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Covid-19: Masks

Volume 803: debated on Thursday 11 June 2020

Question for Short Debate

Asked by

To ask Her Majesty’s Government what plans they have to review their advice on the wearing of masks in public to address COVID-19.

My Lords, 14 weeks ago, I raised in the House the issue of masks. The Government’s response was to reject my case. I have repeatedly raised the issue. Meanwhile, nearly 60 countries worldwide have adopted mandatory mask wearing. During that period, we have registered the second-highest incidence worldwide of death and new cases. Indeed, today there are more cases in the UK, with a population of 67 million, than in the whole of Europe, with a population of 460 million. We are struggling in the UK against an avalanche of reported new cases—between 4,000 and 7,000 a day—and we have moved into second place worldwide for deaths per 1,000 of the population.

I am not arguing that our shocking record is down to PPE shortages, though I do argue that mask policy has been a major contributory factor. The Government’s whole approach to this pandemic has been riddled with miscalculation, misjudgment and mistake. Their errors in the case of the elderly, on PPE, on testing and in the dispersal of the elderly from hospitals to care homes—all unparalleled in medical history—have undoubtedly cost thousands of lives. Those responsible will never be forgiven—never.

Obsession with the herd, the abandonment of test and trace, reliance on Public Health England’s advice on testing and an early failure to take the big decisions have all contributed to this disaster. The sight last week, televised worldwide, of MPs lined up over a kilometre to vote in our Parliament has made us an international laughing stock. That is the background to this affair: the worst example of government incompetence in my political lifetime.

Last week, the policy on masks was finally rescinded. It would be churlish of me, despite what I have said, not to welcome this decision, limited as it is. I understand that, for many in government, the change would have been professionally embarrassing. One would hope that comments in the Lancet of 27 May, where it is stated that there is increasing evidence of aerosol spread of Covid-19, meaning that people further than two metres away are all at risk, help to strengthen their resolve. If that is so, why are the Government still so wedded to hesitant change at a time when the country is desperate for real action and resolve? The truth is that they should never have allowed procurement and supply to compromise their professional judgment. The policy change does not go far enough.

In setting out my case, I thank Mr Philip Collett of Banbury, who has been of invaluable help in carrying out my research. First, on the evidence of transmissibility in the absence of masks, there have been innumerable case reports. In the particularly interesting Hunan bus case in China in January, more than half the people infected were more than two metres away and three were infected at 4.5 metres. People wearing masks were not infected. In a call centre in South Korea, of 1,100 people tested, nearly 100 tested positive—that incident speaks for itself. On 10 March, the US Centers for Disease Control and Prevention reported that one person in a choir in Skagit County, Washington, infected 53 choristers, of whom two died. The virus was spread by a superspreader. This well-documented case was a clear indicator of breath-borne transmissibility. In another choir case, this time in Amsterdam and again well documented, a single chorister infected another 102 choristers. The list goes on. These and many more similarly documented cases should have alerted policy- makers to the dangers of transmissibility and the need for masks.

What has been the response of government? We now have the revised WHO guidance, which recommends mask wearing not only on public transport but in grocery stores, at work, at social and mass gatherings and in closed settings—including schools, churches and all places of religious worship. Then we have the view of the US Centers for Disease Control and Prevention, which strongly recommends the wearing of face coverings in public settings including stores and pharmacies. We have the Royal Society’s working group now strongly supporting masked protection. We also have the comments of KK Cheng, professor of public health at Birmingham University, who charges that without masks we have no defence whatever against asymptomatic superspreaders.

We then have the views of Professor George Gao, who heads the Chinese Center for Disease Control and Prevention. He is a highly respected veterinarian with an Oxford PhD in biochemistry. He did his post- docs at Harvard, specialising in immunology and virology. He states:

“The big mistake in the US and Europe, in my opinion, is that people aren’t wearing masks.”

You have to wear a mask, otherwise droplets come out of your mouth when you speak. He continues: 

“Many people have asymptomatic or pre-symptomatic infections. If they are wearing face masks, it can prevent droplets … escaping and infecting others.”

He has co-authored papers in the New England Journal of Medicine and the Lancet. Researchers at the National Institutes of Health used lasers to demonstrate transmissibility at up to five metres—that is with people without symptoms. That is said to be responsible for half of all cases. Now we have the BMA view. Again, I quote:

“Given there remains a considerable risk of infection … wearing masks can reduce the spread of the virus … measures should not be restricted to public transport but to all areas where social distancing is not always possible - the risk will be much less if the public adopts this now - not mid-June … the Government should ensure a supply of face coverings for the public, similar to practices in other nations.”

