Why have attitudes to face masks changed?

In the past few days, both US President Donald Trump and UK Prime Minister Boris Johnson have been seen wearing masks in public for the first time.

By Helier Cheung BBC News www.bbc.co.uk /news/world-53394525

It’s a dramatic turnaround – Mr Trump previously mocked others for wearing masks, and suggested some might wear such personal protective equipment to show their disapproval of him, even after the US Centers for Disease Control recommended face coverings.

Meanwhile, the UK government was initially reluctant to advise the general public to wear face coverings, even as other countries in Europe did.

It introduced rules requiring people to wear face coverings on public transport in June, and now says people in England must wear face coverings in shops or face a fine.

Globally, many authorities – including the World Health Organization (WHO) – initially suggested that masks were not effective in preventing the spread of the coronavirus. However, they are now recommending face coverings in indoor spaces, and many governments have even made them mandatory.

What’s changed – and why?

The number of governments recommending face coverings has gone up significantly over the past six months.

As of mid-March, about 10 countries had policies recommending face coverings – now more than 130 countries and 20 US states do, says Masks4All, an activist group of researchers that advocates the use of homemade masks during the pandemic.

Some studies also suggest that people’s attitudes have changed.

“Countries with no previous history of wearing face masks and coverings amongst the general public rapidly adopted usage such as in Italy (83.4%), the United States (65.8%) and Spain (63.8%),” says a report by the Royal Society – one of the leading science bodies in the UK.

The changes appear to be partly due to a better understanding of how Covid-19 spreads.

Initially, the WHO said masks should only be worn by medical workers, or people who had symptoms like coughing and sneezing.

However, in recent months, there’s been increased evidence that many people with the virus do not have symptoms – but can still be contagious – and masks can stop them from passing it on to others. The WHO changed its guidance in June.

Meanwhile, there is more awareness that the risk of transmission is higher in poorly ventilated indoor spaces – and evidence to suggest that the virus could be spread by tiny particles suspended in the air.

This means that if everyone wears face coverings it will “protect against the most common mode of transmission – droplets – and to some extent maybe aerosol droplets,” says Kim Lavoie, chair of behavioural medicine at the University of Quebec at Montreal’s psychology department.


Prof Lavoie adds that “there has been increased research” into face coverings, including observational studies which indicate “countries with high mask wearing seem to have lower infection rates”.

Furthermore, a number of scientists now say there is “some evidence” that masks can protect the wearer as well as those around them.

There is also growing acceptance that the pandemic could continue for a long time – and, if so, face coverings could be seen as something necessary to help people adapt, and reduce risks as businesses and schools re-open.

“Covid’s not going anywhere – we’ll probably have a vaccine in years, not months,” says Prof Lavoie, who has been leading the iCARE Study, an international survey into Covid-19 related behaviours. “So all these principles need to be integrated and adapted to the new normal life.”

Why do countries have such different attitudes?

Even as government policies have changed – there’s a big gap in how willing people are to wear masks.

About 83% of people in Italy, and 59% in the US, say they would always wear a face mask outside their home – but only 19% of people in the UK say the same, according to the Covid-19 Behaviour Tracker – a project run by the Institute of Global Health Innovation at Imperial College London with polling company YouGov.

“The US, UK and Canada have been relatively slow to accelerate mask wearing versus, for example, Spain, France and Italy,” says Sarah P Jones, a health behaviour researcher at Imperial College London, and one of the creators of the tracker.

Chart showing the percent of people in different countries who say they would wear face coverings in public

She says mask wearing can vary based on how vulnerable people feel about an illness, whether they believe the costs outweigh the benefits, and how readily available masks are.

In countries with steep rises in mask wearing, people may have experienced “rapid increases in perceptions of severity and vulnerability”, “rapid policy changes mandating use of face masks”, and a sense that “I see lots of other people doing it, so it must not be a big deal to wear a mask”.

Prof Lavoie agreed that places that “got hit quickly and hard”, like Italy, may have adopted mask wearing more readily.

Finally, people in countries that experienced the 2003 Sars pandemic – or other respiratory outbreaks – were readier to start wearing masks.

