Here is an open letter from Valerie Nelson (Mental Health Social Worker) that was sent to various social care organisations. Valerie outlines the many dangers of mask wearing, especially on vulnerable people in care homes and other social care settings.
To the CEOs and Board Members of Scottish Health & Social Care Organisations
Coronavirus (Covid-19): use of face coverings in social care settings including adult care homes – update
Over the last two years I’ve written to you repeatedly, raising significant concerns about harms caused by mask wearing (and other covid-19 management measures). Despite providing sound and world recognised evidence to support these views, I’ve had to work hard to be heard and I’ve been frequently ignored or dismissed. Most professionals and senior managers in health and social care organisations with whom I’ve had conversations agree with the concerns I’ve raised which makes it all the more disturbing that harmful practices, which prior to 2020 would have prompted urgent investigation under the Adult Support & Protection Act 2007, have been normalised and continue unchallenged. I’m not alone in struggling to understand why the Scottish Government’s policy on the continuing use of masks in care homes has not been vociferously challenged by professionals in the organisations who support and guide the health and social care workforce. We seem to have forgotten that the starting point for such devastating mitigation measures in care homes was the surge in deaths in the Spring of 2020 caused by a perfect storm of events, many of them avoidable, that will never be repeated and hopefully addressed in the forthcoming inquiry.
The World Health Organisation’s review of non-pharmaceutical pandemic management interventions in 2019 did not recommend face masks for healthy people. With no change to the scientific evidence, it is unclear as to why the WHO changed their advice in the summer of 2020, although many believe they were under political pressure to do so. In April 2020, Professor Jason Leitch categorically stated, ‘The global evidence is that masks in the general population don’t work.’ Who or what persuaded him to change his mind because it certainly wasn’t the scientific evidence? We should all be concerned that Deputy First Minister of Scotland, John Swinney and others have stated they expect mask wearing to become a normal aspect of Scottish culture.
Scottish Government and Public Health guidance on masks is based solely on advice from the WHO with no acknowledgment of the growing body of global evidence which shows that masks have little to no benefit in preventing viral spread, especially in community settings where improper use can actually increase the spread of infection. Interestingly, in December 2020 a WHO document titled ‘Mask use in the context of covid-19’ stated, ‘There is only limited and inconsistent evidence to support the effectiveness of masking healthy people in the community’; a statement clearly missed by the Scottish Government who are currently encouraging the use of masks in the community.
The assumed efficacy of masks in all Scottish Government and Public Health guidance documents is based on the argument that viruses are spread by droplets while ignoring the fact that viruses are spread mainly by microscopic aerosols which are too small for masks to act as a barrier. The role of asymptomatic transmission is also a major driver of compliance with mask wearing in healthy people. This misleading message is based mainly on early small scale reports from China which stated that 1 in 3 people infected with SARS-Cov-2 are without symptoms whereas the Scottish Government & Public Health Scotland has ignored more robust research suggesting that asymptomatic transmission contributes very little in terms of the spread of viruses. Compliance with mask wearing has also been ensured through inaccurate and fear laden messaging that an uncovered face is a threat to life and this message is threaded through all documents.
It is therefore a matter of grave concern that the Scottish Government has again extended the use of face coverings in adult care homes, thereby taking us a step closer to normalising their use. Care homes are not clinical areas, they are individual’s own homes and should be treated as such with normal infection and prevention control measures. For the majority of care home residents, care staff are in effect their family and may be the only faces they see on a day to day basis; faces they’ve not seen for two years.
It’s a matter of even greater concern that health and social care organisations have been publicly silent on this issue and seem to have failed to openly question the SG on the flimsy evidence base used to inflict this clearly harmful intervention on the very people we have a duty to protect. As pointed out on numerous occasions, by the very nature of living in a care home, every resident depends on facial expression to communicate and most will struggle to make sense of covered faces; something that common sense should tell us without any need for evidence. Even if there was some benefit in mask wearing it would still have to be balanced against risk but the option to remove masks in response to individual need is made virtually impossible by the pervasive threat of risk to self or others.
The guidance relies heavily on the use of transparent masks to mitigate problems with masks but they are equally ineffective, expensive and even more likely to cause harm to the wearer; as well as more likely to confuse individuals with any type of cognitive impairment. Care staff are instructed that masks can be removed for only a brief period in response to distress or where facial expression is important – is there any situation where facial expression is not important? However, to mitigate the risks associated with removing a mask, carers are advised to consider ‘limiting close contact and improving ventilation’. As with SG mask wearing exemption criteria, this is impossible to manage in a care setting and nothing short of potential neglect. It is ridiculous to suggest that carers can distance themselves from residents while carrying out personal care tasks, possibly with an open window on a cold or wet day. It also precludes offering comfort and reassurance when a person needs it most. This situation alone should prompt urgent action.
Mask wearing is far from a benign intervention with evidence clearly showing that wearing a mask of any type, especially over long periods of time, has potential risks to physical, mental and social health. All guidance fails to acknowledge the potential harm to those who wear a face covering for hours on end. Care staff in all care settings are highly skilled but poorly remunerated for carrying out extremely demanding work which is exacerbated by the exhausting demands created by PPE, and further complicated with managing stress and distress caused by covered faces. Despite advising that masks should be worn, the WHO’s interim guidance lists the following potential issues for those wearing masks but there are many more, especially for children:
- Breathing difficulties
- Skin lesions
- A false sense that other containment measures can be disregarded
- Communication difficulties
They also warn that there are significant negative effects on heart and lung function for both healthy people during mild to moderate exercise and those with underlying respiratory diseases. Care work is a demanding role and having done it myself for eight years as a Registered Nurse prior to becoming a Social Worker, I consider it to be in the league of moderate exercise.
The guidance makes no reference to the above harms but does encourage staff to take drinks, possibly because many organisations would not allow staff to remove their masks to drink water outside of official breaks which could be many hours in an overheated environment. Care staff drink less while wearing a mask resulting in urinary tract infections (UTIs) and other problems due to dehydration. The guidance implies that the level of risk created by a healthy person with an unmasked face is so high that any staff member who cannot wear a mask should not be in a direct caring role. The pressure to wear a mask is absolute and may be for as long as 12 hours. It is an inhumane and grossly unreasonable expectation with a total disregard for the health and safety of care staff. Is it any wonder they’re leaving when we care so little for their welfare?
The total reliance and deference to Public Health appears to have absolved professionals of their duty to recognise and report harmful practices and has resulted in the acceptance of risk averse approaches that are focussed solely on virus control at the expense of all other factors that affect mental, physical and social health. Professionals, especially social workers, are well aware that risk aversion has the potential to create more harm than the presenting risk, as has been evident since March 2020. There’s also been an unprecedented and unhealthy absence of balanced debate through the silencing and dismissal of the thousands of eminent professionals who argue against mask wearing policies (and other extreme covid-19 management measures) which has ensured compliance and fueled the appalling message that an unmasked face is a potential threat to life.
Our collective silence as professionals and failure to challenge policies which have no sound evidence base has permitted the Scottish Government to promote the continuation of harmful mask wearing practices indefinitely. Despite our robust Adult & Child protection legislation, we have failed in our duty to support and protect adults and children in this issue and others over the last two years. The responsibility to effect change rests with health and social care organisations who are the public face of the health and social care workforce and who have a powerful voice within the Scottish Government.
I implore you to urgently challenge the Scottish Government to end this illogical and harmful policy that is causing needless and inordinate suffering to care home residents, their relatives and caring staff.
With kind regards
Mental Health Social Worker.