Yes, that is the BMA. The Government say that they go on the advice of experts; now they have it in that presentation.

On 14 May, 100 of the world’s top academics released a statement asking for mask wearing in all public places. During our researches, we were able to identify over 80 highly reputable research sources pointing to the use of masks in reducing onward transmission. I was particularly interested in the suggestion of the noble Lord, Lord Skidelsky, about distributing disposable face masks to all households, because it brings us to the nub of the problem. There can be no doubt that the failure to organise procurement, and inadequate mask-manufacturing capacity in the United Kingdom, have influenced policy.

To put it simply, in wartime the Government direct; we are in a war, with hundreds of thousands of lives lost and many more at risk, yet our approach to procurement has been appalling. We need a Beaverbrook Ministry of Supply, not a Hancock. Ministers are far too preoccupied with hiding behind preconceived views on virus transmission. They should spend more time more accurately interpreting reports from the Covid-19 Mobility Data Network.

Where do the public stand? In this debate, YouGov’s recent polling shows that 73% want compulsory masking in shops and 64% want masking in crowded spaces, such as town centres. The public are not stupid; they live in the real world. So where do I stand? I believe that a combination of track and trace, vaccination and masks will bring it all under control and avoid a second wave. We should have mandatory masking in offices, shops, schools, libraries, factories, hotels, pubs and garages—indeed, all confined areas apart from, obviously, one’s own home. A combination of these measures should bring it all to an end.

Finally, in Stop Press, I hear that only yesterday a Cambridge University modelling study, backed by considerable data, called for the immediate and universal adoption of face masks by the public. It stated that if widespread face-mask use by the public is combined with physical distancing and some lockdown, it may reduce the all-important R factor and offer an acceptable way of managing the pandemic, while reopening—before there is a vaccine—economic activity. That is all we want; let us just all get on with it.

I think the debate is no longer about face masks. We accept that there may be shaky evidence that they are needed, but what we need to debate is when they should be worn and what sort of face mask? The overall European opinion is that they need to be worn in enclosed spaces and where people are together for a minimum of 10 minutes, because that is where the danger lies. I hope that we will look into this and not talk just about face masks. There are different types, with different levels of effectiveness. I would like the Minister to comment on what is going to be done to get them distributed. This morning, at King’s Cross station there were no face masks; at St Pancras, they were being given away free; and in Cambridge station, there were none. What do HMG have in the way of plans to distribute face masks and to look at the quality control of the types of masks that are going to be used?

My Lords, many people now wearing masks may feel that they are protecting themselves. The WHO makes it clear that any role non-medical masks have is to protect others. It advises Governments to adopt a comprehensive strategy to suppress transmission. Only where physical distancing is difficult should Governments encourage the public to use non-medical fabric masks.

In the UK, people have been asked not to buy medical masks so that they do not deprive the NHS and care sector. Will the Government therefore stop companies from advertising these masks, for example in newspapers? The care sector still reports not being able to get adequate PPE, especially via Clipper. When will there be sufficient? Are the Government building reserves of PPE for a second wave of the infection? These issues must be addressed if the risk of coronavirus is genuinely to be reduced.

My Lords, I welcome the Government’s decision to make mask wearing compulsory on public transport from 15 June, but I believe that this needs to be accompanied by two further measures. First, mask wearing should be encouraged by distributing free masks to all households. Japan and Turkey have done just that. Secondly, the recommended measurement for social distancing should be cut. We are now almost alone in asking for two metres. One metre is the distance recommended by the WHO; Austria, Germany and Holland advise 1.5 metres; and Hong Kong, Singapore, France, Italy and China advise one metre. Our Government have made no effort to test the trade-off between social distancing and wearing masks. The noble Lord, Lord Bethell, admitted on 1 June in his reply to a Written Question that I asked:

“No assessment has been made of the change to a face covering’s health benefit when social contact is at two, one and zero metres.”

Common sense suggests that wearing a mask reduces the distance you should keep from someone else. Giving people the confidence to interact normally is the key to reopening schools and to economic recovery.

My Lords, I am pleased to be here supporting the increased use of face masks in public—so ably argued by my noble friend. In his argument, which he made with conviction and authority, he used evidence, information and knowledge to make his case. I want to highlight two of his arguments.

First, he gave us an indication of the bodies that support the increased use of face masks—the BMA, the World Health Organization, the Royal Society, the Lancet, and so on. Then—this is critical—as further evidence, he cited 80 research sources worldwide that found that wearing a face mask increased the success rate in the battle against Covid-19.

