I come from a country where masks are not seen as a restriction of personal freedoms, but more as a part of the social fabric. Having been born in Japan and lived there until age 10, I grew up with masks – I wore them outdoors every day during the hay fever season because it helped with my breathing and often on public transport during the winter to avoid catching a cold. For me, masks have always been a highly convenient and effective tool, NOT an inconvenience.

Masks as a restriction on personal freedoms

In 2022, masks and policies surrounding face coverings remain as contentious, if not more so than at the beginning of the Covid-19 pandemic. Libertarian arguments continue to portray masks (and other public health measures) as not only ineffective and inconvenient, but also as a restriction of personal freedoms.

An alarming aspect of the pandemic has been the adoption of such libertarian ideology by those in positions of power, including clinicians and academics in medicine and public health. I have seen countless clinicians care for clinically extremely vulnerable patients, totally unmasked or with nose over masks. Some academics also appear to be reluctant to challenge institutional policies on face coverings for fear of angering students and university management. Moreover, it greatly upsets me to see some of my fellow Barts medical students take off their masks the moment they leave hospital, entering shops and hopping on public transport totally unmasked. It feels incredibly jarring to me that we strive for “patient-centred care” and “health equity” in our day-to-day work but fail to act in ways which are patient-centred and protect the health of vulnerable people.

Covid and the boundaries between “personal” and “public” health

I am not saying that we should be living in perpetual lockdowns or restrictions, nor that we should be wearing masks everywhere, all the time. I also recognise that there is a small number of people for whom wearing masks is difficult, such as people living with certain disabilities.

But Covid is hardly “endemic” or “just like the flu” and continues to pose a substantial threat to clinically vulnerable people. Although the number of daily Covid cases appears to be winding down, this is more to do with the UK government cutting down on testing and scrapping legal requirements to self-isolate than the number of infections actually decreasing (The ZOE Covid Study continues to report ~200,000 daily cases at the time of writing). Moreover, this so-called “vulnerability” is common.

Even if you take just one condition, say diabetes, 4.9 million people are living with it in the UK – that’s 7.3% of the population! Added to the fact that Covid is not simply a respiratory illness causing pneumonia but a multi-system inflammatory disease leading to long-term morbidity and disability, the government’s “living with Covid” approach becomes a disturbing proxy for labelling the lives of vulnerable people as being less worthy or at worst, dispensable.

There is no such thing as a “risk-free” life. But we try to minimise those risks, where we can. A perfect example is road safety. In 2019, road traffic accidents caused 1,752 deaths and a further 25,945 serious injuries in the UK, a far smaller figure compared to the number of people Covid affects (In the past week alone, there were nearly 1,200 deaths within 28 days of a positive Covid test and an estimated 1.3 million people are currently living with long Covid in the UK) . Yet we have legal mandates on seatbelt use and fines for drink-driving and driving while using your phone; as of January this year, we even have a new Highway Code which prescribes a “hierarchy of responsibility” to protect road-users most vulnerable to the effects of road traffic accidents, such as pedestrians and cyclists. But when it comes to Covid, the talk is all “personal responsibility” and “personal freedoms”.

The bad news is that for people unable to work from home or avoid essential shops and services, there is nothing “personal” or liberating about being infected with a highly contagious virus which causes mass death and long-term disabili­ty. Whether you like it or not, humans live in a complex cluster of social relationships, with each member of the community living with various degrees of health and ill-health. It also means that in a global pandemic, personal health is not personal per se – my health is your health and your health, my health.

Mask-wearing/sense-making

So, what can we do in the face of such complexity and uncertainty? As humans, we go about our daily lives and create meanings around our collective experiences in a process often called sense-making. In the case of masks, those who have grown up in a culture where masks are a part of everyday life (as I have done in Japan), have created meanings of security and collective solidarity around our experiences of wearing masks. On the contrary, those who oppose mask-wearing often associate masks with government overreach and other forceful measures to contain the pandemic, which represent an impingement of personal freedoms.

If we truly want to learn to “live with Covid”, we must change the meanings we have created our experiences of wearing masks, from meanings of restrictions and lockdowns towards those representing empathy and compassion. This becomes particularly important in social spaces where clinically vulnerable people have little to no choice but to attend, such as workplaces, public transport, essential shops and healthcare settings. It’s time to change our relationships with masks – towards an understanding that it is a simple and effective tool which is a matter of convenience for all, NOT an inconvenience.

Myth Busting citations:

Escandón, K., Rasmussen, A.L., Bogoch, I.I. et al. COVID-19 false di­chotomies and a comprehensive review of the evidence regarding public health, COVID-19 symptomatology, SARS-CoV-2 transmission, mask wearing, and reinfection. BMC Infect Dis 21, 710 (2021). https://doi.org/10.1186/s12879-021-06357-4

Eyre, D.W., Taylor, D., Purver, M., Chapman, D., Fowler, T., Pouwels, K.B., Walker, A.S. and Peto, T.E., 2022. Effect of Covid-19 Vaccination on Transmission of Alpha and Delta Variants. New England Journal of Medicine.

Sharma, V., Rai, H., Gautam, D.N.S., Prajapati, P.K. and Sharma, R., Emerging evidence on Omicron (B. 1.1. 529) SARS‐CoV‐2 variant. Jour­nal of Medical Virology.