Should face masks become the new normal, an evidence-based response to the threat of Covid-19 infection? Evidence actually suggests that the policy mandating face coverings is a response to a moral panic and climate of fear aroused by inadequate government messaging. Sociology rather than medical science may provide the best guide.
Evidence on personal, non-medical face masks has always been clear: they make almost no difference to a person’s chances of catching an airborne infection but do make a slight difference to the chances of an infected person passing the infection to others. There is therefore a case for mask-wearing when an infected person is in busy, public situations. By comparison with other personal and public-health precautions, however, masks are of very limited value.
Face masks have, nevertheless, been a long-standing and familiar feature of life in many East Asian countries. In Japan, Singapore, Hong Kong, and mainland China, a culture of politeness has established a custom of mask-wearing by those who are getting over a cold or flu but must leave home. Wearing a mask signals a respect for others and says ‘be careful’.
In the current Covid-19 pandemic the British government, like many others, has mandated the wearing of face coverings in a number of pubic situations. This requirement was introduced at the time that the rate of infection in the community is low and either static or reducing. The ostensible reason is to give some slight support to the policy of social distancing and, perhaps more importantly, to give people more confidence to travel and to visit shops. It is thought that those in fear of the virus will be more likely to venture out from their home if others are wearing a mask.
The need to build confidence, however, is a result of the excessive fear of infection that has been created by the government’s otherwise successful messaging to ‘Stay at Home; Protect the NHS; Save Lives’. While the virus has serious medical effects for only a small proportion of those who catch it, and leads to death in far fewer cases, a large proportion of the population has internalised an inaccurate message. Many believe, wrongly, that they face a high chance of serious illness, or death, if they venture out into public places. Survey evidence shows that many fear that public transport and shops, even with social distancing, are danger zones and so are reluctant to return to anything approaching normality.
Any sociologist would recognise this as a classic example of a moral panic. A legitimate concern has been amplified through mass media and social media reporting and comment into irrational and inappropriate responses that magnify the original concern and so lead to further inappropriate responses. Instead of allaying fear, messaging has exacerbated it.
Consulting sociologist Robert Dingwall has made a number of salient interventions in current media discussions, though barely denting the prevailing consensus. He has argued that the evidence on which government policy is based is almost exclusively drawn from medical science and that those from other disciplines that could offer crucial insight and evidence—most notably engineers, sociologists, and other social scientists—are almost completely excluded from SAGE and its associated advisory groups. Dingwall is one of the few non-medics to be involved.
Drawing on a range of available evidence, Robert Dingwall has argued that the rate of infection is low, which significantly reduces the chances of an uninfected person encountering an infected one. He has also argued that any virus in the breath is rapidly dissipated upwards with vanishingly small amounts carried even one metre. The chances of encountering the virus in sufficient concentration to risk infection when people observe normal conventions of personal space is therefore low. Most cases of fleeting interaction are not directly face to face, making the risk even lower. On the basis of such evidence, mask-wearing makes little or no difference to an extremely small risk.
If, however, the requirement on masks is intended to build public confidence and increase the number of people willing to use public transport and high-street shops, the situation might be different. Sociologists are familiar with the idea of unintended consequences: social life is so complex, with action chains intertwining and extending over great distances, that it is rarely possible to foresee or even to recognise the consequences of actions. People intend to do one thing, but the actual outcome may be very different. Are there possible or likely unintended consequences of the policy on masks?
It is certainly likely to be the case that mask-wearing reduces the propensity to travel and to shop. Surveys show that many who are not lacking in confidence nevertheless intend to travel and shop less because of the requirement to wear masks. Long-distance rail journeys are extremely uncomfortable when wearing a mask, and few will choose to make a three- or four-hour journey wearing a mask unless they really have to. Social research on the decline in the high street has concluded that shops must enhance the shopping experience if they are to attract customers. It is likely that the need to wear a mask reduces the shopping experience for many and they are likely to rely ever-more on online shopping.
An equally significant unintended consequence is that mask-wearing can exacerbate the fears of those who are lacking in confidence. The sight of people in everyday situations wearing masks is a constant reminder of the very danger that they perceive to be present in public situations. Large-scale mask-wearing reinforces the inaccurate beliefs that people have about the risks attached to leaving their homes. This too is likely to reduce the amount of travel and shopping.
As these unintended consequences become more apparent, the government is likely to realise the need to relax and eventually abandon the requirement to wear masks. But how is this ever going to be possible when so many people continue to believe that a mask protects them from a deadly danger? The government must alter its messaging to communicate a realistic view of the risks faced by the mass of the population in a situation where it is estimated that the chances of encountering an infected person are around 1 in 2300 – and this is not the same as the chance of actually being infected by that person.
The risks attached to Covid-19 for ordinary, healthy people need to be clearly stated and communicated, and the risks need to be put in the context of the numerous other risks that we all accept in our everyday lives and that are, in most cases, more likely and more serious than the risk of catching Covid-19: the risk of catching seasonal flu, the risk of being involved in a road traffic accident, the risk of serious injury in the home, the risk of different diets, of alcohol, of smoking, and so on. Most of us have inaccurate perceptions of these risks, yet happily accept or disregard most of them. Placing the Covid-19 risk in the context of accurate information can begin to show us how we might learn to live with the disease as we do with many other daily dangers.
Correcting misperceptions and misunderstandings is not going to be easy, particularly as it goes against four months of direct messaging on the dangers of Covid-19. It is going to be a long haul and government musty clearly state the real public health message: stay at home when ill, wash hands frequently, don’t touch your face with unwashed hands. This would allow it also to wean people off the idea that wearing masks makes all the difference between life and death. Perhaps government should publicise the reasons behind the East Asian practice of mask wearing and nudge us all towards acceptance of the idea that occasional mask-wearing when you are getting over an illness is a simple and polite way of behaving but not a long-term way of life.
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