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The flawed reasoning behind the mask “requirement” in healthcare settings

The spurious attempts of NHS chief executives to defend their positions

Artillery Row

On 8 June 2022, Smile Free (a campaign group opposed to mask mandates) wrote an open letter. Signed by over 2000 medical and healthcare professionals, it urged the NHS chief executives of England, Scotland, Wales and Northern Ireland to immediately lift the “requirement” for all staff, patients and visitors to wear face coverings in NHS venues. 

The damaging monofocus on COVID-19 is set to continue

To date, responses have been received from Wales and Scotland. Regrettably, it appears that the damaging monofocus on COVID-19, with its fetish for masks, is set to continue within our healthcare settings.

Although the NHS Scotland reply contains some welcome elements — for example, endorsing the principle that no patients should be refused treatment (nor visitors refused access to loved ones) should they choose not to wear a face covering — both formal responses from the NHS executives contain three fundamental flaws in their attempts to justify the persistence of widespread masking in their clinical areas.

First, contrary to the evidence, there is an underlying assumption that masks are effective in reducing viral transmission. They defend this position by mostly citing reviews conducted by state-funded public health bodies, with insufficient weight given to 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 benefits.

Second, it is likely that NHS directives regarding how staff can 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 (for example, the elderly, the previously traumatised and those with existing mental health problems), thereby discouraging them from both seeking medical help and visiting hospitalised loved ones. 

NHS chief executives convey a blinkered perspective on risk

Third, and most importantly, both responses from the NHS chief executives convey a blinkered perspective on risk. They focus almost exclusively on the threat associated with the SARS-CoV-2 virus, whilst disregarding the substantial non-COVID harms resulting from the expectation that everyone should wear masks in hospitals, GP practices and health centres. Some of these negative consequences of masking are especially problematic in healthcare settings, including: impaired communication between staff and service users; the aggravation of respiratory problems; the re-traumatising of those with histories of physical and sexual abuse; and the increased risk of falls for the elderly due to the restriction of lower peripheral vision. Apart from fleeting references to “glasses steaming up” and staff sometimes feeling “hot and uncomfortable”, the NHS executives fail to acknowledge the wide-ranging physical, social and psychological harms of masking.

By failing to consider many of the potential harms of face coverings, it is highly questionable whether the NHS is acting in the best interests of their service users. Furthermore, this neglect of the risks associated with masks may leave the NHS vulnerable to future complaints and litigation. How could the NHS defend itself against claims that their blanket masking policies were responsible for catastrophic outcomes? A hard-of-hearing man, for example, who accidentally overdosed on prescribed medication, after a mask rendered his doctor’s instructions inaudible? An elderly lady who died shortly after fracturing her femur in a fall after being pressured to wear a mask in an urgent care department? 

On behalf of Smile Free, I will be replying to the chief executives of NHS Scotland and NHS Wales and — based on the rationale described above — urging them to reconsider their current recommendation that face coverings should be worn in their healthcare settings. As for NHS England and NHS Northern Ireland, their radio silence is disappointing. We hope to hear from them soon.

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