Time for smart masking

‘Masks will be with us for as long as they need to be’, Victoria’s Health Minister Martin Foley said last week.

The good news is that as of now in many settings, especially when outside, masks should no longer be needed. The fact that the Victorian government is sticking by its arbitrary compulsory mask-wearing strategy instead of moving to ‘smart masking’ is a case of ‘once bitten, twice shy’. But like all of us, the government needs to move on.

Risk aversion has resulted in some redundant or excessive restrictions not being more quickly relaxed – not just compulsory mask wearing outside - but other unnecessary stifling limitations such as a maximum of two adults visiting a house, 10 people meeting outdoors, arbitrary office and University closures, and tight caps on numbers in gyms, pools, churches and sporting venues. All of these limitations have been significantly relaxed in NSW – where there are more active cases and more community transmission.

Unnecessary delays to loosening restrictions affect wellbeing, cost livelihoods and stifles business recovery. We can ill-afford further damage to be done to people or the economy.

In July when cases of COVID-19 in Victoria were running at more than 500 a day, I wrote about the benefits of compulsory mask wearing when outside the home. The available evidence suggested mask-wearing cuts down the chances of both transmitting and catching COVID-19, and may even reduce the severity of infection.

As a public health physician I advocated for compulsory masks because they saved lives.

But things have changed.

We have virtually no community transmission and just one mystery case. Other jurisdictions with more cases – like New South Wales – have shown that tight suppression can be maintained without mandatory masks, let alone making people wear masks outdoors. Such decisions should be based on evidence, not politics.

When it comes to outdoor mask wearing the UK Government’s apolitical Scientific Advisory Group for Emergencies (SAGE) advises against compulsory outdoor use as the evidence suggests it would have “very low” impact on transmission of the virus. The massive dilution factor, along with exposure to light, minimises any risk.

SAGE explains that “It is critical that recommendations are seen to be based on the science, and proportionate, otherwise the legitimacy of mask-wearing overall will be compromised”.

In the July scenario of widespread transmission the Victorian Government’s decision to require masks – even outdoors – was perhaps proportionate. As we say in public health – the absence of evidence of effect, isn’t evidence of absence of effect.

But in the context of zero new cases over 12 days it not only defies epidemiology, but also common sense. It results in ‘dumb masking’.

We could all quote numerous examples where compulsory mask wearing doesn’t pass the pub test – like when fishing, private boating, bush walking, or beaching outside of metro Melbourne. My recent experiences of picnicking, eating out and walking confirms what the evidence suggests – it’s time to ditch compulsory outdoor masks as they are unhelpful and even dangerous.

I picnicked in a park this week (along with what seemed like most other Victorians). It was comical. No one quite knew when to have the mask on and off. I watched one friend pull his mask on and off upwards of 15 times in 30 minutes between picking, sipping and munching.

Common sense would indicate this increases risk, not decreases it, potentially contaminating one’s hands and food. By the end of the picnic most people had stopped bothering with the mask.

I also celebrated my Grandma’s 95th birthday with a walk in the Botanical Gardens. I watched her struggle to put her mask on, knock her hearing-aid out and take a juggling catch. She just managed to maintain her balance. Then her glasses fogged up and I grabbed her elbow as she tripped.

It doesn’t take a public health physician to see the danger of masks to the elderly. I work in an emergency department and dread fractured hips as they carry a 30 per cent mortality risk for people in her age group. Unfortunately, hip fractures are common when an elderly person falls. And when you make a few million elderly people wear masks (unnecessarily) the risk isn’t insignificant.

I made my Grandma ditch the mask. With no cases in the community she clearly has a higher risk of dying from wearing the mask outdoors!

A final example. We are building an accessible bathroom and I have watched our builders struggle to communicate with me, and with each others, through their masks. And when machinery, power tools, heavy materials and heights are involved it is more than just inconvenience – it becomes an Occupational Health and Safety issue.

These examples demonstrate the near impossibility or even danger of strictly complying with compulsory masking laws. When compliance with a law is so difficult one needs to question the law’s legitimacy.

It’s time for ‘smart masking’. We need to acknowledge that outdoor masks are of little effect and are potentially dangerous, especially for manual labourers, the elderly and in eating areas.

Smart masking may mean continuing with compulsory mask wearing in high risk environments like public transport, crowded shopping centres, the Boxing Day Test at the MCG, and of course in healthcare.

I know the importance of strict mask compliance in my Emergency Department. Increased mask wearing in infectious disease risk areas, like hospitals, may well have a role beyond COVID-19.

But outdoors, and outside high-risk areas, we need to begin to trust people to make sensible decisions about when and where to wear a mask. By now we all know the higher risk scenarios.

Why is there a delay in scrapping compulsory masks? It seems that a climate of fear is clouding evidence and common sense and delaying the safe loosening of restrictions in Victoria.

Victoria has done the hard work and it’s time to capitalise by loosening disproportionately restrictive measures.

A version of this article has been co-published with the Herald Sun

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