Other than during my time working as a nurse I had never seen anyone wearing a surgical face mask and, even then, it was only in operating theatres and by the surgeons and scrub nurses who were hovering directly over the patient. Of course, I saw builders with dust masks and had worn a respirator during the First Gulf War when we feared that Saddam Hussein was going to send chemical or biological weapons over the border into Saudi Arabia. But these were sealed fitted masks with valves; surgical masks were simply strips of material which left gaps at the sides.
My next encounter with surgical face masks was in 2003. I had the misfortune to be working in Hong Kong in the precise week that the first cases of SARS were identified. My hotel was coterminous with the shopping centre where the first case was identified. I was only there for one week but before I left people began appearing wearing surgical face masks. These flimsy types of disposable masks are meant for only very short term use in situations where droplets may move from the clinician to the patient or vice versa.
I asked senior clinical colleagues there what the evidence was that these were effective at preventing the spread of a respiratory infection and they confirmed, as I suspected, that there was no evidence for their effectiveness. I returned to Hong Kong the year after SARS, by which time the epidemic was over, but people were still wearing surgical face masks. My most recent visit was in 2019 and they were still very much in evidence.
I was also in Wuhan when COVID-19 was first identified. However, it was still being covered up by the authorities when I left, and I returned to the U.K. to find out that I had left an epidemic behind me. I told people I had travelled extensively on public transport, eaten in crowded restaurants and worked out in a gym yet, miraculously, I was still alive. But within days of my return, I saw my Chinese colleagues were all wearing surgical face masks and urging me at the end of each WeChat session to “wear a mask”. How we laughed at their stupidity. That would never happen here where we had a propensity to rely on evidence and were not driven by the ‘you have to be seen to be doing something’ mentality. How wrong I was.
There were serious discussions here and across the rest of the Western world about whether we should be wearing surgical face masks in public. People who knew how to find and assess evidence checked reliable sources such as the Cochrane Collaboration, the international gold standard organisation for assessing evidence. We found exactly what we expected to find, that there was no substantial evidence in favour of the use of surgical face masks, even in situations for which they were designed. We were also encouraged that the WHO in Geneva and the CDC in the USA were not advocating the routine wearing of surgical face masks.