“In East Asia, there’s plenty of recent memory of respiratory pandemics, and a cultural awareness that masks are a good idea,” says Jeremy Howard, a research scientist at the University of San Francisco, and one of the Masks4All founders.

By contrast, “there’s just no recent history of respiratory pandemics in the West” and many Western and international institutions have “almost entirely ignored East Asian scientists”, he argues.

Many countries were particularly cautious over recommending face masks because of a lack of clinical trials proving their effectiveness, says the Royal Society’s report.

However, “there have been no clinical trials of coughing into your elbow, social distancing and quarantine, yet these measures are seen as effective and have been widely adopted,” it adds.

Why are some still reluctant to wear masks?

A majority of countries now recommend or require face coverings in some situations.

However, most people still appear much more willing to use hand sanitiser, social distance or wash their hands regularly, than wear face masks, according to data from both the Covid-19 Behaviour Tracker, and iCARES.

People feel that hand washing and social distancing are things they can easily control, says Prof Lavoie.

By contrast, “mask wearing is a little more complex – you have to find and purchase a mask, put it on and dispose of it a certain way, and they’re uncomfortable to wear.”

And the changing guidance from the WHO and many governments could have caused difficulties.

Many experts believe that governments were reluctant to recommend face coverings because they feared there would be a shortage of PPE equipment for medical workers – but by suggesting that they were ineffective at preventing transmissions, they now sound inconsistent.

“Mixed messaging, not being transparent about data, or how the government makes certain policy decisions, can undermine trust” and make it harder to convince people to wear face coverings now, Prof Lavoie says.

Mr Howard believes that many governments in the West were slow to act on masks until they were badly affected by the pandemic.

Nonetheless, he thinks that Boris Johnson and Donald Trump can have a positive impact now by wearing masks publicly.

“Role models are absolutely real,” he says, and ever since Mr Trump wore a mask, “a lot of folks who were previously anti-mask are now saying that was a patriotic thing for him to do.”

This is especially important now that the US is experiencing a new wave of infections, he adds.

NHS data reveals ‘huge variation’ in Covid-19 death rates across England

“The five trusts with the highest death rates are in the south-west (80%), north-west (68%), south-west (62%), east of England (60%) and London (54%).”

Analysis such as this may make uncomfortable reading, and it may not be perfect, but Owl has consistently argued for more analysis of emerging data. Readers also need to be reminded that the “south-west” referred to above is the NUTS definition extending eastwards to Gloucestershire and Wiltshire.

Niamh McIntyre www.theguardian.com 

A wide disparity in coronavirus mortality rates has emerged in English hospitals, with data seen by the Guardian showing that one hospital trust in south-west England had a death rate from the disease of 80% while in one London trust it was just 12.5%.

The figures, which NHS England has compiled but never published, show the age-standardised mortality rates that all of the country’s 135 acute hospital trusts have recorded during the pandemic. Doctors regard age as the single biggest predictor or risk factor for dying from Covid-19.

They cover the period from the start of the coronavirus crisis in March, through its peak in late March and April, up until 15 May, by which time 42,850 – or 85% – of the 50,219 deaths so far in all settings had occurred in England and Wales.

It is the first such data to emerge about how many people have lived or died in each trust after being treated there because they had been left critically ill by the disease. They are based on patients who were treated in an intensive care or high-dependency unit or on a ward.

Senior doctors said the dramatic gap in death rates of 67.5 percentage points between the trusts with the highest and lowest rates was notable and may mean that some hospitals needed to learn lessons from others.

“That is a huge variation, a huge range. I’m surprised at the degree of variation. A spread between 12.5% and 80% is quite stark,” said Dr Alison Pittard, the dean of the Faculty of Intensive Care Medicine. It represents the intensive care specialists who have played the lead role in treating what is now more than 100,000 people hospitalised in England with Covid-19.

Dr Nick Scriven, a former president of the Society for Acute Medicine (Sam), said: “The range does look larger than you would expect and should prompt further analysis and thought as to why this may appear as it does, which for the general population will be concerning.”

However, both Pittard and Scriven cautioned that the data did not give a full picture of differential death rates between hospitals because it did not take account of four other key factors for risk of death from Covid-19, namely gender, ethnicity, deprivation and underlying health problems. All four have been found to significantly increase a patient’s chances of dying.

