Nathan Grills: Why we need to be smarter about wearing masks
The evidence on masks is clear — wearing them cuts the chances of both transmitting and catching COVID-19. But now community transmission has eased, it’s time to move on, writes Nathan Grills.
Opinion
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“Masks will be with us “for as long as they need to be”, Victoria’s Health Minister Martin Foley said last week.
Good news — the epidemiology would suggest they no longer “need to be” in many settings. Sticking with compulsory mask-wearing instead of moving to “smart masking” is a case of “once bitten, twice shy.” But like all of us, the government needs to move on.
Excessive risk aversion results in holding onto now redundant levels of restrictions. In addition to compulsory outdoor mask wearing, other unnecessary and stifling limitations include a maximum of two adults visiting a house, 10 people meeting outdoors, arbitrary office and university closures, and tight caps on numbers in gyms, pools, churches and sporting venues. All of these have been safely loosened in NSW — where there are more active cases and more community transmission.
Unnecessary delays in safely relaxing restrictions are not innocuous — they significantly affect wellbeing, cost livelihoods and stifle business recovery. We can ill-afford further damage to be done to our people or the economy.
Compulsory masking was important in the context of 500-plus daily COVID-19 cases in Victoria. As a public health physician, I advocated in the media for compulsory mask-wearing.
The evidence suggested it cut the chances of both transmitting and catching COVID-19. No doubt masking saved lives. But things have changed. Community transmission has eased, with only one mystery case in two weeks. Reassuringly, other jurisdictions with more cases have shown tight suppression can be maintained without mandatory outdoor masking.
Such decisions should be based on evidence, not politics. The British government’s apolitical Scientific Advisory Group for Emergencies advises against compulsory outdoor use. The evidence, even in high risk settings, suggests it would have a “very low” impact on transmission of the virus.
“It is critical that recommendations are seen to be based on the science, and proportionate, otherwise the legitimacy of mask-wearing overall will be compromised,” SAGE says.
However, as we say in public health, the absence of evidence of effect isn’t evidence of absence of effect. Therefore, in July the Victorian government’s decision to require masks — even outdoors — was perhaps proportionate.
But it is not in November, when we have near zero community transmission. It defies both epidemiology and common sense and results in “dumb masking”. We could all quote numerous examples where compulsory outdoor masking means “dumb masking” including fishing, private boating, bushwalking and on most beaches. Outdoor masks are now unhelpful if not dangerous.
Like many Victorians, I picnicked in a park this week. It was comical. No one quite knew when to have the mask on and off. I watched one friend pull his mask on and off upwards of 15 times between picking, sipping, and munching. Obviously, in cross contaminating one’s hands and food, the risk is increased, not decreased.
I also celebrated my grandma’s 95th birthday with a walk in the botanical gardens. I watched her struggle to put on her mask, unfog her glasses, knock her hearing-aid out and, predictably, trip.
I work in an emergency department and I know fractured hips are common in the elderly and carry a 30 per cent mortality risk. And when you make a few million elderly people wear masks (unnecessarily) the risk isn’t insignificant.
I gave my grandma a public health order to ditch her mask. With no cases in the community she clearly was at higher risk of dying from mask wearing.
One final example from home, where we are building an accessible bathroom. I noticed our builders struggle to communicate with me and with each other through masks. And when machinery, power tools, heavy materials and heights are involved it is more than just inconvenience — it’s an occupational health and safety issue.
These examples demonstrate the near impossibility, or even danger, of strictly complying with compulsory outdoor masking laws. When safe compliance with a law is so difficult, one needs to question the law’s legitimacy.
It’s time for “smart masking”. This may mean continuing with compulsory mask wearing in high-risk environments such as indoor settings, public transport, crowded shopping centres, the Boxing Day test at the MCG, and of course in healthcare.
I appreciate the value of strict mask compliance in the emergency department where I work. Increased mask wearing in infectious disease risk areas, such as hospitals, may well have a role beyond COVID-19.
But in low-risk outdoor settings we need to begin to trust people to make sensible decisions about when and where to mask up. Masking up at 8pm on Lygon Street might still be advisable. By now we are all experts in identifying high-risk scenarios.
Why the ongoing delay in loosening mask requirements? It seems a climate of fear is clouding evidence, and common sense, and delaying the safe loosening of such restrictions in Victoria.
Victoria has done the hard work and it’s time to capitalise on the results by safely loosening some unnecessarily restrictive measures.
Associate Prof Nathan Grills is a public health physician at the University of Melbourne