My Lords, can my noble friend the Minister say what work is being done with health experts to ensure that face coverings on sale are in good supply, of sufficient quality to stop the virus spreading, and affordable? I looked online yesterday for sales of face masks and saw that some well-trusted high-street retailers now have non-surgical masks in stock—but they are not cheap, especially for those on lower incomes and for those who need to use masks on public transport every working day, perhaps for many months ahead.

Finally, I watched online as Members of the House of Commons voted yesterday and noticed that some wore masks. Has advice to parliamentarians been changed to permit or indeed encourage the wearing of masks while on the Parliamentary Estate?

My Lords, this debate, as well as the one introduced last week by the noble Baroness, Lady Anelay, and the one earlier this afternoon are really opening this House to ridicule, with the lack of ability for us to debate some of these important issues properly.

I live in the Scottish Borders and from next week we will begin to see people again travelling across the border frequently or every day on public transport for retail purposes or for business or securing public services. From next week, those people will also have an unacceptable level of uncertainty over the guidance, legal requirements or ministerial requests on the use of face coverings if they are under 60 or medical face masks if they are over 60. Therefore, I want to ask the Minister a very specific question. Next week, what will be the law—not guidance or ministerial requests—for those crossing the border on public transport to secure public services without being able to socially distance and for those carrying out business activities?

My Lords, this is the Government’s history on the issue of face masks. On 6 March, NERVTAG expressed concern that the public did not understand why face masks were acceptable for healthcare staff but not for them. The minutes explained that, unlike the public,

“healthcare staff are trained to use the masks and know when to change the masks when they become soggy or contaminated.”

In the remainder of March, as lockdown measures were introduced, face masks were not discussed. On 7 April, NERVTAG concluded that the increased use of face masks would have minimal effect on stopping people becoming infected. SAGE agreed. There was no further mention of face masks in SAGE until 11 May, when the Prime Minister issued advice that the public should wear “face coverings” in enclosed public spaces. On 4 June, the Transport Secretary said that face coverings would be mandatory on public transport from 15 June.

I support the use of face masks, but what on earth is the scientific rationale that justifies this handbrake turn in policy? We cannot expect people to know what they are doing unless the Government explain what they are doing. Until they do so properly, people will conclude that the Government do not know what they are doing.

My Lords, it seems that there are two ways to protect oneself and others from the virus. One is distance and the other is face masks and hand washing. Face masks seem to give limited protection to the wearer of the mask from inhaling the virus from others, while giving much more protection to others who do not get exhaled upon. The further the distance the lower the risk, and that risk increases until one is up really close. If two metres is regarded as the safe distance without a mask—except in closely confined public transport—then it seems a no-brainer to reduce the distance to one metre and insist on face masks for all out in public, as the noble Lord, Lord Skidelsky, said. This is a sensible compromise, giving as little risk as possible while opening up the economy. Therefore, we should reduce the distance to one metre and make it compulsory to wear a mask.

My Lords, as we relax the lockdown, the Government have the opportunity to put forward a triad: wash your hands, keep your space, and wear a mask. In doing that, they will not only assist the relaxation, but continue to make clear to the public just how important it is to take the necessary precautions. When we come to precautions, I have a question for the Minister: supposing the wearing of face coverings had been essential—even compulsory—in all the care homes in this country, how much more successful would we have been in preventing the quite tragic number of deaths that have occurred there?

My Lords, I congratulate the noble Lord, Lord Campbell-Savours, on the excellent way in which he introduced this topic. While it is important to understand that the wearing of the face mask offers only slight protection to the wearer, it will offer a degree of protection to others, especially where social distancing rules become difficult. It is also important to understand that we need protection against those who may have the virus without realising it. A face mask worn by a carrier will reduce the chance of the spreading of the infection. A rudimentary mask or scarf is better than nothing; common sense requires that we must use all means if we are to defeat this deadly virus.

My Lords, I will start with a simple question because, like all those who have spoken, I am not clear as to the Government’s evidence or why they are hesitating to recommend the widespread use of face coverings across the board, not just for public transport. There is one question that has not been answered: have the Government had discussions with the security services, the police or other law enforcement bodies on whether they have views on the implications of people being at large, out and about in public, wearing face coverings? I wonder whether that is one of the reasons why they are hesitating so much. I join with others in saying that we need to reduce the social distancing rule to one metre so, if face coverings are the way to go, perhaps we need to find some other ways of reassuring those who are concerned about crime.

