A couple of weeks ago I visited London for work and had to take the Underground. As I walked into the station I pulled my face mask from the pocket of my trousers and put it on. It is after all, the law to wear face coverings in train stations across the United Kingdom, unless you are medically exempt.
Unbeknown to me, my visit to London coincided with a large “anti-lockdown” march that was due to take place in the centre of the city. I watched as people who planned to go to the march boarded the train, unmasked, talking loudly and giving those of us who were wearing masks glaring looks. I will be honest, it was intimidating. One man was walking up and down the train, shouting loudly about how the pandemic was a big conspiracy and how all of us who were adhering to the rules around mask wearing were either sheep or complicit. He then went on to vandalise the train by placing “anti-mask” stickers on all the windows. I was glad when my stop arrived.
This polarised view on masks is not unique to the UK; other countries have seen populations divided as masks symbolise the “health versus economy” debate. This has been most apparent in the United States where, according to surveys, while most Americans chose to wear a face covering during the worst of the pandemic, Democrat voters were more likely to wear them compared to Republican supporters. This has been reflective of the stance taken by party leaders. Democrats have been more vocal about the importance of mask wearing while Republican leaders have been more hesitant in the mandating of masks, including Donald Trump himself while he was still president.
In truth, during the early stages of the pandemic the message in many countries about the need to wear masks was confusing. Health bodies around the Western world, including the Centers for Disease Control (CDC), initially indicated that masks were unnecessary for the general public and not effective in preventing the spread of the disease: “The virus is not spreading in the general community,” Dr Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases at the CDC, said in a January 30, 2020 briefing. “We don’t routinely recommend the use of face masks by the public to prevent respiratory illness. And we certainly are not recommending that at this time for this new virus.”
But, as time went by and we learned more about the novel coronavirus – and saw that those countries which recommended face coverings were seeing lower numbers of people becoming infected and dying from the disease – it became clear that face coverings, alongside other social distancing measures, were stemming the spread of the virus. Now, public health experts unanimously agree that masks help slow the spread of COVID-19. The World Health Organization (WHO) has released recommendations that members of the public wear masks whenever social distancing is not possible.
Since then, the messaging has been clear: wearing a face mask helps to reduce the risk of the wearer passing the virus on to others. And perhaps this is why the issue is so emotive for some: we are doing something that takes us out of our comfort zone for the good of those around us, our community. For many of us, this idea of doing something for the collective good seems fair and reasonable, after all, they are doing the same for us. For some, it is claimed that masks erode their daily freedoms and, for a small but vocal minority, masks have become a symbol of what they think is a wider conspiracy where world leaders plan to take some kind of control of the human population.
In the UK, trouble is now brewing as all legal COVID restrictions are set to be lifted on July 19, including the mandatory wearing of masks in indoor settings and public transport – with scientists and government officials finding themselves on opposite sides of the masks debate.
The date for the lifting of restrictions had already been delayed by a month to allow the National Health Service more time to fully vaccinate a larger proportion of the adult population against the disease against a background of rising positive cases. The UK is at the forefront of the spread of the COVID Delta variant, the variant first identified in India which is known to be more transmissible. We are now starting to see a near-exponential rise of Delta variant cases across much of mainland Europe as well. The timing makes things tricky.
While people in the UK will no longer be required to wear a face covering in shops and other indoor venues, the prime minister has urged the British public to exercise “common sense”. The chief medical officer, Professor Chris Whitty spoke at the same briefing, saying he would continue to wear a mask in three situations: “The first is in any situation which was indoors and crowded; if asked to do so by any competent authority; and thirdly as a common courtesy if others felt uncomfortable.” It was a more balanced approach than that of the prime minister, who has suggested the British public should now learn to “live with COVID” while admitting that inevitably “more people were going to die”.
The UK is not the only country to be relaxing restrictions. In the US, the CDC updated its guidance on mask wearing in May 2021, stating those who are fully vaccinated no longer need to wear masks in indoor settings. This, too, came well before the US had achieved the widely accepted herd immunity figure for vaccinated adults of 85 percent and was more likely a political decision rather than one based on science.
