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The use of face masks has been a much-debated issue during the Covid-19 pandemic. Scientists and healthcare professionals are divided on their effectiveness in preventing the spread of the virus.

However, some countries made face masks compulsory in the early phase of the pandemic, or strongly encouraged their citizens to wear one. Whilst other countries, such as the US and the UK, did not issue any clear recommendations or guidelines on face masks.

Despite a lack of clear guidelines, some people wore face masks in public, and over time a growing number of home-made masks and bandanas coming into use. It now seems that the UK and the US are shifting in their views.

In the UK, masks are now compulsory on public transport, when visiting hospitals, either as an out-patient or visitor, and Scotland went one step further making it compulsory to wear masks in shops. Prime Minister, Boris Johnson, now thinks people ‘should’ wear masks in shops, but whether he will make it compulsory remains to be seen. So why has there been a change in advice on face masks? Should we have been advised to wear them much earlier — as was the case in other countries?

After the WHO announced the pandemic in mid-March, 70 countries immediately recommended wearing masks in public places, this has now risen to around 120 countries. There is some evidence that the number of cases of Covid-19 and the death rates has been lower in countries which introduced mask-wearing earlier.

At the start of the pandemic opinion seemed divided; some experts felt there was no clear scientific evidence that masks offered protection and instead feared that mask-wearing could lead to people reducing social distancing as they feel they are protected by the mask, which can be dangerous as close contact increases the risk of transmission.

Initially, even the WHO was not advising on face-coverings in public, but some countries, e.g. China made it compulsory when going out. This illustrates the divide in opinion about its benefits.

There were also concerns about there being enough supplies of masks and PPE for healthcare professionals, so there was possibly a reluctance to advise the public to wear masks in case it put more pressure on scant resources.

But countries like the Czech Republic recommended that people wear a face-covering that could be home-made from fabric, thus saving medical masks for the health professionals. If it were felt that a face-covering of fabric or a scarf could reduce the spread of the virus to some extent, why weren’t we encouraged in the UK to wear them in public places along with the advice to wash hands and social distance?

Some more sceptical people feel the UK Government was reluctant to advise people to wear masks at the start of the outbreak as there was an issue getting enough PPE for the NHS, and they did not want PPE diverted to non-healthcare uses. Now that more PPE has been apparently been secured for the health services the Government advice is shifting.

By introducing steps such as the compulsory wearing of masks on public transport, the government hopes people will feel safer travelling and this will help get people back to work and get the economy going again. After all, we are facing a recession and the Government needs the workforce back at work. So, this leaves the question –how effective are face masks/coverings at stopping the spread of the virus?

Since the outbreak of the virus, scientists have been studying it to establish how it is spread, how infectious it is and what can be done to prevent the spread. Hence, we were all told to wash our hands, wipe down surfaces and socially distance by 2 m. The virus is spread in droplets of moisture from a cough, sneeze or breath of an infected person.

Therefore, the introduction of face masks or face-coverings was seen as a sensible precaution in many countries, reducing the droplets of moisture from travelling into the air from an infected person. This was particularly important as many people with Covid-19 can have mild symptoms or be asymptomatic.

Many studies have now been done on how effective face masks are at reducing the spread of the virus. There seems to be a growing body of evidence that face masks do help in reducing the spread and offer some protection for both the wearer and others.

The WHO has now recommended the use of face-coverings in public spaces, and the US Center for Disease Control and Prevention has advised all Americans to wear cloth masks in public to prevent the spread of Covid-19 (although not made it compulsory).

This is following research from many academic institutions including Stanford and Oxford University. According to a new study from Oxford’s Leverhulme Centre for Demographic Science, a cloth face-covering and homemade masks made of the correct material are effective in reducing the spread of Covid-19 for the wearer and those around them.

Given the growing evidence that face-coverings offer a reduction in the viral spread, why aren’t governments choosing to make them compulsory? In the UK, Scotland has now made face-covering compulsory in shops, but Johnson has not — although he has hinted that they should be used and was recently photographed wearing one whilst visiting a shop.

One reason cited as to why both the US and the UK seem to have some reluctance to enforce the wearing of face masks is because as nations we are unaccustomed to doing this, compared to other countries.

There has even been a vocal reluctance voiced by some citizens that it is infringing their civil rights to be told what to wear, and the Government seems reluctant to be seen as the ‘nanny state.’

In countries such as China, Hong Kong and Japan people are used to wearing face masks if they are ill or from previous viral outbreaks such as SARS. However, this doesn’t seem to be the case as by late April, mask-wearing was up to 84% in Italy, 66% in the US and 64% in Spain, this increase was almost immediate after clear policy recommendations and advice was given to the public.

However, in the UK the advice on wearing masks has been unclear and inconsistent; as a result, the country has not fully accepted the wearing of masks as a normal thing to do and most people are not wearing them in supermarkets and shops.

There has been no clear policy from Government and no leadership on this issue — interestingly, neither Johnson nor President Trump wore masks in public until recently. Sadiq Khan, the Mayor of London, was quite vocal that he wanted face-coverings compulsory on London tubes and buses before the Government acted.

A clearer message is needed — if MPs and the Prime Minister were seen in public wearing masks it would send a stronger message. There may be some pockets of resistance, but if the majority of people wear masks scientific evidence now shows it will help reduce infection rates.

The Oxford report on the use of face-coverings found that the face-covering policy had been impacted by a lack of clear recommendations, mostly due to an ‘over-reliance on evidence-based approaches and the assertion that the evidence was weak due to few conclusive trials.’

Due to the weak data from previous trials supporting the benefits of wearing masks, some scientists remained unconvinced of their benefits and opinion was divided. As a result, the advice to the public was unclear and confusing. We now have better scientific data demonstrating the fact that face-coverings can reduce viral spread.

The study reported that clear and consistent public messages are vital to the adoption of wearing face masks and need to be seen as part of the other measures such as social distancing and hand hygiene.

The report also stated that the public does not need to wear surgical masks or respirators; these should be saved for healthcare professionals and in the hospital setting, etc.

The Oxford study found that masks made from high-quality material such as high-grade cotton and multiple layers are effective. They also found using different materials for the layers were effective e.g., combining cotton and silk or flannel, provides over 95% filtration. Crucially, the report also finds that wearing a cotton mask protects the mask wearer as well.

Making your own mask is easy and there are lots of ideas on the internet with demonstrations on YouTube videos. Alternatively, many companies are now making them in a range of colours, patterns and styles.

We need our schools open, our economy up and running and the ability to go about our daily lives again. The Government now seems to be promoting face-coverings, but whether they will make them compulsory in all public places is uncertain — after all who will police it? It would put another burden on shopkeepers and staff to try to enforce it. But if wearing a mask can help in any way to reduce transmission of the virus and keep the numbers down, and prevent another lockdown, it seems a sensible and easy intervention.

It remains to be seen if the British Government will give clearer guidelines or make them compulsory in public spaces, or how well the public themselves respond to the growing evidence that face-coverings prevent spread of Covid-19.

Rachel Kayani