Tuesday 19 July 2022

Mask mandates – will we only act on public health advice if someone does to us?

In mid-2020, it was suggested that wearing masks was similar to wearing seat belts in cars. Not everyone wore a seat belt in the early days, but now it's unusual to get into a car and not wear one.


Mask mandates

In reality, it took seven years for seat belt compliance to reach 90%.

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Now that we're about 900 days into the pandemic, we certainly don't see 90% of people wearing masks. In my local area, probably one in ten people wear a mask in local stores. And others on social media report low compliance on public transport.

So is the answer to reintroduce rules for the use of masks in certain environments or a more general mandate on their use? Listening to advice Victoria's Health Minister Mary-Anne Thomas has already rejected recommendations from the state's health director to require the use of masks in retail and early education settings in response to rising case numbers. (People are still required to wear masks in some Victorian settings, including public transport, planes, courts, prison, if they have COVID or are a close contact.) The mandates were not the most effective way to convey the message about the importance of the mask. dressing, said the minister. Instead, the government wants to focus on empowering Victorians to make their own decisions.

The doctors are not happy. Australian Medical Association Victoria president Roderick McRae said it was "very disappointing" that the health minister had ignored recommendations to require masks in schools, nurseries, retail stores and hospitality.

How do you mask mandated and non-mandated compliance tracking? A study tracked mask wearing based on newspaper photos published in Victoria for a month in mid-2020. It found that before the announcement of the mandatory mask policy, 43% of people in the photos were wearing masks.

During the period when the mask policy was announced but not formally enacted, 74% wore masks. Lastly, during the period when the use of masks was mandatory, 98% wore masks.

Obviously, there are limitations to this work. Only a small number of photos were reviewed, and the photographers may have deliberately taken photos of people who were not compliant (before the policy was introduced) or following the rules (once the policy was in place).

However, the study authors also surveyed the community and found a rapid change in self-reported mask use, from just over 40% of participants reporting always or often wearing a mask on July 20, to 100% % who reported always wearing a mask on July 26.

Based on the number of cases, the authors concluded that masks were effective in reducing transmission and, while "somewhat inconvenient" for the individual, were "less likely to have unintended negative impacts on the broader community than policies that restrict movement, social engagement and operations". businesses, schools and nurseries.

Will empowerment promote the use of masks?

Probably not. Community empowerment refers to the process of allowing communities to increase control over their lives. But that doesn't mean everyone will feel empowered to do the safest thing.

“Empowerment” refers to the process by which people gain control over the factors and decisions that shape their lives. It can drive innovation in health messaging and engagement.

In times of uncertainty, such as a pandemic that does not seem to be coming to an end yet and new sub-variants emerging, simply not wearing a mask can give people a sense of control over an unfamiliar situation. How about a push in the right direction? Early in the pandemic, it was suggested that promoting social norms (the values ​​within the community), such as the widespread use of masks (through strategic communication and community engagement), could be as effective as app.

Some suggested strategies included sharing evidence of widespread adherence and encouraging news about positive trends in mask use. Research from Sao Paulo showed that people who received a text message referring to COVID restrictions as a "civic duty" were 12% more likely to report keeping an appropriate distance from others and 3% more likely to always wear masks.

The successful use of messages to increase intentions to wear masks was also reported in another study, when people were encouraged to "trust their reasoning" rather than "trust their emotions" to make the decision. A 2021 US study showed that exposure to a mask-wearing message from the president or the Centers for Disease Control increased the reported likelihood of wearing a mask, particularly among supporters of then-President Trump.

Finally, they found that if a person tested negative, they were more likely to support wearing masks. Testing positive for COVID did not affect mask support and in some cases reduced support.

However, so far in the pandemic, the example for leaders to follow, highlighting the benefits masks can have in reducing risk and potential chain financial gains, might not have the same stimulating effects.

Misunderstandings around masks and vaccines

The decline in immunity from vaccines and the emergence of new variants only increases the value of wearing face masks. However, the current low levels of mask wearing suggest that many members of the public still believe that wearing masks in certain situations is unnecessary.

A study of people surveyed in mid-2021 showed that many thought widespread COVID vaccination would ease the burden of wearing masks. But the risk of reinfection means that's not necessarily the case.

Health experts and government officials need to continually reach out to people to explain how effective face masks are at preventing infection, even after getting vaccinated. Reducing people's uncertainty about the role of masks and vaccines could improve their judgment.

It is important that we continue to build on the learnings so far and the behavioral nudges that have been shown to have an impact on mask wearing. However, we also need to be realistic given where we are in the pandemic. These nudges may not be enough and if there are other changes in severe COVID cases due to new variants, it is important to warn the community that mandates may be needed again.

In the words of Batman, a caped and masked crusader since 1939: I wear a mask. And that mask is not to hide who I am, but to create what I am.

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