Early in the COVID-19 pandemic, I went to a cakeshop in a nearby suburb, wearing a mask. A man in his 50s was being served. As he turned to leave, he saw my mask and asked why I was wearing it. “COVID … obviously” I replied. He then launched into a tirade, asking me “do you think it’s healthy to re-breath your exhaled breath?” “Why do you think your lungs want to get rid of it?” and suggesting that I read some basic medical science.
So I asked him why he thought it was that operating theatre staff always wore masks, sometimes for marathon surgical operations lasting many hours. He turned and left, saying nothing.
Masks are of course a basic component of COVID-19 control. With aerosol transmission being now understood as the main way the virus is spread, masks are dogs balls obvious critical to reducing transmission. The NSW chief health officer Kerry Chant is always wearing one until she begins speaking in daily press conferences. Premier Gladys Berejiklian can barely finish three sentences without imploring people to wear a mask when in crowded situations like shops or using public transport.
An infectious disease doctor or scientist who is not urging governments to make masks mandatory in public settings is a rare as proverbial rocking horse poo. Victoria, which until today went two full months without a locally acquired case, made masks mandatory as an important part of reaching that achievement.
Gladys has surely now exhausted the thesaurus of asking us nicely. She’s urged, requested, enjoined, called on, entreated, pleaded, beseeched and nearly begged us all to wear masks. But she will not yet order us to.
Her trusty lieutenant Brad Hazzard has told us that the government doesn’t want to make it compulsory on public transport because bus drivers don’t want to have to act like policemen. How lame is this? Bus drivers always “acted like policemen” when they wouldn’t let passengers on a bus in the days when they sold tickets. I’ve often seen bus drivers tell people to stop smoking, to refuse to move off the bus stop until people move down the back of the bus when the aisle was crowded, and to refuse boarding to people when buses are too full. And we also have inspectors, remember.
And then let’s not forget that bus drivers would number among the most exposed workers of all to COVID. Failure to protect their health is indefensible.
With her team having to embarrassingly writhe in public like this, what is the problem here. Why can’t the government just require it?
Across my career I’ve seen a huge number of laws and regulations passed in the service of public safety. Entire fields of occupational and environmental health, building and food standards, food service standards, pharmaceutical regulation, consumer good safety standards, health care worker competency standards and road safety are all neck deep in requirements that you often don’t find in the world’s most impoverished nations, but which are taken-for-granted in advanced nations like ours.
Public heath ethics has green-lighted all of this since the time of John Stuart Mill’s articulation in his nineteenth century writings on liberty of when it’s ethically justifiable to curtail freedoms (basically when someone’s actions may harm others). There are hundreds of ways that the nanny state is good for us.
There are also examples where governments allow and enforce laws that restrict freedoms even when the nasty consequences only affect the person concerned and not others. Car seat belts and crash helmets are two obvious examples.
Mask wearing during highly infectious pandemics is clearly an example of where the consequences of not wearing a mask can elevate the risk of harm to both self and others. Indeed, to the whole community.
Laws greatly increase compliance
There is massive evidence across all fields of public health that laws greatly increase compliance. Take smoking in restaurants as an example. Before Australia’s state governments began dominoing bans on smoking in restaurants, we saw truly bizarre efforts to stop tobacco smoke reaching the lungs of those who didn’t choose to breathe it in. There was an era when you couldn’t smoke withing two metres of a bar. It was OK at 2.01 metres, but not at 2m. This made perfect sense to the smoke which unsurprisingly couldn’t read the signs.
A non-smoking section in a bar or restaurant was like a non-urinating section of public swimming pool.
In the weeks immediately after the 2000 Sydney Olympics, I was funded by NSW Health to compare restaurant smoking rates in Sydney (where the Carr Labor government had legislated a restaurant smoking ban) and Melbourne (where the Bracks Labor government had not).
In Melbourne, across 154 hours of observations in 81 restaurants, we saw 176 people smoking out of 2014 diners. In Sydney, we saw no one smoking among 2646 diners in 78 restaurants over 156 hours.
Political urging will get us only so far with mask wearing. Making them mandatory in all shops, malls, crowded footpaths and on public transport will instantly up rates of use.
There’s plainly some visceral ideological biliousness within the NSW Liberal ranks about regulating personal behaviour. Just before I sat down to write this, I went to my local shopping mall. About 80% of women, and 60% of men were voluntarily wearing masks. Good for them and all of us. The others have had 10 months of imploring and are still ignoring it.