Masks in care homes: analysis of risks for staff and residents
Face masks are no longer routinely required in health and social care settings but current guidance continues to recommend their use in the absence of risk-benefit analysis.
Mask wearing is commonly communicated as a relatively risk free intervention with life saving benefits and guidance continues to support their use. Mask wearing should however be understood as a medical treatment (s47(4) of the Adults with Incapacity (Scotland) Act 2000) which requires informed consent from the wearer. Informed consent cannot be given in the absence of reference to risks which should be understood as potential harms, many of which are serious or life threatening for both wearers and those impacted by hidden faces. Mask mandates/requirements were put in place in the absence of any risk-benefit analysis, especially relating to the impact on people with dementia and other cognitive and sensory impairments (and children.
Harm is often unintentional but never the less harm, the threshold for which is likely to be higher due to events since 2020. Suspected harms caused by unnecessary mask use should therefore be subject to further inquiry under the Adult Support & Protection (Scotland) Act 2007. It’s also important to consider if health and social care workers have been placed under ‘undue pressure’ to wear a mask and may meet the criteria of ‘adults at risk of harm’ which should prompt further inquiry.
Despite being at the bottom of the hierarchy of IPC measures, PPE (which includes masks of various types) has received unwarranted attention. Organisations tend to focus on the responsibilities of employers under Health and Safety legislation, most specifically on the risk of not having access to PPE. However, risks associated with wearing PPE (specifically masks), especially for lengthy periods, is minimised with scant or non existent reference to the impact of PPE on cared for individuals.
Current literature and that prior to 2020 has been consistently clear that masks offer little to no benefit in preventing the spread of respiratory viruses. A sample of the high quality literature to this effect is listed at the end of this document. However, even if benefit could be found, as argued by some, then any perceived benefit must be measured against risks.
This brief analysis of risk is intended to serve as a starting point for a more detailed document. It relates to surgical masks and their impact on people with dementia and other cognitive and sensory impairments but should also be applied more specifically to other mask types and other groups and individuals impacted by their use. (Tables not supported in substack so inserted in photo form.)
A sample of high quality evidence that challenges assertions that masks are both beneficial and safe.
Previous to 2020
Prior to 2020 it was known that masks offer no appreciable protection against viral infections and may even lead to more infections. It’s also worth remembering that the WHO changed their advice on mask wearing in 2020, as did key government officials in the absence of any change in the evidence.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006207.pub5/full
https://wwwnc.cdc.gov/eid/article/26/5/19-0994_article
https://www.nejm.org/doi/full/10.1056/NEJMp2006372
2021
https://www.acpjournals.org/doi/10.7326/M20-6817
https://brownstone.org/articles/studies-and-articles-on-mask-ineffectiveness-and-harms/
2022
2023
Cochrane again concluded that masks do not significantly reduce the likelihood of contracting respiratory viral infections:
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006207.pub6/full
Mask requirements in a London hospital made no discernible difference to transmission rates:
https://medicalxpress.com/news/2023-04-requirement-masks-hospitals-impact-covid-.html
UKHSA’s recently published review concluded the evidence for mask wearing was at best, weak.
Masks are harmful for wearers:
https://www.cell.com/heliyon/pdf/S2405-8440(23)01324-5.pdf
https://www.city-journal.org/article/the-harm-caused-by-masks
Contrary to messaging in 2020, it is universally accepted that SARS-CoV-2, the virus that causes Covid-19, is spread predominantly via airborne particles:
S3.2 ’Surgical masks do not provide protection against airborne (aerosol) particles and are not classified as respiratory protective devices.’ ARHAI. https://www.nipcm.hps.scot.nhs.uk/media/2113/2022-01-06-surgical-masks-sicps-and-tbps-v20-final.pdf
This document has been shared with the Scottish Government, Public Health, HSE-Scotland, ARHAI and the CEO’s of leading health and social care organisations in Scotland.