Over the past six weeks I have tried to give you the best advice about how to stay safe and well during this pandemic – and also what to do should illness strike. I’ve also attempted to clarify the often confusing – and, yes, sometimes seemingly inconsistent – recommendations and rules coming from public health officials and the Government.
Everyone is trying their best, but they’ve probably made mistakes. This virus was unknown until December, and although understanding is growing rapidly, there are still question marks and grey areas. That’s why, based on evolving evidence, some guidelines have had to change.
Until now, the consensus has been that mask-wearing wasn’t necessary to protect people from getting Covid-19. I’ve said so myself, many times. Good hand hygiene, covering coughs and sneezes, social distancing and, if showing symptoms, self-isolation are what’s needed. And this remains true.
Dr Ellie Cannon, pictured, has changed her mind about the need to use masks in public and now urges people to make their own from old T-shirts
But over the past week there have been growing calls in the scientific community for face masks or coverings to be made part of this mix.
And it is believed that our Government – like those in Germany, Italy and Spain, and many American states – is poised to make what might seem like a dramatic U-turn: that we should ALL wear a face covering in public.
Having listened to the scientific argument, I agree. In fact, I have already started wearing a mask when out and about myself.
Q&A: Are we at the peak and why is the UK death toll so high?
Q: Have we reached the peak of the outbreak yet? And will things get better now?
A: It’s likely we’re approaching the peak of this outbreak – but it’s a complex issue. When officials talk about the peak of the pandemic, they’re referring to the point at which the number of daily confirmed Covid-19 infections and infection-related deaths reaches an all-time high. The Chief Medical Officer, Professor Chris Whitty, said the UK was ‘probably approaching’ this point after the daily death toll reached 980 on April 11. Numbers of infections and deaths have since decreased, but complications with reporting the figures mean we cannot be certain this is the true ‘peak’.
‘We will still see many hundreds of hospital deaths announced each day for some weeks ahead,’ says Professor James Naismith, Director of the Rosalind Franklin Institute at the University of Oxford. The daily figures also don’t count those who die at home or in care homes, so it’s virtually impossible to know if the infection rate has plateaued, according to Dr Andrew Preston, reader of microbial pathogenesis at the University of Bath. ‘Only a small proportion of people are getting tested – those in hospitals and frontline care workers,’ he says. ‘And many people are asymptomatic.’
Data from Spain and Italy, which saw their peaks earlier, shows that although numbers rose incredibly fast, they decline far more slowly. We have flattened the curve, thanks to social distancing. But it’s not possible to tell exactly what shape the curve will take on the other side of the peak. And if lockdown measures are relaxed too soon, it is clear the numbers could rapidly shoot up again.
Q: Why is the UK death rate so high, compared to other European countries?
A: Reports last week suggested that the UK is expected to have the highest death toll in all of Europe. The current UK toll is passing 15,000 – far higher than Germany, Switzerland and the Netherlands, where only a few thousand have died.
There are several reasons for this, according to Dr Preston. ‘Firstly, many of our big cities are especially densely populated, increasing transmission rates. This is why most of our deaths have been in London. We are also the largest travel hub in Europe, so we’ve had more people bringing the virus over. Like Italy, which has the highest death toll in Europe, we have an ageing population.’
Another crucial factor is that other countries, such as Germany, had a ‘head start’, he says. ‘They had 50 testing laboratories already set up so they could test and isolate cases. Whereas we have only eight, so we’re playing catch-up.’ But Dr Preston adds: ‘It’s very possible that other nations [who relax lockdown measures earlier] will have a second wave and the UK won’t. We simply won’t know until the restrictions have been lifted and the infection can spread again.’
Q: Is it not safe to lift the restrictions until we have a vaccine?
A: An effective vaccine is our best chance of beating the virus. Yet scientists predict it won’t be available until at least the autumn.
‘Studies suggest it is possible to lift some restrictions safely, while keeping infection rates under control,’ says Dr Preston. ‘We’ve seen evidence of this in other countries such as Singapore. We will need to maintain strict social-distancing measures and have controlled access to shops and supermarkets. We’ll need to identify sectors most at risk of infection and those who can remain working from home. Perhaps we let specific sectors go back to work at different times or introduce a shift system. But limits on the use of public transport must remain in place. Mass testing – even for those without obvious symptoms – and contact-tracing is key so we can isolate people and stop the number of cases growing. We must be prepared for a second lockdown, if figures rise significantly again.’
Q: If I’ve had the virus, surely I won’t need to be so careful about social distancing?
A: It is still essential that you follow Government guidelines even if you have recovered, says Dr Preston. ‘Data from China suggests that a small number of people may be susceptible to reinfection.’
He adds: ‘Although most of the reports show that after two weeks of being symptom-free, you are no longer infectious, some reports suggest it could be longer. ’
But it is essential that everyone understands that the mask is not worn to protect the wearer from infection – you should wear a mask so you don’t inadvertently infect other people.
It’ll mean a shift in thinking. But let me explain why it makes sense.
Early this month, evidence began to mount that people with Covid-19 are highly infectious – expelling, or shedding, large amounts of the virus – before symptoms begin and they know they have it. This was initially thought not to be the case.
