THERE has been much debate about personal protective equipment (PPE) for health and other workers, but relatively little until recently on preventing Covid-19 transmission to those workers through the use of non-medical masks by the general population.

The implications of such a decision, positive and negative, need to be addressed in Scotland, as a range of governments across the world adopt or continue the use of these masks.

Important questions arise about the type of masks, their purpose, appropriate use, the target group or groups of wearers, the timing of introduction if they are adopted, and the length of time they will be needed. The answers to these questions have frequently been muddled, confused and compounded by misunderstandings and often a lack of research.

At the same time, there has been a great deal of emphasis by politicians and civil servants across the UK on how they are guided by the scientific evidence and best international practice. It is self-evident that this has been a very selective exercise.

We are told, for example, the WHO does not support the wearing of masks by the public to prevent transmission, so governments will follow that lead.

Yet WHO advice on the need for early and extensive testing in the Covid-19 epidemic was ignored by all four countries in the UK.

Information from China, Italy, South Korea and Hong Kong about how to manage the pandemic was available, including the risks to those in social care and their carers, but this was also ignored across the UK at the beginning of the pandemic.

Sir David King, the UK’s chief scientific advisor between 2000 and 2007, said he was saddened there had not been a much more rapid UK response to the pandemic after it broke out in China. He said the lack of preparation had cost lives.

In contrast, controlling Covid-19 transmission and protecting each other is something we need to address now and in the immediate future. It will save lives.

One major strand in the gradual release of the lockdown should be to follow good epidemiological practice. That is testing, tracing and isolating, steps missing in the developing stages of the pandemic. Non-medical mask use may also be part of that release strategy, prior to the development of an effective Covid-19 vaccine.

On occasion, misleading or incomplete statements have also been made about “the science” the UK and Scottish Governments have used to assess masks. These statements have then been repeated by some Scottish civil servants as off-the-cuff justifications for a range of decisions.

Non-medical face masks, or “community” masks, include commercial masks, self-made masks, or face covers using cloth, other textiles or materials such as paper. There is no standard and they are not intended for use in healthcare settings or by healthcare professionals. There is no evidence that non-medical face masks or other face covers are an effective means of respiratory protection for the wearer of the mask, and so should not be used for this purpose. However, there is some evidence they may reduce the transmission of viruses.

Medical face masks, or surgical or procedure masks, are medical devices covering the mouth, nose and chin to limit the transition of an infective agent between the hospital staff and the patient. There are European standards for these masks. The WHO was clear medical masks should be reserved for health care workers, but found the use of masks made of other materials in the community setting had not been well evaluated.

The WHO therefore concluded there was no current evidence to make a recommendation for or against their use in this setting – which is very different to stating they do not work.

Austria, Hong Kong, Israel, Slovakia, parts of the US and other places have all already implemented or recommended wearing community masks, which can be made from household items at low cost. Most of these countries stress the continued need for testing, physical distancing, and for health care and other key workers to have medical masks. But they also consider masks a part of their toolbox for preventing transmission.

If we don’t want to simply pay lip service to the efforts of those workers who, at great risk, treat us when we contract Covid-19 or keep our society functioning, now would be the time to consider carefully the national options to prevent disease transmission for these workers and the public at large.

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