Dr Kailash Chand OBE is an award-winning GP and former deputy chair of the British Medical Association. Here, he writes in a personal capacity about recommended type of protection for the public when lock-down is eased – and the government’s duty to provide it:
In next few weeks, it looks certain that the the government will relax the lockdown. Irrespective of the debate for or against wearing face masks, I suspect that mask wearing will become the norm in enclosed public spaces.
But what kind of mask? We need to look at what sort of mask would meet the necessary requirements .
In an article in Journal of the American Medical Association, experts led by Dr Eli Perencevich of the university’s department of internal medicine and the Iowa City VA Health Care System advocate the clear plastic face shield or visor already in use by health care personnel. We know the Covid-19 is here to stay for a while, the Face shields might replace masks as a more comfortable and more effective protection against COVID-19.
Laboratory testing suggests that cloth masks provide only partial filtration of virus-sized aerosol particles. According to Perencevich’s group, “face shields may provide a better option.”
“in a simulation study, face shields were shown to reduce immediate viral exposure by 96% when worn by a simulated health care worker within 18 inches of a cough.”
In addition, visors have practical advantages over masks. Firstly, they are endlessly reusable, simply requiring cleaning with soap and water or common disinfectants. Such shields are also usually more comfortable to wear than masks and they form a barrier that keeps people from easily touching their own faces. When speaking, people sometimes pull down a mask to make things easier—but that isn’t necessary with a face shield.
And “the use of a face shield is also a reminder to maintain social distancing, but allows visibility of facial expressions and lip movements for speech perception,”
According to the Iowa team:
in a simulation study, face shields were shown to reduce immediate viral exposure by 96% when worn by a simulated health care worker within 18 inches of a cough.
When the study was repeated at the currently recommended physical distancing distance of 6 feet, face shields reduced inhaled virus by 92%
To be most effective in stopping viral spread, a face shield should extend to below the chin. It should also cover the ears and “there should be no exposed gap between the forehead and the shield’s headpiece,”.
Masks are simple, cheap, and potentially effective. Very respectable researchers like Trisha Greenhalgh believe that, worn both in the home (particularly by the person showing symptoms) and also outside the home in situations where meeting others is likely (for example, shopping, public transport), they could have a substantial impact on transmission with a relatively small impact on social and economic life.
“Matt Hancock and Boris Johnson can no longer hide behind the ever-changing and conveniently-timed ‘science’ they have used so to delay taking measures.”
We definitely need masks – until we reach ‘acceptable’ levels of infection, until a vaccine is produced and until we have sufficient mass testing.
Visors should only be one part of any infection control effort, along with social distancing and hand-washing. A cloth face cover is not a substitute for social distancing.
Matt Hancock and his team must apply the precautionary principle now and encourage people to wear face shields on the grounds that we have little to lose and potentially something to gain from this measure. He and Boris Johnson can no longer hide behind the ever-changing and conveniently-timed ‘science’ they have used so to delay taking measures.
I urge the government to get ready now to quickly produce affordable face shields – and to prepare to distribute them. There can be no repeat of the constant excuses that capabilities are being eternally ‘ramped up‘ and that the government is ‘straining every sinew‘ while sacrificing lives to its failure to actually achieve.
Suitable face shields will save lives. No more excuses.
Dr Kailash Chand OBE
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