Covid-19: Masks

Lord Bethell Excerpts

Thursday 11th June 2020 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con) [V]]

My Lords, I thank the noble Lord, Lord Campbell-Savours, for raising this important issue. I pay tribute to his passion and perseverance on the issue of masks. I thank all noble Lords who have contributed to this debate for their thoughtful comments, which I will tackle at pace. I apologise if I am unable to namecheck each contributor or address each question as I would have liked.

As we ease lockdown restrictions, the debate on these non-pharmaceutical interventions is key, and I very much welcome the debate and the points raised. As for our strategy, the noble Lord, Lord Campbell of Pittenweem, suggested a Covid-19 defence triad, which I welcome, but our triad, which the Government support, is, first, one of social distancing; secondly, one of hand hygiene; and thirdly, one of isolation. This triad offers the best protection from the spread of the disease. These three measures are our priority and our advice on face coverings does not negate this.

The noble Lord, Lord Campbell-Savours, asked what plans the Government have to review their advice on this issue. Noble Lords will be aware that last week the Government made two announcements on the use of face coverings in specific situations. On 4 June, the Transport Secretary announced that the Government will work with transport operators to make it mandatory for passengers to wear face coverings when using public transport in England from 15 June. On 5 June, the Health Secretary announced that all hospital staff in England will be provided with surgical masks, which they must wear, and that all hospital visitors and outpatients should also wear face coverings from 15 June.

Many noble Lords, including the noble Lord, Lord Bilimoria, and my noble friend Lord Blencathra, provided interesting and well-considered ideas on the exact distance that we need to enforce in our social distancing policy. I assure noble Lords that we will continue to review the evidence on social distancing, and on the question of one or two metres, we will be led by the science and the advice of experts on any changes to this policy.

On 11 May, the Government issued their first set of guidance on the use of face coverings. Informed by the scientific evidence, we advised that, if they can, the public should wear a face covering in enclosed spaces where social distancing is not always possible and where they will come into contact with others they do not normally meet. This announcement and the accompanying guidance from Public Health England came after a careful review of the latest scientific evidence by the Scientific Advisory Group for Emergencies, SAGE. The noble Baroness, Lady Northover, makes an important point about the risk of cannibalising the supply of masks to the NHS.

In reply to my noble friend Lady Anelay, I also commend the work of my noble friend Lord Deighton, who is charged with securing a resilient supply of PPE; the progress that he has made is impressive. I assure the noble Baroness, Lady Northover, and my noble friends Lord Holmes and Lord Bourne that his work, and the hard work across all NHS procurement, has ensured that we are now confident in stocks and sources of supply of PPE to meet the needs in health and social care over the next 90 days. We also continue to pursue contracts for additional stock both to manufacture and to purchase.

My noble friend Lord Balfe and the noble Lords, Lord Skidelsky and Lord Harris, raised the important issue of the distribution and supply of face masks to the general population. Our guidance has been and remains proportionate to this evidence, and we have been clear that a face covering is not the same as a surgical mask or respirator used by healthcare or other workers as PPE. These should continue to be reserved for those who need them to protect against risks in the workplace. I emphasise that it is a considerable challenge for the Government to undertake responsibility for the distribution of masks to the whole population.

In response to the noble Lords, Lord Palmer of Childs Hill and Lord Bilimoria, I want to explain that the principle of “There is little to lose” is not one that we subscribe to. If we support measures that do not work, we create a false sense of security and distract from the measures that really do work.

My noble friend Lord Duncan made a critical point about the hygiene of masks and the danger that they can be a vector for infection. A badly maintained or dirty mask, or a mask that is handled badly, can be a dangerous object that spreads disease. We have published guidance to show people how to properly remove masks and wash them. None the less, the public can and should wear face coverings that they make at home. Accordingly, the Government have provided advice online on how to make these using scarves and other textile items. The advice on face coverings was in addition to the key advice about maintaining social distancing and washing hands regularly, which has proven to be crucial in preventing the spread of this deadly virus. We have been clear that wearing face coverings cannot replace those important practices, and if you are symptomatic then you must self-isolate.

