From the outset of the COVID-19 Coronavirus outbreak, the World Health Organisation (WHO) declared that its recommendations, published in 2010, should be followed. These stated that, in addition to pharmaceutical measures to be employed at the front line of disease control, such as the use of vaccination and antiviral drugs, non-pharmaceutical interventions should be used alongside as important control measures. Such measures fall into four groups, aiming to (1) limit international spread of the virus; (2) reduce spread within populations; (3) reduce the individual risk of infection (through personal protection and hygiene measures); and (4) raise public awareness of the risks. These measures drew on the experience of both the SARS epidemic in 2003 and the H1N1 Influenza epidemic of 2009. An important part of reducing the risk of infection by and to individuals was the importance of widespread distribution and wearing of masks.

By contrast, the official recommendation in the UK was to advise that the public should not wear face masks. Indeed, official reports and advice cast aspersions on the efficacy and use of masks. Claims were made that there was no scientific evidence that masks were effective. However, the opposite is the case. In a casual review of scientific studies and papers written between 2010 and March 2020, from journals including the American Journal of Infection Control (2010), Risk Analysis (2010), the peer-reviewed PLOS Pathogens (2012; 2013), and the Lancet Journal of Respiratory Medicine (2020), all show that 'the use of masks during a pandemic can minimize the spread of influenza and its economic impact'. The American Journal of Infection Control (2010) wrote:

"Face masks are an effective, practical, non-pharmaceutical intervention that would reduce the spread of influenza among school children, while keeping schools open. Influenza spreads through person-to-person contact, via transmission by large droplets or aerosols (droplet nuclei) produced by breathing, talking, coughing, or sneezing, as well as by direct or indirect [i.e., via objects or materials which are likely to carry infection, such as clothes, utensils, and furniture] contact. …. poor understanding of influenza transmission risks and a lack of good public health education can lead to the 'worried well syndrome', but an effective, well-publicised science-based policy can minimise the probability of this reaction. Educating the public on the severity of influenza and the effectiveness of masks can reduce its economic impact and spread."

More recently, the UK government has admitted that the motivation in downplaying the use of masks was motivated by the need to save respirator masks for healthcare workers and that there were not enough masks to supply even the hospital health workers, let alone to supply the general population. Similar to the U-turn made by the government from encouraging so-called "herd-immunity" to the now the stated goal to "flatten the curve", it is now becoming apparent that were the government to make masks as widely available as possible, and given out freely at hospitals, care homes, schools, shopping centres, all places of work and places where people congregate en masse, then we would see a "significant reduction in the rate of Influenza-like illnesses (ILI)". Indeed, a PLOS Pathogens Journal (2012) study concluded that the spread of a Corona type virus could be reduced by up to 75% by the simple use of non-pharmaceutical measures such as face masks and hand hygiene combined.

In the Lancet Journal of Respiratory Medicine published Online on March 20, 2020, it quotes that the "WHO called for a 40% increase in the production of protective equipment, including face masks. Meanwhile, health authorities should optimise face mask distribution to prioritise the needs of front-line health-care workers and the most vulnerable populations in communities who are more susceptible to infection and mortality if infected, including older adults (particularly those older than 65 years) and people with underlying health conditions."

The latest edition of The British Medical Journal of April 9 also emphasises the view of experts that it is 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. Professor Trisha Greenhalgh at the University of Oxford and colleagues say that masks "could have a substantial impact on transmission with a relatively small impact on social and economic life". In an opinion piece, researchers recommend that health care workers should not be caring for COVID-19 patients without proper respiratory protection.

In summary, the mass production and use of masks should be promoted and encouraged as a matter of urgency in containing the spread of the Coronavirus COVID-19. All the resources and funding necessary should be done to support these measures. Of course, all necessary measures must be implemented to look after those already infected by the virus, and to roll out widespread testing of the population. But it is clear from all the scientific data we have available spanning a decade of research, that wearing masks works!

Sources

Can we reduce the spread of influenza in schools with face masks? (Del Valle and Tang: American Journal of Infection Control, 2010)

A Study of Barriers to the Wearing of Face Masks by Adults in the US to Prevent the Spread of Influenza by Yu-wen Hung (A Thesis Presented in Partial Fulfilment of the Requirements for the Degree Master of Science in Design; ARIZONA STATE UNIVERSITY December 2018.)

The Effect of Mask Use on the Spread of Influenza During a Pandemic (Brienen and Teunis: Risk Analysis, Vol. 30, No. 8, 2010)

Facemasks, Hand Hygiene, and Influenza among Young Adults: A Randomized Intervention Trial (Aiello and Monto; PLoS ONE www.plosone.org 8 January 2012, Volume 7, Issue 1, e29744)

Rational use of face masks in the COVID-19 pandemic (Lancet Respiratory Medicine 2020 Published Online March 20, 2020. https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30134-X/fulltext

Influenza Virus Aerosols in Human Exhaled Breath: Particle Size, Culturability, and Effect of Surgical Masks (Milton and McDevitt: PLOS Pathogens, www.plospathogens.org, 7 March 2013, Volume 9, Issue 3: e1003205)

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