Update on the moving goalposts on masks

A group of prominent academics have urged the WHO to declare that surgical masks are ineffective but there's more to the story than meets the eye.

I’ve just spent a fair bit of time with a relative who’s been in hospital for a prolonged period. The staff have been inordinately kind but with English as the second language for around a third of them, combined with my relative’s hearing impairment, it was at times challenging to understand what was being said. However, with a bit of patience we got there in the end which was just as well because many of the conversations were around complex medical interventions. Misunderstandings could literally be a matter of life and death.

I couldn’t help thinking how different it would have been if these open and smiling faces had been hidden behind masks. There’s no doubt that communication would have been compromised to the detriment of safety and the quality of relationships.

For the majority of the population, masks are a thing of the past, hopefully never to return. But for anyone caring to seek, they will find that mask wearing is embedded in Government policy where they’re consistently recommended as a safe and effective tool to prevent the spread of respiratory infections. As recently as the end of last year during the seasonal rise of flu like illnesses, staff and visitors were required to wear masks in some NHS areas.

In 2024 I wrote about how proposed changes to respiratory transmission descriptors will affect the guidance in NHS Scotland’s National Infection and Prevention Control Manual, particularly in relation to personal protective equipment (PPE).

As anticipated, the situation is gathering momentum towards the anticipated changes. On the 9th of January, the Guardian reported that a group of academics had sent a letter to the Director-General of the World Health Organisation, urging for a change of policy in relation to managing the spread of respiratory infections. One of the signatories, Professor Trisha Greenhalgh, has been a leading proponent of mask wearing; tirelessly promoting both cloth and surgical face masks as essential components of protection against respiratory infections. In an astounding backpedal, she now agrees with the overwhelming body of evidence which has for decades shown they are ineffective.

However, this backtracking has a more sinister purpose. Surgical masks are declared inadequate but no mask is deemed as unacceptable as the wrong mask. As a solution, Professor Greenhalgh and colleagues urge the WHO to recommend respirator type masks, (commonly feared as a worse fate than surgical masks), for use in every encounter in healthcare settings. The group also expect the WHO to inform the public that the pandemic is still ongoing and that SARS-CoV-2 is spread via ‘airborne respiratory particles’, the new term which combines both ‘droplets’ & ‘aerosols’.

(It’s worth remembering that the WHO gave itself authority to declare any seasonal flu outbreak as a pandemic by changing the (non universally accepted) definition of pandemic in 2009.)

The letter makes frequent references to the dangers associated with not wearing a mask or indeed the wrong mask but makes no reference to the dangers associated with wearing any mask, as I wrote about here. N95, FFP2/3 respirators are every bit as ineffective and unsafe as surgical masks but these so called experts, who shamelessly ignored decades of evidence on the ineffectiveness of surgical face masks, expect respirators to be normalised as a ‘universal healthcare standard’ and a ‘basic tool of infection prevention’. It’s a matter of grave concern that they consider ‘mandates and norms’ to be more effective than recommendations, effectively disregarding informed consent as masks are classified as a medical treatment under s47(4) of the Adults with Incapacity (Scotland) 2000. These recommendations are directed at health care settings but if implemented will surely become more widespread.

Aside from communication issues, particularly for individuals with dementia and other cognitive and sensory problems, common sense alone should tell us that respirators are even more likely to restrict breathing. But this group, who are unlikely to have worn a mask for a prolonged period in a demanding care setting, cherry pick studies to justify their assertion that respirators will reduce hospital acquired infections and subsequent sickness absence levels, when the opposite has been shown to be true.

PPE sits at the bottom of the Infection Prevention & Control pyramid but since 2020 masks have been given the highest degree of attention. This unnatural obsession with covered faces makes no sense, especially when promoted in the absence of rigorous benefit risk analysis and at the expense of promoting individual resilience to infections and other factors which enhance quality of life.

There’s an old saying that a lie becomes truth if it’s told often enough, especially when it’s told by people we should be able to trust. Prior to 2020, masks were never a consideration in the management of respiratory infections, simply because they didn’t work. However, academics like Professor Greenhalgh who advised government officials, were prepared to promote the lie that persuaded an unsuspecting and unnecessarly terrified public to believe they were a risk to themselves and a danger to others if their faces were uncovered.

It’s too much of a coincidence that the recommendations in this letter seem to be on a parallel with the soon to be concluded review of transmission descriptors and proposed changes to PPE guidance as described in my original article. The implementation phase is planned for this Spring which fits perfectly with the timing of the letter. I would like nothing more than to be proved wrong in my prediction that Scotland is about to lead the way in inflicting respirators on our valuable health and social care work force.

The evidence may have failed to prevent this assault on humankind so we can only hope that compassion and common sense will prevail.