In relation to workers in numerous sectors, including public transport, we advise that they continue to follow the advice of their employers and make sensible workplace adjustments. I welcome the comments by the noble Lord, Lord Skidelsky, on this.

Since that initial advice we have continued to review our position, consider the evolving context in the UK and refine our approach accordingly. However, we should note that, whatever we would like to be the case, the available evidence on the efficacy of face coverings has not moved substantially from the initial advice.

I want to update my noble friends Lord Naseby, Lady McIntosh and Lord Sheikh that in recent days the WHO has updated its advice to encourage the wider use of face coverings in public settings, but it has been clear that

“the widespread use of masks by healthy people … is not yet supported by high quality or direct scientific evidence”.

Evidence from the Scientific Advisory Group for Emergencies suggests that face coverings may help to reduce the risk of transmission if you are suffering from coronavirus but not showing symptoms. SAGE also advised that using cloth masks as a precautionary measure could at least be partially effective in enclosed spaces, such as public transport, where social distancing is not possible.

In continuing to take a risk-based and evidence-led approach to guidance, the Government have continued to adapt our guidance proportionately to the science. In answer to the noble Lord, Lord Purvis, I say that it remains guidance, not law. As lockdown restrictions ease, more people will now come into contact with others and there may be incidences where social distancing is more difficult to maintain consistently. For example, as the noble Baroness, Lady Thornton, mentioned, we expect that more people will leave their homes to make essential journeys, returning to work if they cannot work from home, and some children are returning to school.

While we encourage the public to walk, cycle or drive, this may not always be possible and we can expect the transport network to become increasingly busy. That is why, on 4 June, the Government announced that we will work with transport operators to make it a requirement for passengers to wear face coverings when using public transport in England from 15 June. On board public transport is a space in which it is less easy to socially distance, and people may spend extended periods of time in close contact with others they may not normally meet. The Government remain clear that social distancing and hand hygiene remain the most important ways to guard against the virus, but face coverings may help to prevent individuals who have coronavirus but are not presenting symptoms from spreading it to others.

The noble Lords, Lord Campbell-Savours and Lord Mann, the noble Baroness, Lady Healy, and others shared helpful interventional anecdotes. But the consensus in scientific literature is that the evidence base for the effectiveness of face coverings is inconclusive. Mandatory face covering specifically on public transport is the approach taken in a number of countries, including France, Germany and Italy. Although face coverings are more habitually and widely worn in public in some countries, such as China or Japan, the evidence remains inconclusive around their widespread efficacy in protecting individuals from Covid-19. In answer to my noble friend Lord Blencathra, I say that there is no evidence that these masks are interchangeable with other measures in the triad.

The Government have recognised that, as we bring the overall incidence of Covid-19 down, it is important that we cut down on infections passed on in hospitals. We have noted the evidence that healthcare workers are 10 to 20 times more likely to be Covid-19 positive than the general public. In light of this learning from NHS hospitals and IPC teams, the Government announced on 5 June that all staff in hospitals in England will be provided with surgical masks, which they will be expected to wear from 15 June. NHS staff already wear face masks in clinical areas where they come within two metres of a patient. But this new guidance will apply to everyone working in all areas of hospital, including non-clinical settings. Furthermore, all visitors and out-patients will be expected to wear face coverings at all times. These are measures that some organisations have already started to adopt. We are clear that this will not mean that anyone is denied care. If necessary, a mask will be provided for a patient if they arrive without a face covering.

Detailed guidance on these measures will be published this week to enable hospitals to get stocks and put plans in place; we are confident in the stocks of face masks needed to meet this new demand. We also continue to pursue contracts for additional stock, both through manufacture and purchase. The noble Lord, Lord Campbell-Savours, asked at the start of this debate what plans the Government had to review our advice on face coverings. As I have set out, we continually review these measures, evolving them as we have from 11 May by continuing to follow the evidence and the scientific advice. We will therefore continue to review this latest iteration of advice too. As I have set out, the Government will always look to the scientific evidence and advice we are given in continually reviewing and refining our guidance.

I thank the noble Lord, Lord Campbell-Savours, who has pushed hard on this important issue and rehearsed these important arguments. As the pandemic evolves and the science develops, he will have an impact on our understanding of this important issue.