It is increasingly obvious that the covid regulations, at least how they are being used in England need to be reviewed. They were knocked up nearly a year ago on the assumption that would only be imposed for a few months at most after which any issues with them will have disappeared into history.  There are several issues that need to be looked at if we are going to apply rules which might actually reduce the spread of COVID-19.

Firstly, the use of face shields, for which there is no evidence that they actually stop the spread of the virus. they Scots do not allow them but insist on a cloth covering.

The issue of exemptions to wearing face coverings. As people have said it is really easy for anybody to claim an exemption based on the legal criteria and there is no need to provide proof that the exemption is valid: anybody can claim that a face covering causes them “severe distress;”. Somebody needs to evaluate these exemptions (not a GP they are not “medical exemptions”) with the burden of proof being on the person claiming the exemption to establish that they need one. Each exemption should be registered and an official card or permit issued to that person with a photograph. I know that this sounds bureaucratic but I think it will become part of the new normal. We should be working on the assumption that life will never back to exactly what it was like before March 2020.

There is more but we need to look at these as long term issues and the general consensus at WHO etc, is even after covid 19 is back under control, there are other new diseases waiting in the wings.  

We have all bemoaned getting appointments during Covid.

Before last March the local well being service had a waiting list of two years to get a "first" appointment towards an assessment - so no medical record to access. Would a place in the queue count as evidence for exemption?

Regarding positive pressured masks, in an environment requiring FFP3 levels of passive RPE, HSE allows you to downgrade to FFP2 filtration because of the elimination of face fit and contamination issues. and the added protection against infection through the tear ducts.

There are 2 things we need to clarify here,

1) an aerosol is a water droplet small enough that gravitational acceleration is completely negated by the brownian motion of the gases in air and by air currents. In countries with better track and trace than we employ, they have found aerosol infection at a distance of 6metres. The couple that contracted the virus were seated under the air extraction unit and the infected couple that dined at the restaurant were seated 6m away inline with the extraction airflow.

2) I don't recommend face visors because they are any more effective at blocking viron travel than, say,a 3ply surgical mask, I recommend face visors because of the reduction in risk of contact transfer of viral (and other hazardous) contamination from the forehead or neck to the nose, mouth and eyes.

Also, contamination of the inner surface of a visor presents far less of an inhalation risk than it does with a tight fitting mask holding the virus against the breathing passages. Issues of fibre friability and (potentially contaminated) microfibre inhalation are eliminated with a visor. Touching anywhere on the face is prevented by the visor and the ease of maintaining the visor in a sterile condition is why I would favour a visor over a mask. 

The 3D visualisation studies modelling aerosol and small droplet distribution are flawed in one aspect and the results have been cherry picked.

If we are wearing masks to protect others from our pre-symptomatic and asymptomatic viral shedding, why are we looking at models based on coughing and sneezing, which are smptoms? Surely asymptomatic spreading is mainly by small droplet and aerosol spread by talking and breathing etc? 

If they can show you the clips of the face visor result, why do you not see the video clip of a mask for comparison? They tested all the current types of face covering available to the general public, so they could have easily published a video of the best performing mask to compare. I saw some stills from the original study that showed around 1m diameter "clouds" of aerosol hanging around people's heads.

The only protection against inhalation of viral aerosol is FFP3 level of protection. Reduction of exposure by dilution of viral aerosol with air is higher up the hierarchy of control than PPE and a face visor achieves this, unlike a mask.

Edited by user 13 January 2021 04:38:48(UTC)  | Reason: misspelling

Pandatank, you may beright you may be wrong.  I for one certainly cannot definitively argue for or against the points you make.

But here is the thing; right now the WHO, English Guidance and Scottish law is that close fitting face covering and not visors are appropriate.  We collectively could fully agree with you but as of right now (much like if we agreed that 70mph was an innapropriate speed lmit for a motorway) it makes no practical difference.  The guidance not to wear visors (on their own) as a face covering still stands.

At best you are right and should share your opionions whigh whichever SAGE subgroup are looking at this issue, but as things stand we should follow the guidance until this is confirmed.

At worst, your opionion is (whilst potentially well intentioned) is wrong.  In which case you are doing what Sir Simon Stevens got so passionate about in one of last weeks press conferences; spreading information that influences people to do the wrong thing.

I like a good intelectual debate as much as anybody but all this 'why Government advice is wrong' is getting more and more futile in the face of the current state of the pandemic.  Much of legislation/guidance is fundamentally flawed (RIDDOR, DSE, CDM) and we still have to follow those too.  

"Evidence showed that the surgical mask might not be enough to protect the person from air-borne pathogens and might also be the soutrce of air-borne or droplet infection" https//www.thoracic.org/statements/resources/eoh/resp1-13.pdf

"Medical masks were not protective and may in fact increase the risk of viral co-infections.....it is further possible that the physical conditions of a medical mask may increase moisture or other parameters to increase the risk of co-infection"       MacIntyre CR, Wang Q, Cauchemez S, et al. A cluster randomized clinical trial comparing fit‐tested and non‐fit‐tested N95 respirators to medical masks to prevent respiratory virus infection in health care workers. Influenza and other respiratory viruses 2011;5(3):170-79.

https://www.cidrap.umn.edu/news-perspective/2020/04/commentary-masks-all-covid-19-not-based-sound-data

Read on the news yesterday that Austria now require FFP2 masks in public places - i wonder if they bother with face fit tests to ensure people are wearing the right size - and what about people with beards? We are not the only country where strange decisions are made.