It is now suspected that a large number of those infected – up to eight in ten – may never show symptoms at all. These asymptomatic people, while seemingly unaffected themselves, can pass it on.
It’s not just coughs and sneezes that spread this disease. When we speak – and even just breathe – tiny micro-droplets of moisture are ejected from our mouths. If someone is infected with Covid-19, even without symptoms, these micro-droplets contain virus particles.
And this is where masks are vital. They create a physical barrier and block these droplets just as they come out of the mouth. This is called ‘source control’.
As I’ve mentioned, the debate about masks has often centred on whether they protect the wearer. Unfortunately, they don’t always. The problem is that many who wear masks don’t do so properly.
I have lost track of the number of people I’ve seen wearing a grubby, poorly fitted mask that they fiddle with and pull down every time they need to talk on their phone.
This contaminates the mask, and that means it could raise the risk of them getting infected. In these cases, masks may be giving wearers a false sense of security – and lure them into thinking they don’t need to exercise social distancing.
Doctors are taught proper mask etiquette early on in medical school. But there has never really been a concerted campaign to show people how to correctly use a face mask. That’s because, until now, we’ve never needed one. Covid-19 has changed that.
Hand hygiene, learning not to touch your face when out of the house and social distancing are far more effective in everyday life to protect us from catching Covid-19.
My hope is that now, listening to world-leading scientists and doctors, the Government issues clear guidance, so everyone knows why they need to wear a mask and how to do so correctly.
Health officials have been unsure how the public would react to pandemic control measures. There were big concerns, for instance, that people wouldn’t follow social-distancing guidance – but we have taken to it all remarkably well.
So are we all too stupid to understand a simple set of instructions about safe mask use?
Or too selfish to grasp the fact we’re doing it to protect those around us, rather than ourselves?
I don’t think so.
And this is also vital to understand: if mask-wearing is to have an effect, everyone must do it.
Research by Professor Trish Greenhalgh, who is a GP and public health expert at the University of Oxford, suggests that if we all start wearing masks in public – alongside maintaining good hygiene and social distancing – we might drop the rate of transmission enough to see off this devious virus once and for all.
That’s not to say we should now rush out and buy up every mask available.
There is a global shortage of masks and we need to make sure that NHS staff, who are at high risk of catching the virus, can still get hold of them.
In hospitals, healthcare workers in close contact with Covid-19 patients are given medical-grade masks. These are usually worn with other protective kit, such as visors and gowns.
But the average person on the street doesn’t need these.
A DIY cloth mask – or anything that covers the mouth and nose, such as a scarf – will do the job. In fact, that’s exactly what the US surgeon general Jerome Adams currently recommends, and we detail one way of making your own in the panel, above right.
There are loads of alternative methods too, which you can easily find online.
If you are infected, a simple cloth covering your mouth could stop droplets from being expelled – and help to halt the spread of the virus.
Of course, it’s still vital you don’t adjust it, touch it or pull it down or up over your hair.
VIRUS FACT: Tiny droplets from a person’s throat can spread five metres with a cough and as far as eight metres with a sneeze, a US study suggests.
Always assume the outside of the mask is contaminated.
By making your own, you can take a bit of time to make it as comfortable as possible, so you can breathe easily.
This also means you’ll be less likely to fiddle with it.
Don’t take it off until you are somewhere you can wash your hands. And when you do take it off, you should lean forward and drop it into the sink or washing basket, and not touch your face until you wash your hands.
If commuting, having a clean one for the trip home is ideal.
I know, something that seems simple is actually quite complicated. But if we can all start to make it part of our routine, it could have a huge impact.
It’s so easy anyone can do it
Don’t rush online to stockpile masks. You can make your own – just follow these easy steps. Making effective masks is simple, and you will be saving surgical ones for the NHS staff who really need them. All you need for your DIY mask are two elastic bands and a T-shirt that you don’t mind cutting up. Or you can use an old scarf or tea towel.
1. Cut up an old T-shirt into a rectangle measuring roughly 40cm by 30cm. Lay it on a table, with one of the shorter sides closest to you
2. Holding the bottom two corners, fold the fabric up into the middle. Then, holding the top two corners, fold the fabric down into the middle. Repeat this again, so you are left with a thin rectangle
3. Place an elastic band around each end of the fabric, about 3cm in. Choose two bands the same size – you might have to try a few before finding the right fit for you. Fold the ends of the fabric over the elastic bands, so they are facing inwards
4. To put on the mask, place your fingers through the elastic bands on either side. Raise the mask to your face and hook one band over each ear. It should fit snugly against the sides of your face, over your mouth and nose, with no gaps
- A mask is not a substitute for social distancing and hand hygiene, but should be part of the mix.
- Get a comfortable fit. If it’s comfortable, you’re less like to fiddle with it.
- Adjust your mask before you leave the house. After that, do not touch its outside again.
- Wear in public settings where distancing is difficult to maintain – supermarkets, pharmacies and on public transport, for instance. Public-health expert Prof Greenhalgh recommends wearing one at all times while you are out of the house, particularly while exercising.
- To remove it, unhook and take care not to touch the outside, then wash your hands.
- If you do need to take it off while you’re out of the house, and find it’s damp, don’t reuse it – put on a fresh one.
- Wash after every use if possible, at a high temperature.