Face coverings made compulsory after Oxford COVID-19 study inspires debate

Face coverings in shops will be made compulsory from 24 July, and the prohibition may be extended to other indoor spaces. The move follows last week’s COVID-19 face coverings study from Oxford’s Leverhulme Centre for Demographic Science on behalf of the Royal Society and British Academy.

The announcement was made this morning, and comes after Prime Minister Boris Johnson was pictured over the weekend publicly wearing a face covering. The Prime Minister described face coverings yesterday as offering a ‘great deal of value’ in controlling the spread of the coronavirus and giving people confidence to go back to shops and workplaces. But this morning came the news that, from 24 July, shoppers face a £100 fine, if they enter a shop without a face covering.

There is a general assumption that countries such as the UK, which have no culture or history of mask wearing, will not rapidly adopt them or that people will be put off going to shops if they have to wear a face covering. But this just doesn’t reflect the data from similar countries

Professor Melinda Mills, Director of the Leverhulme Centre and lead author of the study on the effectiveness of face coverings, says, ‘It is great news that face coverings are to be made compulsory in shops in England. More than 120 countries around the world have introduced recommendations or regulations and the report last week contains clear evidence that face coverings are effective in respect of COVID-19.’

She maintains, ‘There is a general assumption that countries such as the UK, which have no culture or history of mask wearing, will not rapidly adopt them or that people will be put off going to shops if they have to wear a face covering. But this just doesn’t reflect the data from similar countries. As of late April, mask-wearing was up to 84% in Italy, 66% in the US and 64% in Spain, which by June was over 90%, increasing almost immediately after clear policy recommendations and advice was given to the public.’ 

As early as April, a report in the British Medical Journal was advising people to wear face coverings.  Professor Trisha Greenhalgh, Oxford’s professor of primary health care sciences, was among experts who urged the adoption of face coverings, 'It’s time to encourage people to wear face masks as a precautionary measure on the grounds that we have little to lose and potentially something to gain.'

They maintained in their report that, despite limited evidence, masks ‘could have a substantial impact on transmission with a relatively small impact on social and economic life’. 

Face coverings have not been widely worn in the UK, in spite of the pandemic. The Leverhulme-led study shows cloth face coverings, even homemade masks of the correct material, are effective in reducing the spread of the virus – both for the wearer and those around them

Speaking today about the announcement, Professor Greenhalgh says, 'I very much welcome this news. It made no sense to mandate face coverings on public transport while not requiring them in other crowded and poorly-ventilated indoor spaces such as shops and supermarkets. What we now urgently need is proactive use of behavioural science techniques to inform a public information campaign to overcome weeks of mixed messages and shift the ethos of this policy from something that is 'enforced' and 'policed' to an exercise in common sense and social solidarity. Masking is a symbolic practice as well as a public health intervention. My own team and also Melinda Mills in Demography (among many others) have done research on this topic; we’d be happy to help make this policy a success.'

Face coverings have not been widely worn in the UK, in spite of the pandemic. The Leverhulme-led study shows cloth face coverings, even homemade masks of the correct material, are effective in reducing the spread of the virus – both for the wearer and those around them. And the study reveals that, once the WHO announced there was a pandemic in mid-March, within days many countries around the world had already recommended wearing face masks. Nations including South Korea, Japan and a series of African countries, experienced in handling previous epidemics including SARs and Ebola, have experienced very low numbers of deaths and transmission.

It is ‘far more invasive’ to tell people to stay at home than to wear a mask

Professor Mills, insists that face coverings should be recognised as a public health issue as part of a package of policies alongside hand hygiene and social distancing, not a matter of civil liberties.

She maintains, it is ‘far more invasive’ to tell people to stay at home than to wear a mask, with the report revealing that in order to increase compliance of the general public, it is important that they understand how the virus and coverings works to protect both themselves and others. The study reveals, ‘Next to hand washing and social distancing, face masks and coverings are one of the most of widely adopted non-pharmaceutical interventions for reducing the transmission of respiratory infections.’

Refuting claims that there is no or weak scientific evidence, Professor Mills finds that there has been an over-reliance on medical studies and specifically ‘randomised control trials’ – while high quality behavioural studies have been discounted. But she says, ‘The evidence is clear that people should wear face coverings to reduce virus transmission and protect themselves, with most countries recommending long ago that the public should wear them, particularly in enclosed indoor spaces and crowded areas.’

The evidence is clear that people should wear face coverings to reduce virus transmission and protect themselves, with most countries recommending long ago that the public should wear them, particularly in enclosed indoor spaces and crowded areas

The study calls for clear and consistent policies and public messaging on the wearing face masks and coverings by the general public. Professor Mills says, ‘The public is confused about wearing face coverings because they have heard the scientific evidence is inconclusive and advice from the WHO and others has changed.

 ‘But where are randomised control trials about coughing into your elbow or social distancing?’ And she adds ‘People need to know what to wear, when and where to wear it, how to wear it and who cannot wear it.’

 Professor Mills says, ‘What to wear is high quality multi-layer cloth coverings and not surgical masks or respirators and people need to ensure there are no gaps. For instance, combining cotton and silk or flannel provide over 95% filtration, so wearing a mask can protect others.

The public is confused about wearing face coverings because they have heard the scientific evidence is inconclusive...But where are randomised control trials about coughing into your elbow or social distancing?

 ‘When and where includes crowded shops, where you cannot often keep social distance, are places where face coverings would be valuable, but you don’t need to wear one while outside, walking or jogging, in a socially distanced way. And in restaurants, you need to wear one, until you are sitting down at your table. We also need to acknowledge who cannot wear them such as those with disabilities, breathing difficulties or young children.

Just as the WHO gathered evidence and changed its advice in early June, it is now time to re-evaluate the evidence and make clear recommendations to the public and those who need to re-open their businesses

'By learning from mask-wearing experiences from previous epidemics, such as SARS, H1N1 and MERS, the systematic review revealed key behavioural factors underpinning the public’s compliance to wearing a mask. People need to understand virus transmission and how masks protect them and others. And they need to understand how to reduce the barriers of wearing them related to practical aspects such as comfort or what to do in a restaurant or shop.’

She says, ‘We learned from previous pandemics that individuals underestimate their own risks of contracting the virus or transmitting it to others and think that ‘it won’t happen to me’.’

But, she adds, ‘Just as the WHO gathered evidence and changed its advice in early June, it is now time to re-evaluate the evidence and make clear recommendations to the public and those who need to re-open their businesses.’

 The full text of ‘Face masks and coverings for the general public: Behavioural knowledge, effectiveness of cloth coverings and public messaging’, on behalf of the Royal Society and British Academy can be found here.

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