The transatlantic institutional anti-mask campaign, summarised

Early in 2020 as the pandemic began to surge around the world, Asia and the West were divided on whether people should wear facemasks to try and stop/slow transmission of the new virus. In short, Asian countries went very heavy on masks early on, while most Western countries initially said they wouldn’t help and kept saying so in increasingly forceful ways until suddenly reversing course in April/May 2020. I think most people have forgotten how extreme this divergence in views was, so I’ve tried to summarise it all here.

Reading through it all again, it’s striking how strongly in favour of masks Asian governments were, and how early they were to adopt these views. Even if you just look at January 2020, before the international pandemic really got going and when sensible people were still writing articles worrying that this novel coronavirus outbreak might get as bad the eight hundred deaths caused by SARS, you can see a massive Asian effort to get masks out to their populations: Japan brought their mask factories up to 24 hour production, Taiwan and Singapore turned their standing armies over to staff mask factories as Taipei’s hacker community rapidly built software to help efficiently ration and distribute existing supplies. China made mask-wearing compulsory in virus-affected cities, supported with slogans such as “better to wear a mask than a ventilator” and Hong Kong public health experts listed masks among a list of preventative actions people could take if concerned about the new flu-like illness. There are a ton of stories like this, but suffice to say if you lived in Asia in early 2020, you’d have had a lot of encouragement to wear a mask, and this only increased as the global severity of the pandemic became apparent.

In the anglo world by contrast, the official advice was neutral to negative. The UK’s standing pandemic flu plans (from 2011 and revised in 2015) advised against general mask-wearing, meaning that while there was a small stockpile for healthcare workers, the government would not keep any supplies for the population, and public health advice to UK travellers in Wuhan asked them only to “avoid touching any dead or dying birds”.

At the end of January 2020 the UK’s NERVTAG committee met for the third time to discuss coronavirus. Masks were on the agenda but they concluded that there was “no evidence to support that the wearing of face masks by the general public reduces transmission” and encouraged only hand hygiene measures- also noting that masks “may increase fear and anxiety”, which seems to have been a common expert concern in the early Western pandemic.

In the US, concerned parents in California, many with relatives in Asia who were being exposed to markedly different advice, were the subject of a campaign by US public health officials to discourage their children from wearing facemasks in schools. One district told the media that they were “trying to explain to families that they don’t protect from disease" because public health officials had advised them that "masks give a false sense of protection and add to a climate of alarm, without being of help”. (odd to imagine something creating a false sense of security and a sense of alarm).

The English language media began amplifying the anti-mask message to the public:

"How to prevent coronavirus: Wash your hands and ditch the mask" LA Times

“Why a mask won't protect you from the Wuhan coronavirus” - National Post

“How to Avoid Coronavirus on Flights: Forget Masks, Says Top Airline Doctor” Bloomberg

“Top disease official: Risk of coronavirus in USA is 'minuscule'; skip mask and wash hands” USA Today

“To protect yourself against coronavirus DON’T wear face masks” Metro

“Coronavirus London: Expert hits out at people wearing ‘completely useless’ face masks” Express

etc

By mid-February, UK residential care home workers, who within a few weeks would be seeing the bulk of UK covid deaths among their elderly residents, were told in a government briefing document that “face masks do not provide protection from respiratory viruses such as Covid-19 and do not need to be worn by staff”

Volunteer groups asking to help with the UK’s belated attempt to catch up on pandemic preparedness were asked not to help sew masks, but to make morale-boosting decorated scrubs for hospitals who were running out of uniforms amid swelling staff ranks and extended shifts in preparation for the coming wave.

By late February and early March, as Taiwan’s massive production increase allowed the entire population to receive a fresh weekly supply of surgical masks, the UK advertising standards authority went so far as to ban ads suggesting masks could be helpful during the pandemic, with the Medical Director of NHS England saying firms linking masks to coronavirus were “callous”, “outright dangerous” and had “rightly been banned”.

But it didn’t stop there. The Western anti-mask campaign stepped up a notch- the line now wasn’t just that masks might be ineffective, or deplete hospital supplies; public health officials began emphasising that masks might be worse than useless, and actually be actively harmful to the wearer.

This wasn’t just some overzealous health reporters- the US Surgeon General himself appeared on Fox news to tell the nation that “you can increase your risk of getting [coronavirus] by wearing a mask, if you are not a health care provider” endorsing the idea that unskilled members of the public, untrained in putting on and taking off masks, would actively infect themselves.

This was a transatlantic meme too: the UK’s NHS infection prevention representative told UK government officials that members of the public wouldn’t know to change their mask if it became soggy or contaminated, and would be likely to use the same mask for a week or more at a time, as minutes from a later NERVTAG meeting show:

This ‘incompetent members of the public will infect themselves’ idea was reflected in a public information video filmed in 10 Downing Street, in which Boris Johnson appeared alongside Deputy Chief Medical Officer Jenny Harries. Dr Harries told the Prime Minister, and the nation, that wearing a mask was “not a good idea and doesn’t help” due to contamination risk (the video is also worth watching as a relic from the herd immunity policy era- “most of us will get a mild disease”).

Dr Harries’ also gave this message to the media the following day, saying that masks could “actually trap the virus” and cause the person wearing it to breathe it in"

By mid-March, anybody in the west with international exposure was having a very confusing time. If you looked to China, Taiwan, Singapore, Hong Kong, Korea etc you’d see citizens wearing masks and being encouraged to make their own if none were available to buy. In the US and UK, government advisors simple told us to wash our hands and avoid the dangers of untrained mask-wearing. The contrast between Asia and the rest was becoming impossible to ignore, and in the UK it came to a head in a confrontation involving international businesswoman (and former model) Caprice Bourret, appearing on the UK’s Jeremy Vine show questioning Dr Sarah Jarvis, who endorsed the official government line.

It’s uncomfortable viewing now but a perfect illustration of how successful the official anti-mask position had become- adopted by middle of the road talkshow hosts as “the science” despite being an active matter of debate and the Western view wildly diverging from the scientific consensus in Asia.

Most bizarrely, the anti mask-meme had now begun to take on a new life in US healthcare settings. Spurred by concerns about patient anxiety, a number of US hospitals began demanding their own staff not wear masks when dealing with patients. Numerous cases of healthcare staff being disciplined or even fired for trying to wear a mask at work, in the hospital, appeared in the media in late March:

But these disciplined doctors and nurses were the probably some of the final casualties in the great mask conflict of 2020.

The very next day after the Caprice interview, the Western consensus began to crumble. Zeynep Tufekci wrote a piece in the New York Times questioning the existing consensus and pointing out the obvious: of course masks work:

maybe not perfectly and not all to the same degree, but they provide some protection. Their use has always been advised as part of the standard response to being around infected people, especially for people who may be vulnerable. World Health Organization officials wear masks during their news briefings.

Public opinion began turning, and by the start of April, the CDC had an abrupt about-face: healthcare workers were masking again, and the CDC asked Americans now to wear a “face-covering” when indoors with others.

The UK government followed suit- SAGE, the UK’s emergency scientific advice body agreed to review the evidence again on the 9th April, and by the end of the month was cautiously recommending masks using the same “face covering” language.

One of the most bizarre episodes in public health had resolved, and was almost instantly memory-holed. Now it was those not wearing masks who were stigmatised- those who adopted the prevailing view of March 2020 only a few months later found themselves accused of psychopathy or toxic masculinity.

But how on earth and why did this happen? Was this a noble lie? a fumble? self correcting science? We’ll be exploring all of that next week