Mask Creep

by Molly Kingsley

What difference does it make to the dead, the orphans and the homeless, whether the mad destruction is wrought under the name of totalitarianism or in the holy name of liberty or democracy?
Mahatma Gandhi

An email received a few days ago into the UsforThem inbox reads thus:

I wanted to inform you that my son’s secondary school is stating that after the October half term any child who is exempt must wear a lanyard in future to show they are exempt. The school up until recently was a mask choice school, but now has become masks in all moving spaces to be worn by all.
Kinds regards,
A Concerned Parent

Sadly, there is nothing exceptional about this email. I’ve quoted it precisely because it’s representative of hundreds of messages we’ve received. The details vary, but the gist doesn’t: schools, often not in areas of high viral prevalence, requiring masks in situations over and above those recommended by the Department for Education (DfE). Masks in classrooms, masks for parents at pick-up and drop-off, masks for teachers and staff – including teachers of nursery age children and those with special needs. Proof of exemption required and exempt children made to wear identifying lanyards highlighting their status. The situation in schools is reflective of that in the country at large – so that to travel, shop, watch a movie, pray, or even just walk around a restaurant, we must be masked; smiling in public, at least indoors, has de facto been outlawed and transgressions are met not only with stern disapproval, but potential fines and the risk of a career-limiting criminal record to boot.

I am genuinely bewildered as to how we – liberal, tolerant, sensible – arrived at this point.

It’s all the more bewildering given that various Government officials have made, and continue to make, public statements doubting the efficacy of masks. As recently as August 28^th, the Deputy Chief Medical Officer stated that the evidence around masks is “not very strong in either direction”. The evidence that they can cause harm, on the other hand, is significant. The DfE says: “Face coverings would have a negative impact on teaching and their use in the classroom should be avoided.”

Even outside the classroom, masks are problematic for children. Look no further than Brussels and to a group of 70 doctors who on September 9^th stated: “Mandatory face masks in schools are a major threat to [the] development [of children]. It ignores the essential needs of the growing child. The well-being of children and young people is highly dependent on emotional attachment to others… the face mask requirement makes school a threatening and unsafe environment, where emotional closeness becomes difficult.” Charities in the UK have now started to raise awareness of the mental health issues surrounding mask use and there are a number of general studies highlighting concerns about the physical impact of masks, including on breathing, pulmonary and immune systems, and infections.¹

The Achilles’ heel of our parliamentary system which led to this has been well documented. The original legislation bypassed Parliament and the policy-modifying statutory instruments were discussed behind closed doors. On June 15th, masks were made mandatory on public transport and in clinical settings. Six weeks later, the mandate was extended to shops and supermarkets and barely a fortnight after that to other venues such as theatres, libraries, and churches. The hammer blow for children came later in the shape of a Gavin Special – a summer Bank Holiday U-turn, one of many – under which masks were mandated in corridors and communal areas in schools in lockdown areas, and discretion given to headteachers to mandate them elsewhere. What had been ‘guidance’ became mandatory.

What, then, of the House of Lords? Isn’t it meant to be a last line of defence? Perhaps it was always naive to think the Lords were ever going to provide a voice for the young, but as a parent of a four year-old and a seven year-old I was staggered when I read the transcripts of the ‘debates’ in the Upper House. Snippets speak to the issue better than I can.

Lord Thornton: “Wearing masks will be with us for a long time to come… We need to recognise that this is an important part of ensuring safety for all of us and our families.”
The Earl of Clancarty: “Wearing masks protects others… this begs the question of how masks could be deployed further to tackle the increase in cases we are now seeing… this could include groups of schoolchildren walking to and from school..
Lord Rooker: “Would the Minister agree that it might be a good idea to ask universities to require students who return to campus to wear masks when attending any lectures, seminars and especially lab sessions?”
Lord Blencathra: “I do not care if people cram themselves into a ghastly Ryanair flight or pack a pub and get Covid-19 – it serves them right – but I care very deeply indeed that they are infecting other innocent people, such as their more elderly relatives, their friends and their workmates.”

Only Baroness Sanderson had the audacity to ask how we ensure the “wearing of face masks does not end up becoming a social norm by default?” and Baroness Noakes pointed out “the evidence for efficacy is lacking”.

“This is policy-making at its worst”, concluded Baroness Noakes. Hard to disagree.

In truth, though, we are here because alongside this failure of policy-making have been failures of policy implementation, accountability and public discourse.

The failure in policy making is matched in the schools context, at least, by a failure of oversight and accountability. The DfE churns out guidance but doesn’t seem to collect feedback on whether the guidance is adopted – or in this case over-adopted. Nor does it, or Ofsted, appear to be monitoring the effectiveness of its own recommendations. When the DfE U-turned and introduced masks into educational settings, it referenced WHO Guidance. However, that same WHO Guidance, in a passage conveniently omitted from our own national guidance, also places important responsibilities on national authorities:

If authorities decide to recommend mask-wearing for children key information should be collected on a regular basis to accompany and monitor the intervention… and should include indicators that measure the impact on the child’s health, including mental health; reduction in transmission of SARS-CoV-2; motivators and barriers to mask-wearing.

UsforThem has asked – multiple times – Public Health England (PHE) and the DfE to confirm what data they’ve collected on this intervention since July within and without educational settings, and when this information will be published. We have yet to receive a satisfactory response. According to PHE, the issues raised fall under the DfE’s purview. According to DfE, we should look at the published guidance. We look at the published guidance and it’s silent.

The final failure is that of public discourse.

It’s now been six months and the fact we’ve still had no meaningful public debate is dumbfounding.

As Lord Robathan said, “In this public health crisis, we need courageous political leadership. Self-evidently, the scientists do not agree, so we cannot follow the science. We can only follow the evidence of serious harm and death. What evidence is there that face coverings are saving lives? My own view is that many of those who died earlier in this epidemic were likely to have died anyway and that, while it is tragic, they were the most vulnerable… I took advice on dividing the House on this measure but these rather ridiculous non-debates make it difficult.”

In their paper “Science, society, and policy in the face of uncertainty: reflections on the debate around face coverings for the public during COVID-19”, Martin, Hanna, McCartney and SAGE member Professor Dingwall state:

The consequences of a public health intervention of this nature… are… difficult to anticipate. Face coverings… are complex interventions in a complex system: the results of a change of this nature are emergent, unpredictable, and potentially counterintuitive. The debate becomes polarised and binary: if the science says yes to face coverings, then challenging the orthodoxy or even questioning its universality becomes heretical.

I am increasingly despondent. Many who believe there should have been more rigorous analysis of this, the most intrusive non-pharmaceutical public health intervention of our times, speak as if the argument has been lost, or believe there are more important battles to fight. Alas, there are many battles ahead. But for children, this is a critical one, particularly for children with special needs. It is a debate we must have even when those around us tell us we should be ashamed to do so.

1 E Person, C Lemercier et al. Effect of a surgical mask on six minute walking distance. Rev Mal Respir. 2018 Mar; 35(3):264-268 (https://pubmed.ncbi.nlm.nih.gov/29395560/); B Chandrasekaran, S Fernandes. Exercise with facemask; are we handling a devil’s sword – a physiological hypothesis. Med Hypothese. 2020 Jun 22. 144:110002 (https://pubmed.ncbi.nlm.nih.gov/32590322/), L Zhiqing, C Yongyun, et al. J Orthop Translat. 2018 Jun 27; 14:57-62 (https://pubmed.ncbi.nlm.nih.gov/30035033/)