The Victorian Premier turned up for his weekend delivery of coronavirus infections, gruffly delivering the news. It has become grim if compelling viewing: the announcement about the next spike in coronavirus infections, the next gruesome statistical spread on transmission. On Sunday, Daniel Andrews had a pose that has become legend, a cross between plasticine figure and instructive despair. Stern, humourless, with little to be humour filled about, his role of late is telling people what to do. With stern command he had a message: All those in the state of Victoria, had to wear face masks. “Most of us wouldn’t leave home without our keys, we wouldn’t leave your home without our mobile phone – you won’t be able to leave home without your mask.”
The evidentiary account did not quite square with the urgency of the message. The largest transmissions were taking place in workplaces, not outdoor places of recreation. But it did not matter. This was the sledgehammer of public health, being taken to the public for a quarantine system that failed with abysmal effect. Anyone leaving their home in the Metropolitan Melbourne and Mitchell Shire from Thursday without a mask risk fines of $200. Not complying with such measures will also encourage the government to take further intrusive measures: limitations on shopping; confinement of exercising to a person’s local postcode.
The measure is indiscriminate, but all absolutism comes with its carved exceptions. According to the Victorian health minister Jenny Mikakos, surgical masks, reusable cloth masks purchased or made, can be used. “Or if you don’t have one, you can use a scarf or bandana to cover your nose and mouth. Wash your hands before putting it on and after taking it off.” Those with disabilities who struggle with putting on such face wear and those with breathing difficulties will also be spared the fining wrath of the state.
The catch all measure casts aside criticism and critics about masking protocol. Putting on such wear comes with its canonical tips and tried methods. Avoiding them, and you risk doing greater harm to yourself than otherwise. Brett Mitchell, professor of nursing at the University of Newcastle, is distinctly apocalyptic in describing the consequences for the sloppy mask wearer, and others. “The front of the mask will ‘catch’ pathogens. Every time you adjust or touch your masks, your hands could become contaminated. Everything you then touch could become contaminated.”
The focus on the face mask remains problematic. It arises from a discipline that was never quite sure about its effective use in coping with pandemic transmissions. Positions have been upended, adjusted, revised. On June 9, the Australian deputy chief medical officer Nick Coatsworth explained that vulnerable people who had to use public transport might well use masks, but did not “think that general, healthy members of the community need to be considering wearing masks in that context.” On June 22, Coatsworth reiterated the point in a press conference, despite “an increase in the absolute number of cases in Victoria”. In instances of “very low levels of community transmission the value of face masks in the community is limited, and that recommendation has not changed.”
Victoria’s Chief Health Officer Professor Brett Sutton has now come around to the idea of total masking, suggesting that recent evidence showed that wearing a mask “makes a practical difference”. Those “who wear masks and the settings in which masks are worn has shown that there’s a really significant – two thirds or more – reduction in transmission.”
Sutton would be placing much stock in such studies as those made in the journal Infectious Disease Modelling. The authors, using model simulations based on data from the US states of New York and Washington, found that “broad adoption of even relatively ineffective face masks may meaningfully reduce community transmission of COVID-19 and decrease peak hospitalizations and deaths.” Masks were also “found to be useful with respect to both preventing illness in healthy persons and preventing asymptomatic transmission.”
The shifting sands in the advice on face masks can also be found in the assessments of such epidemiologists as UC San Francisco’s George Rutherford and infectious disease specialist Peter Chin-Hong. For Chin-Hong, the US Centers for Disease Control and Prevention reversed its initial advice in insisting people mask up because of accumulating evidence. Initially, the CDC was “preaching that the juice isn’t really worth the squeeze to have the whole population wear masks in the beginning – but that was really a reflection of not having enough testing anyway.” This led to a “false sense of security.” Rutherford takes a harder line. “We should have told people to wear cloth masks right off the bat.”
In June, the World Health Organization also reversed its position on face coverings, premised on the basis that encouraging such wear would deprive health workers of essential safety equipment while encouraging a false sense of security. As the body’s director-general Dr Tedros Adhanom Ghebreyesus observed, “in light of evolving evidence, the WHO advises that governments should encourage the general public to wear masks where there is widespread transmission and physical distancing is difficult, such as on public transport, in shops or in other confined or crowded environments.”
The trend towards recommending and even mandating masks despite an initial opposition to that policy was already taking place in April. France’s Académie Nationale de Médecine (Academy of Medicine) took the position that donning such facial wear should be compulsory for outings during and after the lockdown. Physician turned television personality Marina Carrère d’Encausse did her little bit to sabotage trust in public health expertise by suggesting that the official line against masks was a “lie” initially told “for a good cause”: ensuring that health care workers had adequate supply.
In all of this, it is hard to avoid the feeling that millions of people have become part of an enormous, live experiment in public health, a trial-by-error approach that has already proven to be very costly. Science is marked by the operation of the falsifiable hypothesis; but each falsification, notably in the field of epidemiology and disease, can come staggering loss. The “we are all in this together” message is starting to look a bit tatty.