Many are sceptical of the wisdom of relaxing restrictions. Though not addressing the UK directly, Mike Ryan, the United Nations’ global health body’s head of emergencies has warned countries not to lift restrictions too early for fear of “losing gains that they have made” (through vaccinations). He also described the idea of letting people get infected with COVID to build up herd immunity as “epidemiological stupidity”.
My opinion is that the combination of lifting all indoor restrictions and no longer mandating the use of masks before vaccinations have hit the levels required to protect much of the adult population is a dangerous game. It will inevitably lead to a surge in COVID cases among the unvaccinated. Yes, they may be younger and less likely to develop severe symptoms from the virus, but they are not completely immune to its effects.
I understand the need for easing some restrictions to allow parts of the economy to recover, and I am all too aware of the harms that lockdowns inflict on a population, particularly the young, for whom lockdowns have come at the expense of their education, social lives and mental health. But retaining the legal requirement to wear face coverings in indoor spaces, while opening up the rest of the economy is a sensible and evidence-based idea. The alternative is to allow the virus to rip through a generation of our young adults and children, most of whom will only have mild symptoms but a significant number will still need hospital treatment and many will be confined to months and years of long COVID, a debilitating disease I have started to see in many of my patients already.
The inevitable increase in cases we are likely to see as restrictions ease will also mean the virus will find fertile ground in those who are unvaccinated, increasing the likelihood of a new variant emerging that may be much less susceptible to the effects of the vaccine.
I think it is important to state here that I, like many healthcare professionals and scientists don’t particularly enjoy wearing a mask. I would much rather we did not have to, but the truth of the matter is we are still living in a pandemic and there is good evidence that masks are an effective way of reducing the spread of the virus.
Vaccinations have certainly weakened the link between infection and hospitalisation, but they have not broken it. They are safe and effective but not 100 percent effective and, with large swaths of the adult population across the globe yet to be vaccinated, it seems folly to me to open up travel, bars and nightclubs while simultaneously removing the mandate to wear masks.
Worse, I worry about the abuse hurled at those people who choose to continue to wear masks by those who are vehemently opposed to them. We need our leaders to step up – now is not the time to give in to popularity politics. It is time to make tough decisions about what is best for the people as well as the economy. Wearing masks while easing restrictions is a fair compromise, but it may be unpalatable for many world leaders who want a return to times past in a new world.
Progress report: I am fully vaccinated – how safe am I?
The creation of the COVID vaccines is an incredible medical feat. They have been produced and rolled out in record time, while undergoing the same stringent safety measures that all other medications and vaccines have been subjected to before them. In a time of darkness, they continue to offer hope. However, it is important to remember that no vaccine is 100 percent effective, even for the healthiest among us. Although the COVID vaccines have significantly reduced the risk of a recipient becoming seriously ill from COVID-19, none of the vaccines are 100 percent effective in preventing the disease.
According to the CDC, a small percentage of people who are fully vaccinated will still get COVID-19 if they are exposed to the virus that causes it. These are called “vaccine breakthrough cases“. This means that while people who have been vaccinated are much less likely to become sick, it will still happen in some cases. It is also possible that some fully vaccinated people might develop infections, but not have symptoms (known as asymptomatic infections). However, fully vaccinated people are much less likely to be hospitalised or die than people with similar risk factors who are not vaccinated. The vaccines’ effectiveness may also vary from person to person depending on risk factors such as age, whether or not they are immuno-compromised or have any underlying health conditions.
According to the UK Office for National Statistics (ONS), from a sample of 210,918 adults who had received both doses of a vaccine, only 0.1 per cent were subsequently found to develop a new infection. This is very low, and shows that you have a much lower risk of catching the virus if you have been fully vaccinated when compared with the unvaccinated population. More importantly, the vaccines have been shown in the real world to reduce the risk of death from COVID-19. In the US, an Associated Press analysis of available government data from May 2021 shows that “breakthrough” infections in fully vaccinated people accounted for fewer than 1,200 of more than 107,000 COVID-19 hospitalisations. That is about 1.1 percent. And only about 150 of the more than 18,000 COVID-19 deaths in May 2021 were in fully vaccinated people. That translates to about 0.8 percent, or five deaths per day on average.
