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Mask-wearing at the heart of the great British Covid divide

Mask wearing has been the most visible symbol of Britain’s political divide over Covid-19, illustrated by images of the House of Commons chamber in which many Labour MPs have face coverings and most Conservatives do not.

Under strong pressure from medical campaigners who insist that masks help to reduce coronavirus transmission in crowded settings, health secretary Sajid Javid said on Monday that he personally would cover his face during Wednesday’s Budget debate but again called mask wearing “a matter of personal judgment”.

In contrast, Boris Johnson’s spokesman refused to say whether the prime minister would be masked for the Budget, an event when the chamber is usually packed.

The UK — and England in particular — stands apart from the rest of western Europe, where people are more likely to wear a mask in public and where Covid cases are well below British levels. Since August, mask wearing in England has decreased by about 30 per cent.

Masking on its own does not come close to explaining why the UK is an outlier. Contributory factors include higher rates of indoor mixing in crowded spaces and slower rollout of vaccines to teens.

Masks are a rare sight among Conservative MPs in the House of Commons © Jessica Taylor/HoC

Another is the earlier onset of waning immunity in the UK where vaccines were introduced earlier and relied more on the Oxford-AstraZeneca jab, which may be slightly less effective than the BioNTech/Pfizer product more widely used on the continent.

A mask is a “second line of defence,” said Muge Cevik, an infectious diseases specialist at St Andrews university. “Masks reduce transmission to some extent but the most important factor is to take the infectious person out of circulation or reduce their chance of transmission by vaccination,” she added.

Professor Peter Openshaw, an expert on respiratory infections at Imperial College London, said there was a “real consensus” that worn properly a mask was “very good” at reducing transmission. “It protects you as the wearer and at the same time it protects others.”

The UK government’s Scientific Advisory Group for Emergencies took a more cautious view after looking at two reports into the effectiveness of masks published within the past month by its Environmental Modelling Group and the UK Health Security Agency’s Respiratory Evidence Panel, which brought together multiple studies from around the world.

Taking all the evidence into account, Sage stated masks were “likely to reduce transmission through all routes by partially reducing emission of and/or exposure to the full range of aerosol and droplets that carry the virus”.

Misconceptions frequently distort people’s views of mask effectiveness, according to Openshaw. “For example, I have heard it said in parliament that the virus particles are too small to be filtered by masks and therefore wearing one is futile,” he said.

Chart showing that England has been faster to abandon masks than the other UK nations and other major Western European countries. As of mid October, only 42% of adults in England say they are always wearing a mask in indoor public spaces, compared to 60% in Wales and Germany, 70% in Scotland and France, and 80% in Spain and Italy. Similarly, 17% of English adults say the no longer wear a mask at all, compared to around 10% in Wales and Scotland, 5% in Germany and France, and 2% in Spain and Italy.

“In fact, we are not trying to stop individual viruses but the fine clusters of material that fly through the air from someone who is infectious, carrying hundreds or thousands of virus particles. They can be stopped by the fabric in masks.”

Masks can also help indirectly to influence behaviour by reminding people that there is still a pandemic, said Robert West, professor of health psychology at University College London. “At a time when we need to be doing as much signalling as we can, masks are very helpful,” he said.

Studies attempting to quantify the effectiveness of masks in reducing infection rates established a range of 6 to 15 per cent, according to a review by Paul Hunter and colleagues at the University of East Anglia in Eurosurveillance.

Masks are still mandatory on London Underground but many passengers opt not to wear one © AFP via Getty Images

A randomised controlled trial in Bangladesh involving 340,000 people from November 2020 to April 2021, in which half the participants were encouraged to wear a cloth or surgical mask and half were not, found that face coverings reduced symptomatic Covid by 9.3 per cent.

Modelling by the London School of Hygiene and Tropical Medicine submitted to Sage found that government-mandated mask wearing would reduce Covid infections substantially by cutting the R number for the virus, which measures how many people one person with the virus would infect, by 7.5 per cent.

Many experts now regret the way authorities in the UK and the World Health Organization advised against general mask wearing in the early stages of the pandemic. Such advice was prompted by a combination of lack of evidence at the time, doubts over the willingness of the general public to wear masks and a wish to reserve scarce supplies for health workers.

But memories of the way masking was officially discouraged early in 2020 continue to fuel doubts about the measure’s effectiveness, Openshaw said.

Such doubts persist among Tory MPs. Desmond Swayne, a backbencher who represents the New Forest West constituency in the south of England, questioned whether masks prevented “the spread of disease” and asserted they could “only have the most marginal effect.” He said he disliked “having to appear as if I were about to rob a bank” and declared that having to wear a mask one of “the most irritating” aspects of lockdown restrictions.

Swayne may yet be spared. While ministers said they stand ready to reintroduce mandatory mask wearing as part of their Plan B if the NHS comes under intolerable pressure, the latest case data provided a tentative sign that may not be needed. On Monday, the government reported 36,567 positive Covid tests across the UK, a fall of nearly 26 per cent from 49,156 cases on the same day last week.

Additional reporting by John Burn-Murdoch

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