Will face masks be with us forever?

Will face masks remain a cultural norm in the UK even after the immediate danger of Covid-19 has passed? Scientists are quick to point out that Covid-19 is not going away any time soon: the most likely scenario is that the virus becomes endemic but, through a combination of vaccination and natural evolution in the virus, it will become much less harmful and disruptive, giving symptoms similar to the common cold.

And, at that point, will we still feel compelled to cover our noses and mouths while in public places?

For some, the idea is preposterous. Boris Johnson was quick to dampen down the suggestion when it was made by Prof Jonathan van Tam, the UK’s Deputy Chief Medical Officer, at a Downing Street press conference in October.

But in other parts of the world, it’s not so absurd. In parts of east Asia, face masks became commonplace for years for people with a cough or cold after the 2002 SARS pandemic – even once the immediate threat had receded. In an interview last week, Prof Van Tam said: “I think there are going to be people who make a personal decision to say, you know what, when I’m in a crowded place in the winter I’m going to put a face covering on. When I’m on a tube I am going to put a face covering on.”

A new study, published in Proceedings of the Royal Society A this week, supports the case for face masks. The Cambridge University researchers found that social distancing alone does not protect against infection from Sars-Cov-2, the coronavirus that causes Covid-19; face masks and ventilation are also necessary. They also found the virus is far more likely to spread through maskless chatting than coughing and that it can travel farther than two metres within seconds in a poorly ventilated room.

But it remains controversial.

Changes in behaviour

Whilst many in Britain share the Prime Minister’s desire to get back to normal life as soon as possible, we need only look a few years back to find that pandemics can cause long-term changes in behaviour.

In parts of Asia, it has become a social obligation to cover your nose and mouth if you are ill, even if it is just a cough or mild cold. And the UK’s HIV crisis of the Eighties and Nineties (and ongoing crisis in sub-saharan Africa) prompted a huge uptake in the use of condoms during sex.

“For Ebola, there was clearly a change in the way people greeted each other, which was often with hugs. Only over time is that beginning to come back,” Prof Dame Til Wykes at the Institute of Psychiatry, Psychology and Neuroscience, King’s College London, told The Telegraph in October. “In a post-vaccine world, most people will try to revert to their usual behaviours. But some behaviours are quite difficult to roll back easily.”

It’s important to point out, however, that in the summer government scientists said Britain was “lagging behind” Europe in its uptake of face masks (although coverings have since become more popular; 87 per cent of UK adults now say they are “very” or “quite” willing to wear a face covering, according to a study by LSE in November). With a vocal minority of refuseniks still out there, the idea that masks will remain a cultural norm – even outside of a pandemic emergency – might seem unlikely.

Is there a medical benefit?

Most of our data on the efficacy of face masks in protecting us against infection comes from studies on influenza, rather than coronaviruses (until last year, influenza viruses were generally much more harmful in the UK than coronaviruses).

Those studies show that face masks do reduce infections from influenza, protecting both the wearer and people in their vicinity, but only by about “10 to 20 per cent,” says Paul Hunter, professor of Medicine at the University of East Anglia.

The numbers suggest that, if we carried on wearing face masks after the pandemic at the same rate we do now, we would reduce some illness – but not a huge amount. “Face coverings aren't going to protect you totally, but it will have some value," says Prof Hunter.

Studies carried out in the early months of the pandemic suggest it is a similar picture for Covid-19, he adds.

This year’s flu season was much milder than normal: Holger Rabenau, of the Frankfurt University Hospital, says the European flu season “ended earlier” in 2020, with just 4,000 flu patients requiring intensive care treatment as of May (when the flu season in the northern hemisphere typically ends); around half the number of the previous two seasons, according to data from 11 European countries. Some mask advocates have linked these lower rates of illness and death to the widespread use of face masks across the continent – but Prof Hunter says that social distancing was “almost certainly” responsible instead.

“Seasonal influenza has a lower R [reproduction] value than Covid, so anything that reduces the R value by a certain proportion is going to work a lot better on flu than it is on Covid,” he said. “That's why we didn't see much flu around this year, and why the Australians and the South Americans didn't see much flu around in our summer.”

What do scientists think?

Experts are divided on the question of whether face masks are a good idea outside of a pandemic. In addition to Prof Van Tam, those in the “Yes” campaign include Dr Tom Friedman, the former director of the Centers for Disease Control during the Obama administration, who told CNBC in October: “I think we do need a new culture of masks, at least any time not feeling well, and I think masks are in and handshakes out for the indefinite future.”

But Prof Hunter thinks face masks are largely unnecessary outside of a pandemic emergency: “If it became a cultural norm, and people felt more comfortable wearing face coverings, then I'm happy for them and that's their choice. Personally, I couldn't see myself wanting to do that because I don't think it's that necessary.”

He thinks there is “more to be said” for wearing masks when you are ill with a cough or cold, “but it really depends on what's circulating. If we've got a particularly bad influenza season, then maybe it might have some value. Apart from this, we've done pretty well without having to wear masks for most of the last century, with the exception of the Spanish flu.”

Some also point out that universal face mask use would probably mean more litter and more single-use plastic.