Moving the goal posts on masks

It seems that too many of us are now aware that masks don't work which is a problem for governments who are determined to prove that they do.

The continuing threat posed by mask wearing should concern us all but particularly those of us who live in Scotland. The deputy chief medical officer Professor Graham Ellis recently echoed the words of First Minister John Swinney by stating to a group of care home relatives that, “masks would be built into the culture in future”. 

Unbeknown to most, masks are an ongoing issue in care homes, a situation that will almost certainly get worse as winter approaches along with the normal rise in respiratory infections.  Earlier this year, with help from Professor Richard Ennos, I prepared a benefit-risk analysis to raise awareness of the potentially serious harms associated with mask wearing in care homes.  The document lays out the evidence on why masks are ineffective in preventing the the spread of respiratory infections.  It then describes in detail the harms associated with both wearing masks for lengthy periods and for those with dementia and other cognitive and sensory impairments who rely on facial expression to communicate.

Prior to distributing it to care homes across Scotland, I shared it for comment with the Scottish Government, Public Health Scotland, ARHAI (Antimicrobial Resistance and Healthcare Associated Infection) Scotland) and other health and social care organisations.  It clearly gave them a problem because none of them disputed the evidence as laid out in the document. Indeed, the CEOs of Alzheimer Scotland and Scottish Care supported it but both stopped short of sharing it on their websites.

The SG replied to me that Public Health and ARHAI provide advice based on the best available guidance. This is not true because, in the midst of the high volume of gold standard evidence refuting claims of mask efficacy, a soon to be updated ARHAI document specifically refers to a European directive that clearly states, ‘Surgical masks do not provide protection against airborne (aerosol) particles and are not classified as respiratory protective devices.’

The SG clearly has a problem on their hands when the guidance they’re given conflicts with the literature of those providing it.  But it seems they’ve found a way to get round this ‘problem’. As much of the evidence on the absence of mask efficacy is based on how respiratory infections are transmitted, predominantly via aerosols, the answer it seems is to change the transmission descriptors, thereby changing the understanding of how masks work.

This is explained as follows in the NHS Scotland National Infection and Prevention Control Manual which is also under review:

“The pandemic highlighted the way in which respiratory transmission (droplet and airborne transmission) is currently described may not reflect what is happening in real life.  We need to look at whether there is a better way to describe transmission and whether this would lead to any improvements in infection prevention and control practices.  

Understanding how infectious agents are released into the air and the risks associated with particle size and distance from source will help inform this.  Reviewing the evidence to understand if there is an increased risk associated with certain medical procedures will also inform IPC practice.

The WHO and CDC have also reviewed transmission descriptors indicating a global shift in the way transmission routes are described.  ARHAI Scotland were invited to meet with the WHO global IPC unit to discuss the topic and our literature review findings were well received.”  

They go on to say;

“It’s too early to understand what might change in practice but it is likely that there will be a need for healthcare workers to consider more factors when risk assessing what PPE to wear.  The goal of the NIPCM is to provide healthcare workers in Scotland with guidance that is evidence based, up to date, effective, practical, and as a result safe.  

There should be clear benefit associated with any guidance change and this benefit should outweigh any potential harms.  Guidance will only change if these conditions are met.  Supporting resources and education needs will be considered alongside any potential changes to the NIPCM to enable application to practice.”  

References to benefit and risk are new as is reference to harm as laid out in the benefit-risk analysis, but the SG failed to direct me to these very significant proposed updates.

I don’t believe I’m jumping the gun by concluding that the new understanding of transmission will be used to show that the benefits of mask wearing (or even worse, respirators as feared by many health and social care workers) outweighs even the most serious of risks, thereby undermining current gold standard evidence and any benefit-risk analysis.

The implications of this reach far beyond Scotland and we must ask ourselves, why would Public Health Scotland go to all the trouble of changing decades of established knowledge and evidence if it wasn’t to perpetuate the illogical obsession with covering our faces.