I am grateful to my noble friend for giving us this opportunity to discuss another government U-turn. Originally, masks were not recommended: we were told that they were counterproductive, ineffective and would produce a false sense of security. What has changed and why? Is it advice from SAGE, Dominic Cummings or a focus group?

I have four questions for the Minister. First, will sufficient masks be available for those who are now required to use them? Secondly, what measures are there to make sure that the masks available to the public are of an appropriate quality? Thirdly, will there be a kitemark so that the public know whether what they are buying is of good quality? Finally, what are the Government doing to prevent retailers hiking up prices and making excessive profits on the masks they sell?

My Lords, there is a significant difference between cloth coverings that can be reused and disposable face masks. Will the Minister commit to explaining clearly to the public how cloth coverings for faces can be disinfected to ensure that there is no accidental spread of the virus?

We have compulsory mask wearing for NHS staff on 15 June at all times. At the daily rate at which the NHS uses face masks, are there enough masks? The Government announced on 28 May that all dental practices would open as normal from 8 June. They also have to source masks, competing with hospitals and care homes.

What about the general public? An article in the BMJ raises the ethical question: should the Government apply the precautionary principle and encourage the wearing of masks on the grounds that we have little to lose and maybe something to gain?

There are four key messages on Covid-19. The precautionary principle is to act without definitive evidence. It is contested that wearing masks will reduce transmission, and limited protection could prevent some transmission, but because it is such a serious threat, the wearing of masks in public should be advised under the precautionary principle.

My Lords, as my noble friends Lord Duncan of Springbank and Lord Balfe said, there is a great deal of confusion among the public about not only the wearing of face masks but what constitutes a suitable face covering. For example, does a cotton scarf constitute a suitable face covering? I hope that my noble friend the Minister will tell us that there will be ample publicity to ensure that the public know exactly what is what.

My Lords, the University of Cambridge has just said that we have little to lose from the widespread adoption of face masks, but the gains could be significant. On 15 June, face coverings will be mandatory on public transport in England. On 5 June, the WHO updated its guidance on using face masks.

Does the Minister agree that the reduction of social distancing from two metres to one metre is really crucial now? The risk goes up from 1.3% to just 2.6% by doing so. Denmark has moved to one metre, as have France, Singapore, Hong Kong—I could go on. From a business point of view, one metre could be the difference between survival or bankruptcy. A pub or a restaurant can operate at barely 30% with two-metre social distancing; with one-metre social distancing it can operate at more than 70%. With one-metre social distancing, we can get four times as many people into any space than with two metres. The difference between opening or not is for not just the hospitality sector, which employs 3.5 million people, but schools, theatres, cinemas and universities. The wearing of masks on public transport can add to making one metre even safer. For the sake of our economy and livelihoods, could the Government please bring social distancing down from two metres to one metre immediately?

My Lords, I too welcome the Government’s sadly rather late decision to advise the mandatory wearing of face coverings on public transport from next Monday. The Mayor of London had recommended this two months ago at the height of the pandemic, when drivers were already dying.

I asked on two occasions in late April when Ministers would consider encouraging the public to wear coverings, only to be told that there was insufficient scientific evidence to do so. Surely the Government must regret taking so long to make this recommendation. No one is suggesting that masks are a cure but, as SAGE said on 20 April:

“Wearing facemasks outside the house could complement existing government messaging of social responsibility”.

They could have helped to provide protection from others who showed no symptoms but were infectious. It is regrettable that the Government have again been too slow to act, disregarding lessons from abroad.

Back in March, we were told by the Health Secretary, Matt Hancock, that the science behind the general population wearing masks was “extremely weak”. At the same time, the WHO said to wear masks, and Germany and the others followed. Two months later, based, presumably, on new evidence that no one has seen—if, in fact, there is any evidence at all—we have advice on transport and hospitals; I am not sure about advice for care homes, or whether they have been forgotten again. The WHO continues to advise 1-metre distancing, and that is immediately followed by France, Italy and the others. Meantime, we poor souls have to stick with 2 metres, and a whole host of queries around why the WHO advice is yet again being ignored. Frankly, this is not acceptable.

On a related issue, can my noble friend confirm that there is no longer any out-of-date PPE in the NHS and care home delivery pipeline, and if there is, when that will no longer be the case?

To the matter at hand, it is clear that if one wears a face mask, it does not stop one getting the disease, but it prevents others getting it. To that end, would the Minister agree that, logically, if we all come together and wear face masks, we will all necessarily stop each other getting the disease? Does he agree that it is time to mask up and make the difference? It would enable us to drop 2 metres to 1 metre, get the economy back up and get kids back in school—they desperately need to be learning. If the Government want a line for it, does he agree that it is time to come together as a country, mask up, cover up and kill Covid-19?