The vaccines are not perfect but real-world data has shown how effective they are at preventing serious disease, and that is what is going to see us out of this pandemic.
Personal account: My holiday dilemma
It has been a tough 18 months. Between working in the NHS during a pandemic, setting up a vaccination hub and going through repeated lockdowns and waves of infections as a healthcare practitioner, I feel very much in need of a holiday. Like many people across the world, we forfeited our holiday last year due to the uncertainty of the pandemic and restrictions on foreign travel.
This summer is different; the adults in my family have all been fully vaccinated and it was recently announced that those who had had both doses of the COVID-19 vaccines would be able to travel abroad to countries on the UK’s green and amber list without the need to quarantine from July 19. The question for us then became, is it right to travel abroad during a pandemic just because we are able to?
Being fully vaccinated means we are unlikely to become sick if we do catch COVID-19 abroad, and there is evidence to show we are less likely to transmit the virus as well (although it is not impossible), but that does not make travelling abroad the morally correct thing to do.
Currently, the UK is still in the grips of high infection rates, due in large parts to the Delta variant. Our European neighbours are also starting to see numbers of Delta variant cases rise, albeit at much lower numbers than ours. COVID tests are not 100 percent foolproof and, if I had only just contracted the Delta variant and viral numbers inside my body were low, a PCR test may not even pick it up and I could unwittingly transport the virus to a country that is not as far ahead as the UK in its vaccination programme.
It is also impossible to know where the next variant is going to spring up, and we have seen how the Delta variant, which was first detected in India, and the Alpha variant, first identified in the UK, has been exported around the world. So, while it would be largely safe for me to travel abroad, I may be doing others a disservice. And that is what this pandemic has tested us on time and time again: our compassion for others over ourselves.
We have all had to make sacrifices over the last 18 months to protect the most vulnerable in our society. Some may feel they have done enough and their need for a holiday is such that the risks to themselves and others no longer outweigh the benefits. Personally, I do not feel right taking a foreign holiday right now, it is not a necessity – so after much discussion, my family and I booked a UK “staycation” instead – and in true Great British form, it rained the entire time (we still had a great time, though).
And now, some good news: Vaccines are highly effective against the Delta variant
A study conducted in May 2021 by Public Health England (PHE) of 1,054 vaccinated people, found both the Pfizer and AstraZeneca vaccines to be highly effective against the Delta or Indian variant two weeks after the second dose of each. The Pfizer-BioNTech vaccine was 88 percent effective against symptomatic disease from the Delta variant two weeks after the second dose, and two doses of the AstraZeneca vaccine were 60 percent effective against symptomatic disease from the Delta variant compared to 66 percent effectiveness against the Alpha variant. PHE has stated it may take the AZ vaccine longer than two weeks to reach full protection, which might explain its lower but still good efficacy against the Delta variant. Either way you look at it, vaccines are still our best defence against the Delta variant.
Reader’s question: Is it normal to be anxious about the easing of COVID-19 restrictions?
I get asked this question a lot. Most of us have spent the last 18 months watching the horrors of the pandemic unfold and some of us will have been personally affected by the tragedy that it brought with it. We have been told consistently that social distancing and mask wearing are important tools for keeping infection rates down but, now, some countries are relaxing these rules and while some people will be elated by this news, many will feel anxious. This is completely normal. We are in unchartered territory and you should go at your own pace. If you feel uncomfortable in a setting because people are not wearing masks or practising social distancing it is perfectly fine for you to remove yourself from that setting. If you want to continue to wear a mask despite others not doing so, you should feel well within your rights to wear one. Even if you have been fully vaccinated, it is a perfectly normal human response to feel anxious as we adjust to a new world. If you feel your anxiety is becoming overwhelming or giving you physical symptoms such as shortness of breath or palpitations, however, you should speak to a doctor who can support you through it. Also, share how you are feeling with family and friends; you will probably find many are feeling the same way.