Masking for the modern plague

I have just finished reading The Plague, by Albert Camus, first published in 1947. The last few sentences in this novel are quite fascinating and haunting. I will quote directly from the text.

[Rieux] knew that... …the plague bacillus never dies or vanishes entirely, that it can remain dormant for dozens of years in furniture or clothing, that it waits patiently in bedrooms, cellars, trunks, handkerchiefs and old papers, and that perhaps the day will come when, for the instruction or misfortune of mankind, the plague will rouse its rats and send them to die in some well-contented city.

The very thought of catching Bubonic Plague from the bacilli of Yersinia Pestis lurking in an old handkerchief fills me with horror and dread. However, it made me think about the current trend in mandating the use of facemasks by the asymptomatic public during this time of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV-2).

I worked as a consultant Thoracic Physician in Brisbane from 1988 to 2018 during which time, I gained enormous experience in treating sick patients with acute viral respiratory infections. I have spent many hours reluctantly but obediently wearing facemasks and other personal protective equipment during direct close contact with febrile, acutely unwell patients suffering from all manner of viral respiratory infections. However, I do not intend to discuss the use of facemasks by health professionals in acute care settings such as hospitals and Emergency Rooms.

The first important question which I wish to consider is: Does the regular use of a facemask during the SARS-COV-2 epidemic provide any significant benefits for the public?

Henning Bundgaard and colleagues recently investigated this question in a simple, well-designed, randomized, controlled study in Denmark from 3 April 2020 to 2 June 2020. 3,030 adults over the age of 18 years who dwelt in the in the Danish community were randomly assigned to the "recommendation to wear masks" group and 2,994 similar people were assigned to the "control group" where there was no recommendation to wear facemasks. At the end of this study, SARS-CoV-2 infections were recorded in 42 people in the "mask" group (1.8%) and in 53 people in the "control" group (2.1%). There was no significant difference in the rate of SARS-CoV-2 infection between the two groups (P = 0.33).

In other words, if people are already taking sensible precautions against infection during a viral respiratory epidemic, the addition of a facemask does not provide any additional benefit for the public. This simple, "real world" community study did not rely on modelling or artificial laboratory experiments to answer a particularly important question regarding the efficacy of using facemasks during the SARS-CoV-2 epidemic. The answer to the question is clearly "No".

The next question which I wish to discuss is: Do members of the public wear masks correctly?

On walking into my local supermarket, I have witnessed numerous instances of incorrect mask usage by members of the public, the commonest being the tendency to leave the nostrils free from the constraints of the suffocating facemask. Considering that they are not trained health professionals, it is not surprising that members of the public do not use facemasks correctly.

The final question is: Is the Government providing the public with clear, sensible guidelines on the use of facemasks, including the scientific evidence for the efficacy of using facemasks during a respiratory viral epidemic?

I believe that the answer to this question is "No". Our current world has become a "Theatre of the Absurd" where cyclists were wearing masks as they performed their daily exercise out in the open air and far away from any other living souls. People were wearing masks to walk their dogs around their local neighbourhood streets. Drivers were wearing masks, alone in their cars, with some risk of fogging up their glasses and crashing their cars. It is almost as if our Government advisers have been acting roles in a bizarre pantomime where they simply read their lines without really understanding the plot.

During these uncertain times, I believe that our Government has not provided the public with a well-balanced summary of recent research into SARS-CoV-2, including proper analysis of symptomatic cases, hospital admission rates and lengths of stay, ICU usage, and overall death rates compared to previous years. We have not witnessed any vigorous debate regarding the benefits and unintended side-effects of restrictions imposed on the public by Government. I believe that important decisions on Public Health which involve any restrictions of personal freedom should not be made by one person (e g the Chief Health Officer).

It would be more democratic for Government to involve a committee including, but not limited to, doctors with experience in treating patients with acute viral respiratory infections, doctors trained in Public Health, an economist with expertise in Health Management, a statistician or epidemiologist with expertise in Causes of Death and National Death rates, a Social Worker with expertise in Psychology and a consultant with experience in private enterprise to represent the Business Sector.

Let me conclude with a quote from verse one of Psalm 15 (16): "Keep me safe, O God; you are my hope."