We all know how indebted we are to certain centres that care for rough sleepers. But, unfortunately, some of these centres are unable to function and, shortly, folk who need help will have to go by public transport. They go a lot from the west to the east. This morning, the Whitechapel Mission served over 300 breakfasts. People travel, and they have to travel on public transport, so who is going to be responsible for giving these folk fresh, clean face masks to face the day? Is it going to be the local authority, or the Government themselves?

I congratulate the noble Lord, Lord Campbell-Savours, on his persistent campaign, and only wish that the Government had acted earlier. We knew in April, from Jeremy Howard’s research, of the significant effect that mandatory face masks had in Austria and Czech Republic. A new German study finds that masks reduced reported infections there by 40%. Lives will still be saved in the UK if mandatory mask wearing is extended to other public spaces. That is particularly important in those areas of the country where there is still a high rate of infection, and local authorities should be involved.

Will the Government ensure that masks are worn on station platforms and concourses, by all station staff, as well as those on trains, and by the British Transport Police, who should be seen to set an example? Will this measure be extended to shops, where close contact with people is often unavoidable, as well as to restaurants and pubs providing takeaways? Current guidance for restaurant staff does not recommend face masks for Covid-19. Will that be urgently reviewed?

My Lords, I grew up in a world where the only wearers of face masks were bank robbers, sexual deviants and the Lone Ranger, in a mining community where the underground workforce would have benefitted from wearing face masks, but did not, and paid the price. It seems now that, in many situations, masks will be mandatory, yet not long ago, we were informed by Public Health England that face masks were worse than useless outside of clinical settings. The subsequent volte-face, inconsistency across the devolved Administrations, and publicity given to more draconian recommendations by the World Health Organization are confusing and damaging to essential credibility and trust. Whatever the veracity of the mask concept, if we want the public to take our advice, then the message needs to be bold, clear and, above all, consistent until the pandemic is over. At that time, I trust that non-clinical masks will be worn only as a fashion accessory, and by those with unusual hobbies.

My Lords, I understand that the noble Lords, Lord Pendry and Lord Wei, have withdrawn, so I call the noble Baroness, Lady Barker.

My Lords, on 4 March, the government advice on face masks was that they do nothing, so do not wear them. On 17 April, the advice was that they do more harm than good, and on 11 May, it was that wearing one is an added precaution. As of 4 June, wearing them is to be compulsory. In that time, the science did not change but the death toll rose. Why have the Government failed to distinguish between PPE standards necessary in acute treatment settings and masks which are suitable for people using public transport? Why, given this record, should the public trust them during a second spike?

My Lords, there is strong scientific evidence to support the obligatory use of face masks as part of a strategy to fight Covid-19. To name a few examples, as mentioned by my noble friend Lord Campbell-Savours, there is the modelling survey published yesterday by the Universities of Greenwich and Cambridge; the compelling evidence from Japan, Hong Kong, South Korea and Germany; and evidence that shows that droplets can linger in the air for tens of minutes, which potentially rides roughshod over the effectiveness of measures for queueing in shops. With shops reopening on Monday, social distancing will become harder. The government advice is to wear a face covering where social distancing is not possible, especially indoors, but when we decide to go to a shop, we will have no idea how empty or busy the streets or shops will be. Rather than the government advice remaining vague and weak, should the advice not now be strong and clear: wear a mask to protect others and their mask will protect you?

My Lords, first, I thank the noble Lord, Lord Campbell-Savours, for his very cogent presentation. I have several questions for the Minister. The first relates to supply: do we have enough, and enough for venues other than transport? If it is right for transport, it is hard to see why it is not right for religious buildings, town centres, shops and so on. As others have said, surely that is the case. We need to make sure that masks are of an appropriate quality—is that being monitored? We need to make sure that appropriate publicity is given to this.

As a country, we seem to have been a bit too leaden- footed in our response to this. To get the R rate down, we clearly need face masks in all sorts of venues. I hope that the Government will proceed with this, and I look forward to hearing from the Minister on those specific questions.

I do not intend to tell the Government what they should be doing, but I hope that they are following the science. In Germany, Berlin is not mandating or requiring the use of face masks, unlike some other regions, such as Saxony, which are. Are the Government evaluating any difference in the prevalence or death rate in Berlin compared to, say, Saxony, where the policy on face masks is entirely different?

