Intended for healthcare professionals

Letters Face masks for the public during covid-19

Covid-19: face masks could foster distrust and blame

BMJ 2020; 369 doi: (Published 20 May 2020) Cite this as: BMJ 2020;369:m2009
  1. Frances M King, consultant anaesthetist
  1. Queen Alexandra Hospital, Portsmouth PO6 3LY, UK
  1. frances.king{at}

“We should advise the public to wear face masks”—Greenhalgh and colleagues detail the absence of an evidence base to support this advice and, along with Javid and colleagues, argue that population benefits are plausible and harms unlikely.12 My experience of communication difficulties while working in a hospital during the coronavirus epidemic leads me to the opposite conclusion—potential harms are likely.

As an anaesthetist, my recent workload has been largely in operating theatres. I meet my patients on the ward, where we both wear surgical masks, being within 2 metres of each other. I have found that communication is not “all in the eyes.” The many subtle facial expressions—twitches of mouth and wrinkling of nose that convey a range of emotions—are lost, and my hopefully reassuring smiles remain unseen. In theatre, I greet them in full personal protective equipment with fitted mask and muffled voice, further magnifying their fear and apprehension.

On my days off I am fortunate to take dog walks and cycle rides in quiet country lanes, and in my local shops I can keep a 2 metre distance. Yet I still get the occasional scowl when cycling, and some people exaggeratedly avoid dogs. The wearing of face masks would further foster an air of distrust and blame, with the loss of reassuring facial communication. Those not wearing masks might experience abuse or intimidation.

While the numbers infected remain unknown and potentially high, and where the confines of a workplace or means of transport make social distancing impossible, then optional mask wearing seems sensible. But requiring us all to live in a society where our faces are concealed based on an interpretation of the “precautionary principle” as there is “little to lose?” I beg to differ.


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