As Dr Hammond pointed out in another recent column, it might reasonably be supposed, seventeen years on from Sars in 2003 and after multiple pandemic warnings since then, that definitive research would have proven the case for masks in public, and what type of masks to wear, but it has not.  He says that if masks do work, they are more likely to reduce infection during the heat of an outbreak rather than at the tail end of it, and they are being introduced on the back of observational studies rather than definitive randomised controlled trials.

He adds that masks, if properly used, may reduce, but not stop, viral shedding by people who do not realise they are infected.  Those with symptoms should be isolating indoors, not using masks as an excuse to go out.  To avoid confusion, many countries use the simplest advice: to always wear a mask in public.  In contrast, to show the chaos that seems to be getting worse across the UK, Dr Hammond highlights that in England you now need to carry an entirely illogical checklist to remind you when you do and don’t have to mask up.

For example, masks are obligatory in shops, enclosed shopping centres, banks, building societies, post offices, railway and bus stations, airports, on public transport and when queuing for food.  They are voluntary in pubs and restaurants, libraries, museums, galleries, theatres, concert and bingo halls, gyms, leisure centres, beauty salons and when walking around your house when you know you’re infected.  This has probably all changed since he wrote the article, but hardly anyone would notice if it has, because we are all so baffled by the contradictory and ever-changing messages. 

Hammond concludes that masks do not reduce your oxygen saturation, but they can only work if used correctly, and yet many spectacle-wearers steam up and lower the mask below the nose.  Repeatedly touching your mask is poor infection control, as is leaving it lying around on the sideboard after use.  Disposable masks are a pollution hazard and unaffordable for some, who may also struggle to regularly wash and dry cloth masks.  Reused disposable masks and unwashed cloth masks comply with the law but may spread the virus.  With justified sarcasm, he asks if there will be mask banks for the poor and if you will need a mask to enter them. 

The different attitudes to the wearing of masks across the world is reflective of significant cultural diversity and opinion.  Matthew Syed, in his recent book Rebel Ideas, describes how, when a group of Japanese people and a group of Americans were shown the same footage of an underwater scene, the Americans talked about the fish, while the Japanese overwhelmingly talked about the context of the objects – streams, rocks and shells.  Psychologists concluded that these different perspectives were driven by the differences in the two societies, with Americans much more focused on individualism and Japanese on interdependency. 

This is echoed by Susan Cain in Quiet, who makes the point that many Asian cultures are team-oriented, but not in the way that Westerners think of teams.  Individuals in Asia see themselves as part of a greater whole – whether family, corporation or community – and place tremendous value on harmony within their group.  They often subordinate their own desires to the group’s interests, accepting their place in its hierarchy. 

Western culture, by contrast, is organised around the individual.  We see ourselves as self-contained units; our destiny is to express ourselves, to follow our bliss, to be free of undue restraint, to achieve the one thing that we, and we alone, were brought into this world to do.  We may be gregarious, but we don’t submit to group will, or at least we don’t like to think we do.  We love and respect our parents, but bridle at notions like filial piety, with their implications of subordination and restraint.

She says that when we get together with others, we do so as self-contained units having fun with, competing with, standing out from, jockeying for position with, and loving other self-contained units.  Her conclusion is that it therefore makes sense that Westerners value boldness and verbal skill, traits that promote individuality, while Asians prize quiet, humility and sensitivity, which fosters group cohesion.  If you live in a collective, then things will go a lot more smoothly with restraint, even submission.

The famous declaration of Patrick Henry in 1775 to ‘give me liberty or give me death’, when arguing for soldiers to join the revolution against the British, was echoed in America at the start of the pandemic, with libertarians claiming the government had no right to tell them to socially distance or stay indoors.  I believe several of the loudest critics subsequently died from the virus, fulfilling Henry’s words with an irony that no one would want.  The debate between the need for governments to protect their people and the need for people to be free to make choices looks set to continue for some time yet, not least if and when a vaccine is developed. 

In a final mention for the time being of Dr Phil Hammond, I thought this was an interesting analysis of what constitutes a healthy life, and it would seem to be something that all schools would benefit from teaching more explicitly wherever possible.  He says that the basic ingredients of health are well known, well evidenced and fairly easily remembered using the mnemonic CLANGERS: Connect; Learn; (be) Active; Notice; Give back; Eat well; Relax; Sleep.   

Friendship and a feeling of belonging; an ability and curiosity to learn and adapt; purposeful physical and mental activity; observation and appreciation of the environment; compassion for others; food that is both delicious and nutritious; an ability to switch off and relax; and regular, restorative sleep – collectively, he says, these daily joys of health are more powerful than any drug.  The privileged can do them every day, even in lockdown.  If we all managed them, we would barely need the NHS.  But if you are living with debt, discrimination, depression, domestic abuse, drug addiction, dementia, etc., they are much harder to achieve.  This focus on prevention, helping others and lifestyle medicine is a lot cheaper and more enjoyable than medicating for diabetes and depression.  Indeed, he summarises, it is the one thing that can keep communities alive and health services viable.