Some football clubs are now producing their own face masks. Can we anticipate, at some stage later this year, socially distanced spectators at outdoor sports, such as cricket and football, wearing face masks in order to watch their favourite team?

My Lords, I very much welcome the chance to enter this debate. If there are powerful reasons now for wearing face masks, I think it is up to the Government to give very clear, practical guidance to members of the public as to what kind of face mask they should use. I feel that single cloth masks are probably worse than useless, but I would like guidance on that, as well as guidance on actually using them. On my limited excursions outdoors, I have seen people take them on and off, and touch their faces. I wonder whether this really makes it difficult for them to be as hygienic as they should be. Finally, I think we need guidance on their disposal. Are they to be the type that can be washed thoroughly, and if so, how? If they are to be disposed of, are they to be disposed of very safely indeed? I hope that the Minister will be able to give us some real guidance on these matters.

My Lords, there is evidence that wearing a mask can reduce the risk of transmitting and succumbing to infection. The most precise that I have seen is from the US Centers for Disease Control and Prevention, which states that if a Covid carrier wears a mask and a close contact also does so, the risk of contagion is a mere 1.5%. I wonder why the Government are not giving more clarity on the use of masks. I also wonder whether there have been discussions on potential protection from masks making school openings possible. It may be difficult to insist that younger children wear masks, but surely older pupils and staff can. This will be essential if lessons cannot be outside or classrooms cannot have good ventilation. Will the Government, while relaxing some of the measures, enforce the wearing of masks more widely? The wearing of masks is an important issue, and I thank my noble friend for raising it.

My Lords, in support of the noble Lord, Lord Campbell-Savours, I call on the Government to give explicit instructions about the mass use of masks in all public spaces, including community organisations, retail and the hospitality sector. In countries where masks are mandated, the infection rate appears drastically lower. How will the Government ensure that local health and community organisations are given adequate supplies, particularly for households in areas deemed vulnerable and disadvantaged by low income? Finally, I acknowledge Edmund Yeo from the Chinese Information and Advice Centre, Yisha Xieu, Emma Zhong and the Beijing association for enabling me to distribute thousands of masks to vulnerable women in the East End of London.

My Lords, it has been announced that from 15 June anyone travelling on public transport must, as a rule, wear a face covering. In addition, all hospital visitors and outpatients will have to wear a face covering and all staff will have to wear surgical masks at all times. The WHO has now revised its guidance relating to the wearing of masks. Will the Minister comment on the recent announcement by the WHO and on whether we should make it compulsory for face coverings to be worn by everyone where social distancing is not possible, as advised by the BMA? As someone who wears a face mask all the time when I go out, I would like us to follow the BMA’s advice. I also feel that the social distancing rule should be reduced from two metres to one metre. Lastly, we need to ensure that face masks sold in the market are of appropriate quality.

My Lords, the serious failure of the Government over face masks lies in communication. They have been neither clear nor consistent, which makes the situation all the worse. Wearing face coverings when you are out, travel on public transport or go shopping helps stop the spread of this terrible infection. Business wants to get back to work and our economy needs to start moving again, so we need a secure supply of non-medical face coverings and a proper communications plan. We need a clear, consistent message broadcast from the Government on social media, national and local government websites and terrestrial television channels and through civil society: “Wear a face mask when you leave your home as we ease lockdown. You will help stop the spread of this terrible disease, help save lives and help our country get back on its feet.” That should be the clear and consistent message.

My Lords, the advice of the World Health Organization is very clear: wearing a face mask or face cloth protects the wearer against any infected person and prevents an infected person infecting another person. Does my noble friend therefore agree that wearing a mask can help and that the guidance from the Government could and should be clearer, particularly on the use of masks in restaurants and hospitality in addition to on public transport? Will my noble friend agree to extending the guidance to the wearing of gloves by all of us, further to protect the wearer and others from being infected or from infecting surfaces, where we know the infection can remain for a long time?

My Lords, as we have heard, the Government’s policy on wearing face masks has been shambolic, like much of their response to Covid-19. My wife and I went into voluntary lockdown on 14 March, and if the Government had brought lockdown forward similarly, tens of thousands of lives would have been saved. The president of the Royal Society has pointed out that mask-wearing countries have a much lower rate of transmission of Covid-19, as has been mentioned. The evidence for wearing masks is now overwhelming. I shall ask the Minister two questions. First, where does he expect people to buy the masks required to travel on public transport et cetera? Secondly, will Her Majesty’s Government, like some other countries, be handing out free masks at railway stations and shopping outlets, as some noble Lords have suggested?

