This article explains the guidance on if and/or when members of the public should wear face coverings in Northern Ireland and explores some of the available evidence regarding their use.
[This article is part of the COVID-19 Information Dissemination (COVID-19 ID) Project — a partnership between Community Development and Health Network (CDHN) and FactCheckNI. Its aim is to improve people’s health literacy about COVID-19 by providing accurate and up-to-date information which will increase knowledge, understanding and confidence and enable people to make good health decisions.]
What is the guidance on face coverings in Northern Ireland?
The Northern Ireland Executive issued advice about face coverings on 7May 2020. This was announced by Health Minister, Robin Swann.
The advice, supported by the Public Health Agency (PHA), recommends that people “think about using face coverings” in situations where they are spending “short periods in enclosed spaces where social distancing is not possible”. Examples given include shops and public transport.
On 2 July 2020, Minister for Infrastructure, Nichola Mallon, announced that face coverings will become mandatory on public transport from Friday, 10 July, to “support efforts to reduce the risk of transmission”. This applies to most bus, train and ferry services operating in Northern Ireland, as well as on public transport premises, such as stations. People with relevant medical conditions and children under 13 are exempt. A cross-departmental group has also been established to explore if, and when, this will apply to the tour coach and taxi industry. Face masks will not be mandatory on outdoor areas of ferries, or on school transport. In the announcement, Mallon explained that a face covering “is a covering of any type which covers a person’s nose and mouth; it does not have to be a surgical face mask”.
On 23 July, Ministers also agreed to legislate to be able to enforce the mandatory use of face coverings in a number of indoor settings. Enforcement was not immediate.
On 6 August, the NI Executive announced that the use of face coverings in certain indoor settings will be mandatory from Monday August 10. A public information campaign called ‘Wear one for Everyone’ was announced to raise awareness of the benefits of face masks/coverings.
How does the advice in Northern Ireland compare to other jurisdictions?
In England, wearing a face covering on public transport (bus, coach, train, ferry and aircraft) was made compulsory from 15 June 2020. From that same date, all visitors and outpatients in English hospitals must wear face coverings.
In Scotland, wearing a face covering is mandatory in shops, on public transport and in railway stations, bus stations and airports. Wearing a mask is recommended in other enclosed spaces where physical distancing is more difficult and where there is a risk of close contact with multiple people who are not members of your household, you should wear a face covering.
In Wales, wearing a face covering in situations where social distancing is not possible is recommended. It is not mandatory and is “a personal choice”.
In the Republic of Ireland, face coverings are required on public transport and will be mandatory in shops and shopping centres from 10 August. Wearing a cloth face covering is also recommended in other situations where it is difficult to practise social distancing.
Policies on face coverings in these jurisdictions are reviewed on a regular basis and current advice is subject to change.
Face masks or face coverings?
There is a difference between medical face masks and face coverings for the general public.
Medical face masks include respirator and surgical masks. These are considered to be PPE (personal protective equipment), and are primarily for use in health and social care settings and some specific work environments.
The general public, in contrast, are advised to wear face coverings. These are most commonly made out of cloth and cover the nose and mouth. They can be secured to the head with ties or straps. They may be manufactured or home made.
Are face coverings effective against COVID-19?
Scientific research about the effectiveness of face coverings in reducing the spread of COVID-19 is limited.
On 4 May 2020, the Royal Society’s DELVE group (Data Evaluation and Learning for Viral Epidemics) published their evaluation of available relevant research. Their report underlined how COVID-19 spreads through droplets from coughing, sneezing, talking and breathing. The studies they reviewed found that 40-80% of COVID-19 infections may occur from individuals without symptoms. DELVE concluded that face coverings may help prevent virus spread via droplet dispersal from asymptomatic and presymptomatic individuals.
On 1 June 2020, medical journal The Lancet published a review of 172 studies on virus transmission prevention across 16 countries. It found that physical distancing was an effective means of virus prevention, as were eye protection and face masks in the form of “disposable surgical masks or reusable 12–16-layer cotton masks”.
On 5 June 2020 the World Health Organisation (WHO) stated that “the widespread use of masks by healthy people in the community setting is not yet supported by high quality or direct scientific evidence”.
However, WHO also said there was enough emerging information to now update their previous advice in favour of wearing face coverings in certain situations where distancing is not possible. These include public transport, some enclosed work environments, cramped living environments, and in areas with known widespread COVID-19 transmission where other containment measures (distancing, testing, contact tracing, isolation) are limited.
Two subsequently published studies, using data collected in the current pandemic, have found strong evidence in favour of face coverings. A discussion paper for the Institute of Labour Economics found that face coverings, which were made mandatory in the German town of Jena on 6 April 2020, reduced the daily growth rate of COVID-19 infections by 40-60%.
The US Centres of Disease Control conducted a study of a COVID-19 outbreak on board aircraft carrier Theodore Roosevelt in March 2020. They found that 56% of those who wore a face covering became infected, compared with 81% who did not wear a face covering.
New mathematical modelling by scientists at Cambridge and Greenwich universities suggests that if an entire population were to wear home made face masks, an ‘R’ number — or infection rate — of 4.0 could reduce to 1.0, even without the aid of lockdown.
In June 2020, the Oxford COVID-19 study was published. It found:
- Cloth face coverings are effective in reducing source virus transmission, i.e., outward protection of others, when they are of optimal material and construction (high grade cotton, hybrid and multilayer) and fitted correctly and for source protection of the wearer.
- Socio-behavioural factors are vital to understanding public adherence to wearing face masks and coverings, including public understanding of virus transmission, risk perception, trust, altruism, individual traits, perceived barriers.
- Face masks and coverings cannot be seen in isolation but are part of ‘policy packages’ and it is imperative to review interrelated non-pharmaceutical interventions in tandem including hand hygiene, sanitizers and social distancing when maintaining the 2 metre or 1 metre+ distancing rule is not possible.
- Consistent and effective public messaging is vital to public adherence of wearing face masks and coverings. Conflicting policy advice generates confusion and lack of compliance. Populations without a previous history of mask wearing have rapidly adopted face coverings during the COVID-19 period.
The European Centre for Disease Control (ECDC) summarises the pros and cons of wearing face masks and coverings as follows:
Particular groups (such as those living with chronic obstructive pulmonary disease or COPD) may need to take care in relation to, or avoid, wearing face masks, as they may potentially make breathing more difficult.
The PHA advice in Northern Ireland reflects the concerns and language of the European Centre for Disease Control. They urge people not to develop a “false sense of security” if they are wearing a face covering. They underline that social distancing, hand washing, and respiratory etiquette — “catch it, kill it, bin it” — remain the best way to protect people from contracting the virus.
The ECDC adds staying at home when ill, and working from home where possible, to this list. They stress that face coverings should be seen only as a complementary measure to, and not a replacement for, core disease prevention measures.
Appropriate use of face coverings is essential. The Irish government has produced guidelines about how to wear face coverings properly to prevent cross-contamination. These include how to fit a mask on your face, how to take it on and off, when to wash it, and when to throw it out. This advice is echoed in a shorter document from the UK government.
This article was originally published on 15 June 2020.