NHS England has plotted each trust’s death rate, and the number of patients with Covid-19 each of them admitted, on a graph which it has shared with some senior doctors. Crucially, though, it has not identified the trusts on it. It has only disclosed which of the NHS’s seven regions the trust is in.

The five trusts with the highest death rates are in the south-west (80%), north-west (68%), south-west (62%), east of England (60%) and London (54%).

The five trusts with the lowest death rates are in: London (12.5%), Midlands (13%), London (14%), London (15%) and the south-east (15%).

Doctors pointed out that some trusts’ apparently high mortality rates could be skewed because they were based on them having treated fewer than 100 patients by 15 May, which makes their rates less reliable. But other trusts with notably high or low mortality had treated up to 2,350 patients over the same period, so their rates are more likely to be reliable.

Research published by the Intensive Care National Audit and Research Centre shows that of 9,995 patients treated in intensive care units with known outcomes, 5,985 (59.9%) have been discharged and 4,010 (40.1%) have died, while 426 others are still receiving critical care.

Mortality among such patients in intensive care has improved from 50% early in the pandemic to 41% now, reflecting in part medical teams’ better understanding and treatment of Covid-19.

There is no suggestion that a high or low death rate indicates that patients have received a worse or better standard of care at any particular hospital. The makeup of the local population that a trust serves is the single biggest factor underlying a high or low death rate, Pittard said.

“We know that poorer communities and BAME communities have a higher risk of mortality, so if a trust is in an area of higher-risk individuals you woud expect that trust’s Covid-related mortality rate to be higher,” added Pittard.

NHS England’s data shows that 26 of the 135 trusts had a death rate between 12.5% and 25%. “That’s reassuring, absolutely. It’s positive that 26 trusts had that low mortality,” said Pittard.

However, at least half of patients treated at 11 trusts died. “Eighty percent does seem an extremely high number,” she added.

Dr Sue Crossland, the president of the Sam, said hospitals’ use of non-invasive ventilation, the early involvement of critical care teams and lying ventilated patients on their front – “proning” – have saved patients’ lives as doctors have better understood how to deal with Covid-19.

An NHS spokesperson said: “We do not recognise these figures, which appear to be experimental analysis of unverified data. But there is now a wide range of published data on the role that health inequalities, including pre-existing conditions and other health factors, have played when it comes to the impact of Covid, including from the ONS and Public Health England.

“The NHS is accelerating work to tackle health inequalities, and will shortly be providing local services with a range of actions they should build in to their plans for the coming months.”

Hot air & warm words from Neil Parish on those excluded from Covid support measures


Honiton MP: We are trying to help those that fall outside of government schemes

The MP for Honiton has said he is trying to help people who fall out of the Government’s support schemes but it is ultimately up to the chancellor.

Sam Cooper www.midweekherald.co.uk 

Speaking to the Herald, Neil Parish was asked about groups such as Excluded UK who represent individuals and businesses excluded from the Government’s Covid-19 financial support measures.

He said: “We have been supplying their problems into government but the policy comes via the chancellor so I will do my best to represent people’s views and where we can help, we do.

“Some people do fall outside of the schemes and that’s what we have been trying to sort out with a meeting with the treasury minister this week.”

Mr Parish was in Honiton visiting the street market and said he was happy to see businesses begin to reopen so that the life can begin to return to some kind of normal.

He said: “We now need to start opening things because while the government has quite rightly supported businesses by furloughing people, we are borrowing huge sums of money to do it and of course at some stage, this money will have to be paid back.

Mr Parish also encouraged tourists returning to the area to act responsibly. He said: “What I said in parliament last week was we want the tourists to come back but we want them to behave.

“By that I mean, just don’t take too many risks. Please don’t get too drunk so that you don’t know what you’re doing and just take it carefully.

“I think then most people will be happy to have tourists back but we don’t want too many people ignoring the rules. It is a very difficult one but I think on balance I welcome them back but I can see people being concerned.”

Mr Parish, who has been the local MP for a decade now also said the pandemic shows how important health is. He said: “I think this has been the hardest period [of my tenure as MP]. We’ve come through Brexit, one way or the other which every side of the argument you were on, and in a way it shows that our health is so important and something like Covid has laid us completely low but what it has also shown is that the community can come together. I think there are some positive sides and fortunately, Devon has not seen a massive amount of Covid but we just hope there won’t be any spikes.”