My Lords, a speed dating debate such as this one at least ensures brevity. I congratulate noble Lords. There is a theme to the questions: our regret at another issue that exemplifies the Government being slow to act. Is this yet another policy announced without discussion with the devolved Administrations?

Two months ago, Labour backed the Mayor of London’s call for face masks on public transport to be compulsory. Two months ago, we raised the issue of bus drivers needing PPE, and asked whether buses should still run if there is not sufficient PPE. Does the Minister know the answers to these questions, and is he aware of the vulnerability and risk to bus drivers? We must wear masks on public transport from Monday, but who will enforce this policy, and who will help those who forget to bring their masks, forget to put them on, or cannot afford them? We need a comprehensive transport policy, to get our public transport moving, to protect staff and to protect passengers.

My Lords, may I just see whether the noble Lord, Lord Rennard, is available before we come to the Minister? No, I think he is not. In that case, I call the Minister.

My Lords, I thank the noble Lord, Lord Campbell-Savours, for raising this important issue. I pay tribute to his passion and perseverance on the issue of masks. I thank all noble Lords who have contributed to this debate for their thoughtful comments, which I will tackle at pace. I apologise if I am unable to namecheck each contributor or address each question as I would have liked.

As we ease lockdown restrictions, the debate on these non-pharmaceutical interventions is key, and I very much welcome the debate and the points raised. As for our strategy, the noble Lord, Lord Campbell of Pittenweem, suggested a Covid-19 defence triad, which I welcome, but our triad, which the Government support, is, first, one of social distancing; secondly, one of hand hygiene; and thirdly, one of isolation. This triad offers the best protection from the spread of the disease. These three measures are our priority and our advice on face coverings does not negate this.

The noble Lord, Lord Campbell-Savours, asked what plans the Government have to review their advice on this issue. Noble Lords will be aware that last week the Government made two announcements on the use of face coverings in specific situations. On 4 June, the Transport Secretary announced that the Government will work with transport operators to make it mandatory for passengers to wear face coverings when using public transport in England from 15 June. On 5 June, the Health Secretary announced that all hospital staff in England will be provided with surgical masks, which they must wear, and that all hospital visitors and outpatients should also wear face coverings from 15 June.

Many noble Lords, including the noble Lord, Lord Bilimoria, and my noble friend Lord Blencathra, provided interesting and well-considered ideas on the exact distance that we need to enforce in our social distancing policy. I assure noble Lords that we will continue to review the evidence on social distancing, and on the question of one or two metres, we will be led by the science and the advice of experts on any changes to this policy.

On 11 May, the Government issued their first set of guidance on the use of face coverings. Informed by the scientific evidence, we advised that, if they can, the public should wear a face covering in enclosed spaces where social distancing is not always possible and where they will come into contact with others they do not normally meet. This announcement and the accompanying guidance from Public Health England came after a careful review of the latest scientific evidence by the Scientific Advisory Group for Emergencies, SAGE. The noble Baroness, Lady Northover, makes an important point about the risk of cannibalising the supply of masks to the NHS.

In reply to my noble friend Lady Anelay, I also commend the work of my noble friend Lord Deighton, who is charged with securing a resilient supply of PPE; the progress that he has made is impressive. I assure the noble Baroness, Lady Northover, and my noble friends Lord Holmes and Lord Bourne that his work, and the hard work across all NHS procurement, has ensured that we are now confident in stocks and sources of supply of PPE to meet the needs in health and social care over the next 90 days. We also continue to pursue contracts for additional stock both to manufacture and to purchase.

My noble friend Lord Balfe and the noble Lords, Lord Skidelsky and Lord Harris, raised the important issue of the distribution and supply of face masks to the general population. Our guidance has been and remains proportionate to this evidence, and we have been clear that a face covering is not the same as a surgical mask or respirator used by healthcare or other workers as PPE. These should continue to be reserved for those who need them to protect against risks in the workplace. I emphasise that it is a considerable challenge for the Government to undertake responsibility for the distribution of masks to the whole population.

In response to the noble Lords, Lord Palmer of Childs Hill and Lord Bilimoria, I want to explain that the principle of “There is little to lose” is not one that we subscribe to. If we support measures that do not work, we create a false sense of security and distract from the measures that really do work.

My noble friend Lord Duncan made a critical point about the hygiene of masks and the danger that they can be a vector for infection. A badly maintained or dirty mask, or a mask that is handled badly, can be a dangerous object that spreads disease. We have published guidance to show people how to properly remove masks and wash them. None the less, the public can and should wear face coverings that they make at home. Accordingly, the Government have provided advice online on how to make these using scarves and other textile items. The advice on face coverings was in addition to the key advice about maintaining social distancing and washing hands regularly, which has proven to be crucial in preventing the spread of this deadly virus. We have been clear that wearing face coverings cannot replace those important practices, and if you are symptomatic then you must self-isolate.

