidence supports this. The key concern has always been to ensure that recommendations for the general public about the wearing of masks does not deprive supplies for those caring for patients in hospitals, care homes or other clinical settings, or for those who are sick and need them. Since the masks/face coverings recommended for wearing in public can be made from cotton and other materials this fear can be laid to rest.”

 

Dr Simon Clarke, Associate Professor in Cellular Microbiology, University of Reading, said:

“This policy will add more burden on the general public to prevent the spread of COVID-19. This is much more complicated than ‘wash your hands for 20 seconds’ or ‘stay at home’. We are asking the whole population of Britain, with no prior experience of mask-wearing, to overnight become competent makers, wearers, and maintainers of PPE. I hope the government has a fool-proof plan in place to educate every family in the country on how to do this, or it could actually put people at higher risk of infection.

“Wearing a basic face mask does little or very little to prevent the wearer from getting infected by others, but there is some limited evidence that wearing one can prevent others from being infected by the wearer. I have seen no new evidence to suggest why the government is reversing its previous policy, and ignoring its previous scientific guidance and the guidance of the WHO. I’m left wondering if this is a political decision, rather than one based on science.

“If this change in policy is to be successful at reducing infections, it  will have to be accompanied by a major new campaign to educate 66 million people on how to properly make, put on, handle and clean their face coverings. A badly-fitted, damp or dirty mask, or poor habits such as regularly touching eyes or adjusting the ties, can put the wearer at greater risk of infection. Most people in the UK have no experience of wearing face coverings, and it will be much harder to get used to than washing hands more often or keeping 2m distance from others.”

 

Declared interests

None received

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