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Members of the public wearing face masks on the Luas last week. Leah Farrell/
winter surge

Immunologist says stronger advice on mask-wearing needed amid surge in respiratory viruses

Professor Christine Loscher told The Journal that the Government “missed a trick” in not issuing stronger advice sooner.

AN IMMUNOLOGIST HAS said that the Government “missed a trick” by not strongly advising the public of the importance of wearing masks before the current winter surge that is seeing record hospital overcrowding due to a rise in respiratory illnesses.

Professor Christine Loscher told The Journal that while the current public health advice doesn’t need to be changed, there needs to be more communication on the effectiveness of mask-wearing in preventing the spread of Covid-19 and influenza. 

The health service is coming under an increasing amount of pressure at the moment due to the number of patients presenting with respiratory viruses.

While Covid and RSV are significant factors, officials have singled out influenza as being of particular concern, with cases increasing rapidly and no clear indication of when they might peak.

On Tuesday, a record 931 patients were without beds in Irish hospitals, the highest figure ever recorded by the Irish Nurses and Midwives Organisation (INMO).

While that figure has reduced in recent days, the interim CEO of the HSE, Stephen Mulvany, has said that despite this week being the worst on record for hospital overcrowding, he cannot say for certain that “it won’t get worse before it gets better”.

Mask wearing

Speaking to The Journal, Dr Christine Loscher said: “I think that we missed a trick in that we should have been getting the public on board with the fact that when things surge, we could do something to help the situation, and that this is what we should have been doing all along.”

“Now we’re not just dealing with Covid, but we’re dealing with RSV and the flu,” she said, adding that she doesn’t know whether the public “are as on board as we need them to be” with the public health advice because of a lack of messaging and not being used to following the advice since restrictions were lifted.

“We have evidence from the last couple of winters that when we do behave differently, we also impact on those viruses. There needs to be very strong advice that we should wear masks on public transport and in crowded indoor, poorly ventilated spaces at the moment, in order to reduce everyone’s risk.”

Currently, the public health advice on mask-wearing is that while they are no longer mandatory, masks are still advised on public transport and in healthcare settings such as hospitals and GP surgeries.

Call for mask mandate

But last week, the INMO called on the Government to “make difficult decisions including the return of mandated mask-wearing in congregated settings” in an effort to reduce the spread of respiratory infections. 

“We know that one of the main pressure points in our health service is the rise of respiratory infections. Asking people to return to mask-wearing in busy congregated settings is a simple measure,” Phil Ní Sheaghdha, general secretary of the INMO, said.

However, Health Minister Stephen Donnelly has said that the official advice to Government is that mask mandates are not required.

“I don’t anticipate any change coming in terms of the public health advice from the Chief Medical Officer,” Donnelly said.

“However, I want to fully acknowledge the INMO’s concerns, I think they are playing a very constructive role. I got a letter in from them today, we had a good chat earlier on today. They’re looking for solutions,” Donnelly said. 

“The public health advice to Government, to me at the moment, it is not a move to mask mandates, but obviously we will keep the situation under review on a daily and on a weekly basis.”

Loscher is not in favour of introducing a mask mandate, and believes that issuing stronger advice is the way to go.

“We’ve missed the boat on forming that habit, now we’re in dire straits and we need people to respond. I can totally understand the INMO calling for a mandate because they’re the frontline dealing with the desperate situation that everyone’s in at the moment,” she said.

“Mandates come with controversy; it ends up being huge discussions, whereas I think that it needs to be, again, reiterating the benefits to people of infection control using masks, hand washing and sanitising.”

At a briefing on Tuesday, the Government said flu cases are much higher than in previous years, with the number of people being hospitalised more than doubled compared to pre-Covid.

Flu vaccines

Compared to 2019, there were 2,331 lab confirmed cases of flu identified up to Christmas week. This is in contrast to 1,000 cases in 2019.

Of the 2,331 cases, a total of 637 people hospitalised which compared to 350 people on past figures.

Loscher said the current flu season still hasn’t peaked and that there’s “still an awful lot of people out there who will get the flu”.

There is no doubt that when we were wearing masks in the context of Covid, that it did have a huge impact in terms of the incidence of things like flu and other respiratory viruses.

She previously told The Journal that she would have liked to have seen flu vaccines free for everyone the way they were in the last few years.

The vaccine is currently free for people aged 65 and over, children aged 2-17, healthcare workers and people with long-term health conditions.

She said that by making the flu vaccine free for all age cohorts, it is likely to improve the uptake of the vaccine and reduce the spread of the virus.

“If you want people to behave a certain way, you’ve got to make it easy for them. When you put barriers in the way like increased costs, I think it really impacts on people engaging with them anymore,” she said.

Attitude towards masks

While more people have been visibly wearing face masks on public transport and in crowded settings in recent weeks, the vast majority of people are not wearing one. 

Pete Lunn, the head of behavioural research at the Economic and Social Research Institute (ESRI), told The Journal that it is unlikely that there will be a significant increase in mask-wearing under the current guidance.

“When the mandate was lifted for masks on public transport and in some other public settings, there was a very rapid fall-off in people wearing them. There is a very big difference between having a rule and something being guidance, however strong that guidance is,” Lunn said.

“Part of the reason for this is that because mask-wearing is very much a collective activity, people tend to do it much more when they see that other people are doing it too. The existence of a rule really, really drives up the proportion of people who are wearing masks. And when you take the rule away, even if it remains guidance, as soon as people see that some other people aren’t doing it, the numbers doing it drop.

From a behavioural science point of view, essentially you move from an equilibrium where people are cooperating with each other because they can see other people are doing it – to a situation where because a lot of people aren’t doing it, the people who would cooperate don’t, because they can’t see why they should bother if other people aren’t bothering.

“You end up with a minority doing it, who are the ones who are perhaps most at risk or ones that believe in it most, or whatever it happens to be, but you get a really big change.

“If I’m honest, I think it would be very difficult to get mask-wearing back up to a high level again purely through voluntary guidance. Ultimately, it’s going to take a decision to say: ‘Look, there is a mandate in these circumstances, this is what everyone has to do.’”

Lunn said that were a mask mandate to be introduced, it is difficult to know what the public response would be.

“In the past, whenever we’ve introduced genuine rules about this, the very large majority of people stuck to it,” he said.

“I think it’s pretty clear to everyone at this stage that we have a problem. Given what they’re seeing on the news and given the way people have responded in the past to pressure on the hospitals and rises in case numbers, I would anticipate that if we strengthen the rules surrounding wearing masks, that more people will wear them and we’ll get pretty high compliance, but I can’t be sure about that.”

Loscher said that while it is possible that people may not resume wearing masks at the level previously seen, a strong message from Government could still see an increase in the number of people following the public health advice. 

“One way of changing behaviour is to make it mandatory. We all know that when people have to comply, they will. I think the reason that maybe the uptake on mask wearing won’t be as much as it could have been, is because this is what we should have been doing over the last few cycles of Covid so that people are used to: ‘This is what we do when we get a surge and the healthcare sector is impacted’,” she said.

“I do think there’s lots of very small things that we can do, and that will help, but I think it’s about the Government and the HSE coming out and asking people to help support the healthcare sector and the healthcare workers at the moment by doing that range of things where they can. That message is very strong, and I think that’s a message that people respond to very well.”

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