Why the Mask Requirement Must Be Dropped From All Healthcare Settings

Over 2,000 medical and healthcare professionals signed an open letter to NHS Chief Executives of England, Scotland, Wales and Northern Ireland urging them to lift the requirement for staff, patients and visitors to routinely wear a face covering while on their premises. The letter, organised by Smile Free – a campaign group opposed to mask mandates – was sent on June 6th 2022. To date, responses have been received from Scotland and Wales, each attempting to justify, in very similar ways, their persistence with routine masking of professionals and service users.

Smile Free believed that the NHS bosses’ attempts to defend their pro-mask position contained several major flaws, and duly detailed these in further correspondence. The response to the Chief Executive of NHS Scotland is reproduced in full below. (A similar, slightly shorter version was sent to the Chief Executive of NHS Wales.)

Syed Kerbalai (Chief Nursing Officer, Healthcare Associated Infection & Anti-Microbial Resistance Policy Unit).

Dear Mr Kerbalai

Thank you for your letter dated July 14th 2022, responding to our expressed concerns about the persistence of mass masking in healthcare settings. We appreciate you taking the time to reply.

We welcome your recognition that staff members can use their “professional judgement” and remove masks to reduce a patient’s distress and enhance communication. And we also support your expressed concern for the wellbeing of staff who experience emotional or physical discomfort as a direct result of wearing a face covering. In addition, it is reassuring to note your endorsement of the principle that no patients should be refused treatment – nor visitors refused access to loved ones – should they choose not to wear one.

We would, however, wish to highlight some fundamental flaws in your attempts to justify the persistence of widespread masking in your healthcare settings.

First, there is an underlying assumption throughout your response that masks are effective in reducing viral transmission. The evidence for this premise is – at best – weak and contradictory. The science reviews you refer to are skewed towards the recommendations of state-funded public health bodies, with insufficient weight given to more independent researchers who have conducted randomised controlled trials in real-life settings (for example here and here) and comprehensive evidence reviews (here and here) that all conclude that masking healthy people achieves no appreciable reduction in viral transmission. Furthermore, two literature reviews of the impact of surgical masks in hospital settings (here and here) indicate that even these higher quality face coverings did not protect either patient or health professional from infection.

Second, the risk of those without symptoms passing the SARS-CoV-2 virus to other people does not justify masking healthy people. So called ‘asymptomatic transmission’ is rare, and pre-symptomatic transmission – although a little more common – is unlikely to make a significant contribution to the propagation of a pandemic. 

Third, it is likely that your directives regarding how to promote the wearing of face coverings – expressed as “politely encouraged”, “strongly encouraged”, “highlight the benefits” and “recommended” – will habitually morph into the harassment of those people opting not to follow this advice. Consequently, there is a risk of alienating a vulnerable subset of the general public (the people you are commissioned to serve), thereby discouraging them from both seeking medical help and visiting hospitalised loved ones. 

Fourth, and most importantly, you disregard the wide range of significant harms associated with masking healthy people, instead displaying a blinkered mono-focus on the risks associated with the SARS-CoV-2 virus. Apart from passing references to “glasses steaming up” and staff sometimes feeling “hot and uncomfortable”, there is no acknowledgement of the many recognised negative consequences – physical, social and psychological – of masking (see here for an overview of the evidence).

At Smile Free, we routinely hear anecdotal reports of how (often vulnerable) people suffer as a direct consequence of the expectation to wear a mask in healthcare setting. What defence would NHS Scotland offer when faced with complaints – and threats of litigation – from:

1. The family of an elderly lady who died shortly after fracturing her femur in a fall after being pressured to wear a mask in a hospital outpatient department?
2. A hard-of-hearing man who accidentally overdosed on prescribed medication, a mask having rendered his doctor’s instructions inaudible?
3. Relatives of an inpatient who died directly as a result of miscommunication between two masked health professionals?
4. The father of a young woman, a victim of historical sexual and physical abuse, who was re-traumatised by the obligation to wear a mask for an outpatient appointment resulting in her subsequently taking her own life?
5. A long-standing patient with respiratory difficulties who contracts pneumonia as a consequence of repeated masking when attending for appointments?
6. A lady whose historical problem of recurrent panic attacks is re-activated by the somatic sensations of a mask over her mouth, leading to a prolonged admission to psychiatric hospital?
7. A coroner’s report of the death of a young child from a non-Covid illness after the parents were too scared to attend hospital (partly as a result of the fear perpetuation associated with widespread masking)?

In the above scenarios it is questionable whether professional leads, and those in senior management roles, could rely on a defence of, “We were following protocols”.

In light of the above, together with the concerns raised in our original letter, we respectfully request that you reconsider your decision to persist with recommending masks for all staff, patients and visitors and – instead – allow people a genuine choice as to whether or not to cover their faces in healthcare settings.

Yours sincerely

Dr. Gary Sidley (Retired NHS Consultant Clinical Psychologist) on behalf of Smile Free

It is encouraging that, over recent months, the dominant ‘masks-work’ and ‘masks-do-no-harm’ narratives are – seemingly – beginning to crack. The large majority of sports-events attendees, shoppers, pub-goers and diners are now mask free, the richness and complexity of their facial expressions routinely available to their fellow humans. With few exceptions, the requirements to wear a face covering on transports systems, including airlines, have been ditched. Some of our MP are, belatedly, waking up to the futility (and harms) of the mask craze, a cross-party group of MPs recently writing a letter to Liz Truss and Rishi Sunak urging them to “rule out future mask mandates”. And even in Scotland – a country characterised by strict enforcement of COVID-19 restrictions – care home staff and visitors are no longer being advised to wear face coverings all the time, the latest guidance importantly acknowledging the “rights and choices of those within the social care sector”, while also explicitly recognising that masks can have harmful effects “on health and mental wellbeing” and create “communication barriers”.

Regrettably, the main outliers to this gradual return to non-mask sanity are healthcare premises.

Although a significant number of NHS Trusts appear to have relaxed their mask requirements, many are persisting with the expectation that staff, patients and visitors should cover up. The current position is often confusing, with ‘guidance’, ‘policy’ and ‘legal requirements’ typically being in conflict. Healthcare professionals who contest the imposition of face coverings in the workplace are performing an important role in the ongoing mission to rid our society of mask mandates, yet they can often find themselves in a bewildering situation, unclear about their rights and options. (In such situations, the support and guidance offered by the Workers of England Union can be helpful, as illustrated by this webinar.)

As we move through the autumn and into the winter, the prevalence of respiratory viruses will significantly increase and it is inevitable that the pro-mask fanatics will, once again, be screaming for the imposition of mandates. In order to neutralise these irrational voices, it is vital that the embers of the ‘masks-are-an-effective-and-harmless-way-of-controlling-a-respiratory-virus’ myth are fully extinguished within our healthcare settings. If not, the ineffective and harmful practice of masking heathy people will re-ignite. The stakes are high.  

Dr. Gary Sidley is a retired NHS Consultant Clinical Psychologist and co-founder of the Smile Free campaign.

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