Dr James Jansson has PhD in mathematical modelling of HIV epidemiology from UNSW and is the Science Party candidate for Eden-Monaro.
Today I make public my call for masks to be made a legal requirement as part of the social distancing rules in situations where many people congregate together. This move is to save lives and save the economy. It will greatly increase most freedoms through prevention of spread of COVID-19.
This requirement is based on increasing scientific evidence that masks work in preventing not only droplets and other respiratory diseases, but also COVID-19. It also comes after the recommendation from the US CDC, WHO and even our own Chief Medical Officer recommending masks in situations where many people are in close proximity such as on public transport and in shopping centres.
Argument for masks now
Given that Victoria has just wound back lifting of restrictions due to the recent spike in cases, the case for masks is strong. The determination of the federal and state governments to 'open up' while there are still community transmissions of COVID-19 from unknown sources means that we must try something new that is working elsewhere.
It has become plainly obvious: shutting down then opening up with little behavioural change will not prevent the epidemic, it will simply delay it.
Australia could shut down hard then open up completely if Australia were aiming for elimination like New Zealand, however the Liberal government has explicitly said that they are not aiming for this. The Liberal government has also said that there will not be a second lock down. The choice then is stark: make masks a requirement, or possibly see deaths like in the UK or US.
What will be Australia's requirements
My proposal is for masks to be worn in:
- shops and shopping centres
- public transport and taxis
- large family gatherings
- weddings (excluding the couple and the celebrant)
- and any case in which social distancing cannot be adhered to
Restaurants and bars will be excluded from the mask requirements while the patrons are consuming food and drink, but all guests will be required to register their attendance and contact details. Staff at restaurants and venues will be required to wear a mask.
The type of masks used will NOT be required to be an N95 or surgical mask. Cloth masks, folded t-shirts, scarfs or other material that cover the nose and mouth will be sufficient to avoid a fine, however it would be recommended to use either surgical or N95 masks for comfort and efficacy.
These requirements can be lifted on a state-by-state basis, dependent on the number of community acquired infections being zero for 3 weeks. For example, people in the NT would not be required to wear masks at the moment.
It appears that the resistance to recommending masks have been at least in part influenced by fears that there was insufficient supply even for medical workers. Even Dr Fauci admitted that his previous position on use of masks by the general public was influenced by supply concerns.
As stated above, cloth masks will be sufficient to avoid penalty and should provide at least some protection.
If we have insufficient masks to achieve this policy, this is a clear failure by the federal government to attain or produce sufficient masks to protect the community. I will make it a national priority to increase mask supply for general use in our community.
Science of masks
The science on the efficacy of masks is quite strong at the moment.
There has been substantial evidence for months, if not years, that even basic masks are effective in preventing respiratory illness. A study from China in 2004 showed that people who always wore masks had a 70% reduced risk of infection from SARS.
It has also been shown that masks are 60-80% effective in preventing respiratory illness transmission in a household, as long as people wear the mask routinely and follow other hygiene procedures like hand washing.
While previous results were not about COVID-19 specifically, new results have proven what could be easily inferred. The argument has been put to rest, with a new study on masks and COVID-19 infections, showing mask use at-home reduces transmission from an infected family member to an uninfected family member by 79%.
Although surgical and N95 masks are more effective, cloth masks can also be effective in reducing spread of COVID-19. The filtration rate of even basic t-shirt material for droplets containing viruses is around 50% (table 1), and home-made masks prevent around 78% of droplets from escaping (ref, table 2).
For further information on the efficacy of face masks, you can refer to this document.
Masks are a legal requirement around the world, but not Australia. Masks appear to be working. In jurisdictions where masks have been a requirement and re-opening has occurred, the number of cases continue to drop even with relatively high case loads.
New York made masks required since April 15th, and they have had a steady decline in cases since.
France made masks a requirement in public on May 10, the same time that they exited their lockdown, and they have maintained relatively low transmissions, despite Paris being one of the most densely populated European cities.
Similarly, Germany made face masks compulsory when shopping and on public transport on April 22 and has suppressed infections at low levels since.
Regions continue to implement mask laws. California has seen rising trends, but just this week implemented a mandatory face mask law.
Around the UK, it is now a requirement to wear masks on public transport from the 15th of June and recommended in shopping centres.
In fact the list of countries that have implemented some form of mask requirement is so long, you would struggle to name a country that doesn't have some form of requirement and the list keeps growing.
Australia can and should follow the lead of countries around the world implement a mask law immediately to finally extinguish COVID-19 community spread.