In relation to workers in numerous sectors, including public transport, we advise that they continue to follow the advice of their employers and make sensible workplace adjustments. I welcome the comments by the noble Lord, Lord Skidelsky, on this.

Since that initial advice we have continued to review our position, consider the evolving context in the UK and refine our approach accordingly. However, we should note that, whatever we would like to be the case, the available evidence on the efficacy of face coverings has not moved substantially from the initial advice.

I want to update my noble friends Lord Naseby, Lady McIntosh and Lord Sheikh that in recent days the WHO has updated its advice to encourage the wider use of face coverings in public settings, but it has been clear that

“the widespread use of masks by healthy people … is not yet supported by high quality or direct scientific evidence”.

Evidence from the Scientific Advisory Group for Emergencies suggests that face coverings may help to reduce the risk of transmission if you are suffering from coronavirus but not showing symptoms. SAGE also advised that using cloth masks as a precautionary measure could at least be partially effective in enclosed spaces, such as public transport, where social distancing is not possible.

In continuing to take a risk-based and evidence-led approach to guidance, the Government have continued to adapt our guidance proportionately to the science. In answer to the noble Lord, Lord Purvis, I say that it remains guidance, not law. As lockdown restrictions ease, more people will now come into contact with others and there may be incidences where social distancing is more difficult to maintain consistently. For example, as the noble Baroness, Lady Thornton, mentioned, we expect that more people will leave their homes to make essential journeys, returning to work if they cannot work from home, and some children are returning to school.

While we encourage the public to walk, cycle or drive, this may not always be possible and we can expect the transport network to become increasingly busy. That is why, on 4 June, the Government announced that we will work with transport operators to make it a requirement for passengers to wear face coverings when using public transport in England from 15 June. On board public transport is a space in which it is less easy to socially distance, and people may spend extended periods of time in close contact with others they may not normally meet. The Government remain clear that social distancing and hand hygiene remain the most important ways to guard against the virus, but face coverings may help to prevent individuals who have coronavirus but are not presenting symptoms from spreading it to others.

The noble Lords, Lord Campbell-Savours and Lord Mann, the noble Baroness, Lady Healy, and others shared helpful interventional anecdotes. But the consensus in scientific literature is that the evidence base for the effectiveness of face coverings is inconclusive. Mandatory face covering specifically on public transport is the approach taken in a number of countries, including France, Germany and Italy. Although face coverings are more habitually and widely worn in public in some countries, such as China or Japan, the evidence remains inconclusive around their widespread efficacy in protecting individuals from Covid-19. In answer to my noble friend Lord Blencathra, I say that there is no evidence that these masks are interchangeable with other measures in the triad.

The Government have recognised that, as we bring the overall incidence of Covid-19 down, it is important that we cut down on infections passed on in hospitals. We have noted the evidence that healthcare workers are 10 to 20 times more likely to be Covid-19 positive than the general public. In light of this learning from NHS hospitals and IPC teams, the Government announced on 5 June that all staff in hospitals in England will be provided with surgical masks, which they will be expected to wear from 15 June. NHS staff already wear face masks in clinical areas where they come within two metres of a patient. But this new guidance will apply to everyone working in all areas of hospital, including non-clinical settings. Furthermore, all visitors and out-patients will be expected to wear face coverings at all times. These are measures that some organisations have already started to adopt. We are clear that this will not mean that anyone is denied care. If necessary, a mask will be provided for a patient if they arrive without a face covering.

Detailed guidance on these measures will be published this week to enable hospitals to get stocks and put plans in place; we are confident in the stocks of face masks needed to meet this new demand. We also continue to pursue contracts for additional stock, both through manufacture and purchase. The noble Lord, Lord Campbell-Savours, asked at the start of this debate what plans the Government had to review our advice on face coverings. As I have set out, we continually review these measures, evolving them as we have from 11 May by continuing to follow the evidence and the scientific advice. We will therefore continue to review this latest iteration of advice too. As I have set out, the Government will always look to the scientific evidence and advice we are given in continually reviewing and refining our guidance.

I thank the noble Lord, Lord Campbell-Savours, who has pushed hard on this important issue and rehearsed these important arguments. As the pandemic evolves and the science develops, he will have an impact on our understanding of this important issue.

Sitting suspended.