Coronavirus: Fines for failing to wear a face mask in shops in England

How long does it take for “Bumbling” Boris and his lacklustre Cabinet to take a simple decision?

Face masks compulsory in shops but not for ten days! All clear? – Owl

Oh -and are there prizes for the first to spot Dominic Cummings breaking the rules – probably doesn’t do pleb things like “shopping”?

Jon Craig news.sky.com 

Face coverings must be worn in shops and supermarkets in England from Friday 24 July, Boris Johnson has announced.

Enforcement will be carried out by police – not retail staff – and anyone failing to wear a face covering while shopping will be subject to a fine of up to £100, or £50 if paid within 14 days.

The rules to tackle coronavirus will be the same as those currently applicable on public transport in England, which means children under 11 and people with certain disabilities will be exempt.

The wearing of face coverings became compulsory in Scotland last week and around 120 countries – including Germany, Spain, Italy and Greece – now require coverings to be worn in public places.

Announcing the move, a Number 10 spokesperson said: “There is growing evidence that wearing a face covering in an enclosed space helps protect individuals and those around them from coronavirus.

“The prime minister has been clear that people should be wearing face coverings in shops and we will make this mandatory from July 24.”

The decision, due to be outlined by Health Secretary Matt Hancock in a Commons statement on Tuesday afternoon, follows four days of conflicting statements from ministers and demands from opposition MPs for clarity.

Responding to the announcement confirming mandatory face coverings, shadow health secretary Jon Ashworth said: “The government has been slow and muddled again over face coverings.

“Given the government’s own guidance issued on 11 May advised in favour of face masks, many will ask why yet again have ministers been slow in making a decision in this pandemic, and why it’ll take another 11 days before these new guidelines to come into force.”

London mayor Sadiq Khan went further and called the government’s “confused communications” on the subject a “disgrace”.

“We can’t afford to wait another day and the government should bring this policy in immediately – further delay risks lives,” he urged.

And the British Chambers of Commerce’s co-executive director Claire Walker said: “Businesses need clarity on the approach to the wearing of face coverings that is consistent and supported by public health evidence.

“Shops and other indoor businesses need to know what the new rules are as soon as possible.

“Updated guidance, including on enforcement, should be issued swiftly so firms can maintain their COVID-secure status and continue their operations successfully.”

In his most recent statement on face coverings, 12 hours before the official confirmation by Number 10, Mr Johnson said: “I think that as throughout this crisis people have shown amazing sensitivity towards other people and understanding of the needs to get the virus down by doing things cooperatively.

“I think wearing masks is one of them. In a confined space what you’re doing is you’re protecting other people from the transmission that you might be giving to other people.

“And they in turn they’re are protecting you. It’s a mutual thing. People do see the value of it.”

But just one day earlier, Michael Gove suggested masks in shops should not be mandatory, saying he believed shoppers should be encouraged to wear them, but he believed in “people’s good sense”.

And Home Secretary Priti Patel was pictured meeting her French counterpart indoors without wearing a mask over the weekend – despite being seen wearing one speaking to him outdoors on the same day – sparking claims ministers were sending mixed messages.

Priti Patel greeted French interior minister outside with a face mask on - but took it off when they met inside
Image: Priti Patel switched between wearing and not wearing a mask

Since 11 May, government guidance has advised the public to wear face coverings in enclosed public spaces, where they may come into contact with people they would not usually meet.

The use of face coverings became mandatory on public transport in England from 15 June.

Although Mr Hancock will confirm that the government guidance will be updated to make the wearing of face coverings in shops and supermarkets compulsory, he will say that guidance for other settings will be kept under review.

Regulations will be made under the Public Health (Control of Disease) Act 1984. While shop employees should encourage compliance, the government said retailers and businesses will not be expected to enforce the policy.

Impact of HGVs on Sidford and Sidbury to be assessed by highways chiefs

Devon’s cabinet member for roads had asked officers to look into limitations on the A375 which runs through the two East Devon villages.

The impact of HGVs travelling through Sidford and Sidbury is to be assessed – with a weight restriction on lorries still possible.  

