Wearing Facemasks

The WHO has shown inconsistency in their initial guidance on whether these should be worn. 

In January 2020 the WHO did not recommend the mass wearing of masks in healthy individuals within the community as a way to prevent infection of COVID-19.  Public Health England in its interim guidance in April 2020 also made similar recommendations. 

By contrast the CDC in the US advised the wearing of cloth masks in public and many countries such as Canada, South Korea and the Czech Republic require or advise their citizens to wear masks in public places.

Evidence review and analysis has supported mass masking in this pandemic and it is suggested that the WHO and Public Health England are re-visiting they’re advice. 

However there is an absence of evidence from clinical trials for the effectiveness of mass masking. However, this should not be equated with evidence of ineffectiveness. 

There are clearly reasons for covering the mouth to reduce respiratory droplet transmission and indeed cough etiquette is based on these thoughts and not on evidence from clinical trials.  A workshop convened by the WHO in 2019 concluded that in a severe influenza pandemic the use of masks in public should be considered.

Clearly, there is a concern over the shortage of mask supply to the community and medical use masks must be reserved for healthcare workers.  It is believed that to control infection source rather than to self-protect, the wearing of a cloth mask as recommended by the CDC is likely to be adequate, especially if everyone wears a mask.  These can be easily manufactured or made at home and re-used after washing.  Public education can be brought in to advise on the correct techniques for wearing, removal and disposal of face masks.

It has been raised that mask wearing might endanger a false sense of security and lead to other techniques of infection control such as social distancing and hand washing being overlooked. There is no evidence to suggest that the wearing of masks would mean other approaches to infection control would be forgotten. 

However this point would have to be emphasised to the public if they chose to wear masks. 

Controlling harm at source, as in masking, is at least as important as mitigation – hand washing. 

Masking brings little benefits to an individual, but large benefits to a population.  Masking can be compared to safe driving.  Other road users and pedestrians benefit

from safe driving and if everyone drives carefully, the risk of road traffic accidents is reduced.  Mass masking would be of particular importance for the protection of essential workers who are unable to stay at home. 

South Korea and Hong Kong have managed to limit their outbreak of COVID-19 without lockdowns.  Clearly it is difficult to apportion the contribution of various measures but in both places the use of masks in public is universally practiced. 

Masking can become a symbol of social solidarity in the global response to this dreadful pandemic. 

I am delighted to hear that fashion houses such as the luxury brand Louis Vuitton and fashion designers have started to make gowns and many fashion houses are beginning to make masks. 

The London General Practice

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