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Masking the future (CW5.3)

Relaxing in a vaccinated world

Last week the media was awash with reports that the success of the vaccination programme in the UK may mean that face masks will not be needed this summer, whilst government advisors continued to highlight that this could change as we move into autumn and winter. In the same week, Israel relaxed its rules on outdoor mask wearing (more), now that 81% of its citizens over age 16 have had both doses of the Pfizer/BioNTech vaccine. And back on March 8, the CDC in the USA issued revised guidelines that those that were fully vaccinated (2 doses for Moderna or Pfrizer or 2 weeks after the J&J vaccine) could meet others similarly vaccinated indoors without masks (more).


But where is the evidence of how successful the vaccines are in stopping transmission of the virus? Two studies based on the experiences of 370,000 adults released by the University of Oxford, together with the ONS and the Department of Health and Social Care for England, revealed that between 57% and 70% of both asymptomatic and symptomatic infections were prevented after vaccination with Oxford/Astrazeneca or Pfizer/BioNTech vaccines (more). This is a major finding and an incredible success.


However, as highlighted by Professor Sarah Walker, the chief investigator for the COVID-19 Infection Survey, this means that there is still a risk of onward transmission in a vaccinated population. It is all about how we understand and address that much reduced risk, and what each of us will actually do when it comes to preventative measures such as masks and social distancing. What will be the new “normal”?


Interestingly, there was a study before COVID that estimated that the average person would shake 15,000 hands in a lifetime. There was a very significant gender difference with 32% of women stating that they would never shake hands versus 6% of men (more). Increasing awareness of the potential for spreading infections and lack of personal hygiene meant that fist bumps were already trending before the appearance of the somewhat awkward elbow bump. The last two years will provide valuable evidence to challenge or support the oft-stated importance of handshakes and other personal greetings to developing social circles and trust.


Face masks and individual behaviour

In many Asian countries, face masks have become ubiquitous, particularly during flu season, ever since the first SARS outbreak in 2002/03. Face masking is the minimum expectation when you have a cold as part of being a “good, responsible citizen”, but masks also serve a range of other purposes in these countries such as combating allergies and protecting against pollution. It has not been necessary for governments to mandate the wearing of masks. By March 2020, surveys in Hong Kong suggested that 99% were wearing face masks when leaving home (more).


Indeed the history of face masks in public health dates all the way back to the 1910/11 pneumonic plague in China (more) and the 1918/19 influenza pandemic globally, but their use rapidly faded in Western countries after the end of the latter pandemic. Anti-mask sentiment is nothing new with reports of “mask slackers” across the USA in 1918 (more) in defiance of the law, reflecting confusing messages and the assertion of individual rights over collectivist good.


On 21 March, Mary Ramsay, head of immunisation at Public Health England, suggested that the UK population had got used to lower level restrictions such as face masking and social distancing and may need to continue these “certainly for a few years, at least until other parts of the world are as well vaccinated as we are” (more). Burden, protection, politeness. The balance is likely to be different for everyone, with some ripping off their masks as soon as allowed and others following the Asian model. Further divisions in an oft fractured society.

Back in February before the UK roadmap out of the pandemic was published, the New Scientist convened a poll of 52 epidemiologists and public health researchers to canvass their views on future restrictions and behaviours (more). Figure 2.1 sets out their collated views on when they expected personally to resume “normal” activities.


Figure 2.1 – New Scientist poll answering question “When will you personally expect to do the following?”

Source: New Scientist


At that time, half of the survey thought that face masks would continue into 2022 or later and 60% believed that physical contact outside of support bubbles and international travel would not be seen in the UK in 2021. Two months on, the future is still uncertain – but for some it will be masked.

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