Devon’s cabinet member for roads had asked officers to look into limitations on the A375 which runs through the two East Devon villages.

Both have been blighted by big vehicles using their narrow roads, and it is feared a new business park off Two Bridges Road in Sidford will make the situation worse.

Plans for the scheme had been turned down over highway safety concerns but were approved on appeal.

A government inspector ruled that the benefits of the multi-million-pound scheme outweighed the effects and inconvenience of an increase in HGV traffic in the area.

Councillor Stuart Hughes, Devon County Council (DCC) cabinet member for highways, has previously championed the idea of a 7.5-tonne weight restriction on the route through Sidbury to the traffic lights junction at Sidford Cross.

A meeting of the East Devon Highways and Traffic Orders Committee (HATOC) heard an update on the proposal on Friday.

Cllr Hughes said: “There has been a lot of concern in Sidbury and Sidford about the increase of HGVs using the road to the business park following the planning approval.

“We will keep an eye of things to see how it pans out and we will be monitoring the impact on traffic carefully and consider any interventions that may be needed on the highway, including a weight limit.”

If the idea became a reality, HGVs which fell foul of the restriction would have to take a signed diversion route away from the villages.

This would likely to be via the A30 to the Daisymount roundabout.

However, Ottery Valley representative Cllr Claire Wright said this would have implications on traffic flows in the B3180 in her ward.

Cllr Hughes added: “Whenever you introduce a weight limit, it will just move the HGVs elsewhere.”

The impact of HGVs will be monitored before any interventions aimed at road safety, if required, are put in place.

Vehicles heavier than 7.5 tonnes would still be able to use the A375 for necessary access and to carry out deliveries.

Support for calls to cut 60mph speed limit on ‘danger’ Axminster road

Proposals that could see a ‘dangerous’ 60mph speed limit on the approach to Axminster reduced have been backed by East Devon highways chiefs.

Councillor Ian Hall has called for the move on the A358, to the north of the town, over safety fears.The road’s current 60mph limit runs from just past the entrance to Axminster Town Football Club’s ground in Tiger Way to the single-file Weycroft Bridge.Calls had been made to cut the restriction to 30mph.

The East Devon Highways and Traffic Orders Committee unanimously agreed on Friday that a Speed Compliance Action Review Forum (SCARF) should look into the measure.

Cllr Hall said: “This stretch of road is a 60mph zone and, as you go south into Axminster, it is still 60mph.

“Literally 20 yards away is the turning into Tiger Way where the football club is and there are real concerns about turning right and left.

“We have speeding motorists who jump the traffic lights on the bridge and it is a real issue at night.

“The stretch needs to be reduced in speed.”

Cllr Phil Twiss added: “I support this as the town has expanded north towards the Weycroft Bridge.

“While the 60mph was sensible ten years ago, it isn’t now, and it is very dangerous, so would support some sort of activity to reduce the speed of cars.”

Councillors unanimously agreed that Devon County Council officers should carry out a review through the SCARF process.

Data from this will help determine if the the current speed limit on the road is still appropriate.

Claire Wright’s analyses of the fallacies and influences behind the Greater Exeter Strategic Plan (GESP) 

 Proposals for thousands of houses in East Devon, as part of new plan to 2040

Claire claire-wright.org

[Owl simply gives a taster to encourage readers to go to her blog. At last we are getting some transparency]

Clair: “A plan to build thousands of new houses across East Devon was unveiled last week, with proposals for specific areas in the county.

I have since spent time talking with strategic planning officers to try and understand the detail of the national policy driving this.

Strategic planning is technical and complicated and takes some learning. I was heavily involved in strategic planning while a councillor on East Devon District Council between 2011 and 2015, so I felt compelled to examine this new plan and its proposals.

I will endeavour to explain my findings below!”

This she does under the following headings. Owl’s view is that her “explanations” highlight the absurdity behind most of the policies and government diktats that will lead to a massive increase in house building in East Devon.

Government housing policy

Affordability uplift

Affordable/social housing element within GESP

Developers fund the Conservative Party

The employment land con

Police investigation into planning in East Devon, in 2013

Areas of Outstanding Natural Beauty

Who leads this work?

Green proposals


GESP timetable and supporting papers can be found here