Does Scotland's guidance on Covid-19 face coverings flout World Health Organisation advice?

Nicola Sturgeon’s call for the Scottish public to wear non-medical face masks in shops and public transport is an example of the difficult, sometimes conflicting decisions leaders are having to make during the coronavirus pandemic.

First Minister Nicola Sturgeon conceded the evidence supporting the use of face coverings was "relatively weak."

On the one hand, it puts Scotland in line with several other European nations, including Germany. On the other, Ms Sturgeon admits the evidence for its effectiveness is “weak,” and the new policy sits at odds with the World Health Organisation’s (WHO) stance.

Ms Sturgeon addressed the issue at length during her daily briefing today, and her choice of wording was careful and deliberate, She referred to the overarching issue of “face coverings,” such as scarfs, or other garments made out of cloth or textiles, and not “medical grade face masks,” the type worn by health and social care professionals.

Ms Sturgeon said that there “may be some benefit in wearing a face covering” for people leaving their home to go to a “enclosed space” where the presence of “multiple people” make social distancing problematic. The examples she cited were food shops, or public transport.

Her remarks have surprised some, and sparked increasingly commonplace accusations of Scottish ministers seeking to “defy” official Downing Street advice.

The fact is, however, no such advice exists. The UK government is awaiting the results of a review that has been carried out by the Scientific Advisory Group for Emergencies, “Once a decision has been reached then we'll announce it publicly.” a Downing Street spokesman explained.

In any case, Ms Sturgeon made it clear last week that the new guidance was imminent, while setting out a tentative roadmap of Scotland’s response to pandemic in the weeks and months ahead in the government’s framework document.

"it is likely that in very limited circumstances we will advise people to wear face coverings,” she said last Thursday.

If that served as primer, today’s announcement contained a wealth of detail and, perhaps more importantly, caveats.

The evidence on the use of face coverings during the pandemic, Ms Sturgeon conceded, was “limited,” with any benefits of wearing such items mainly reserved for those who are asymptomatic and not isolating.

“Wearing a face covering in these circumstances may reduce the chance of that person transmitting the virus to others,” she pointed out.

The difficulty with that scenario is that asymptomatic carriers of the virus will not know they are infected, or at risk of infecting others.

That, in part, explains why the Scottish Government’s new stance is advisory only, and described as a “precautionary measure” in “limited circumstances.”

Ms Sturgeon, ordinarily a stickler for evidence-based policy solutions, admitted that the evidence is “relatively weak,” and she stressed the government was not making the wearing of face covering a mandatory, enforceable measure. That, though, could change. She has promised to keep the issue under review.

“The wearing of facial coverings is an extra precaution that you can and, we are suggesting, you should take,” she added “It may do some good in some limited circumstances. It is not – and must not be seen as – a substitute for the other rules and guidelines that we have been stressing.”

What is perhaps most striking about the new guidance is the way it sits uneasily with advice issued by the WHO.

It does not regard the use of cotton cloth masks as an appropriate or protective alternative to medical masks or respirators, pointing out that fabric thickness and weaving standards can vary widely, meaning that the filtration efficiency - in layman’s terms, the barrier - against microorganisms passing through the material is unknown

The WHO also stresses that cotton cloth masks are not fluid resistant, and may retain moisture, becoming contaminated as a result and acting as a potential source of infection, instead of protection.

The evidence about the benefits of these masks is limited. One good quality study showed that the risk of respiratory infection is increased, and not reduced, in health care workers using cotton cloth masks when compared to medical masks,” it states.

However, it goes on to note that while the benefits to people wearing such items are unknown, they “may protect others” if the wearer is presymptomatic or asymptomatic, a theory echoed by Ms Sturgeon.

Scotland is not the first country to issue advice on face coverings which goes against the WHO guidance, and it is unlikely to be the last.

In Germany, where authorities have been widely praised for their response to Covid-19, the use of cloth masks is mandatory on practically all forms of public transport, save for long-distance trains.

The rules vary between the country’s 16 states, but in most regions, the same mandatory decree applies to people visiting shops.

The actual wording is predictably vague, given not everyone has access to a bona fide mask while outside the home, but the definition of “mouth nose protection” generally covers anything from a scarf or balaclava to a kitchen towel.

And unlike Scotland, authorities in Germany are enforcing the new measure. The severity of penalties varies across the country, but in Bavaria, people found flouting the rules can be fined £130, with the sum doubling for repeat offenders.

In other European nations, such as Austria, the Czech Republic, and Slovakia, the compulsory use of face coverings in similar settings has been compulsory for several weeks, while even in the US, the Centres for Disease Control and Prevention issued guidance in the first week of April, urging people to wear cloth face coverings in public settings where other social distancing measures are difficult to maintain.

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