I'm an ER doctor, so it's time to start wearing masks again… as experts issue dire warnings about a virulent new Covid variant

It is that time again. No, I don't mean New Year's and resolutions: I mean mask time.

I can hear the universal groan. But if you want to spend the winter without an irritating cough that rattles through your chest day and night (you know, the one that makes the rounds in the office or at the grocery store) or that gnawing ache in your entire body, where even your hair hurts, wear a mask.

I always wear one in crowded places, but on a short flight back in the fall I forgot to bring one. The plane was full of coughing fits and, unsurprisingly, a few days later I became unwell with what turned out to be a four-week viral illness.

It coincided with a long-awaited knee surgery, which almost had to be canceled because those with coughs had chosen not to wear masks and instead spread their viral droplets to the rest of us.

Fortunately, I was able to turn the corner just in time – the operation continued – but since then I have never forgotten my mask.

Now one of Britain's leading experts, Sir Andrew Pollard, professor of infection and immunity at the University of Oxford, predicts 'a rise in the number of (Covid) infections in the population over the course of the next week', driven by a highly contagious strain of the virus known as JN.1.

Considering the rising number of Covid-19 cases and viral infections as we happily socialized over the holidays, you'd think masks could play a big role in keeping us safer.

Because despite the confusion over the pandemic mask messaging caused by the government and its senior advisers (the then deputy chief medical officer Jenny Harries), Boris Johnson told No 10 fireside chat video in March 2020 that wearing masks 'wasn't a good idea'), the consensus is now clear: masks help prevent the spread of infections by droplets and by viruses and bacteria.

An article published in the BMJ in May 2020 about a retrospective study of 335 people found that masks are 79 percent effective at reducing transmission from infected people to others.

They also prevent you from contracting viruses – a study in the Journal of Medical Devices and Sensors in February 2021 found that 'correctly wearing masks of all types… reduces the overall risks of Covid-19 infection and increases the overall risks '. protection against the coronavirus'.

A few weekends ago I was in the emergency department, returning to clinical work (doing my PhD) after a break. The last time I was there was two winters ago, during the second wave of Covid.

When I entered the emergency department, it was as if time had stood still; people being swabbed for viral infections, many of whom test positive, and patients with breathing problems brought in by ambulance – many of whom are elderly and vulnerable.

It brought back painful memories, and my legs felt the same feeling of weakness I had when caring for my father as he struggled to breathe due to Covid-19. I nursed him for five days until he died.

This time it wasn't just Covid-19: today we're dealing with respiratory syncytial virus (RSV) and influenza, adding to the virus cocktail floating around us and overwhelming emergency departments.

And the numbers confirm this; According to the latest figures, for the week of December 11 to 17, the number of patients visiting their GP for flu-like illnesses increased by 19 percent compared to the previous week, while hospital admissions for flu rose by 77 percent.

In mid-December, Mary Ramsay, the director of public health programs at the UK Health Security Agency (UKHSA), warned: 'Flu levels are starting to rise, so get your vaccine now to stay strong for winter.' She said she didn't socialize with others when she wasn't feeling well, but made no mention of masks.

In contrast, the US equivalent of the UKHSA – the Centers for Disease Control and Prevention – states in its flu prevention advice that those infected “are asked to wear a mask to protect others, but a mask can also protect the wearer.”

And now Covid-19 is back in the news: 4.2 percent of the population – equivalent to 2.5 million people – tested positive in England and Scotland on December 13, up from 1.8 percent at the end of November.

Just days before these figures were released, the World Health Organization (WHO) announced that JN.1, a new 'variant of concern' from Omicron, had been classified – likely the strain that would cause the rise in numbers predicted by Professor Pollard.

Its rapid spread is leading the WHO to implement “universal masking in health facilities” and “provide ventilators and other personal protective equipment to health workers caring for suspected and confirmed Covid-19 patients.”

Singapore's Ministry of Health said in a press release on December 15 that it “strongly encourages the public to wear a mask in crowded places even if they are not sick, especially indoors, or when visiting or interacting with vulnerable people.”

It also strongly advised those who were feeling unwell and had symptoms of Covid or other respiratory infections to wear a mask when going outside.

Meanwhile, in Britain, Professor Steven Riley, the director general for data and surveillance at UKHSA, said people with respiratory illnesses, including Covid, should limit contact with others, especially older or vulnerable people. But he wasn't talking about masks.

I find it remarkable that the Singapore government has distributed over nine million masks to its 5.6 million residents during the pandemic, giving every household access to four reusable masks.

Singapore's infection rates and deaths – during the pandemic and now – have been much lower than ours. The economy has not been hit in the same way either.

In Asia, masks have long been accepted as a mutually protective act of social respect within the community. Its use – especially in Japan, China and Taiwan – predates Covid-19 and dates back to the 1950s to protect against pollution. Use took off in 2002 following the deadly outbreak of acute respiratory syndrome (SARS) in the region.

According to figures from organizations such as Our World in Data, a free-to-access online publication focusing on global health issues, Covid death rates in Asia-Pacific, where masks were worn early on by the entire population, were up to 42 times lower than in the UK , US and Europe, in each quarter of 2020 through January 2021.

In Taiwan, the infection rate was one case per 54,000 inhabitants – more than 100 times lower than in the West.

Its success is widely attributed to the non-pharmaceutical interventions of the pandemic response, including mask-wearing. A 2021 article in the International Journal of Infectious Diseases noted the widespread early use of surgical masks as part of Taiwan's arsenal against Covid and how we could get through it without a lockdown. By contrast, Britain went into three lockdowns as both infections and deaths soared.

Learning from their SARS experience in 2003, the Taiwanese government began coordinating the supply and distribution of masks early on. Only last April were mandatory rules on wearing masks lifted. They are still required within medical institutions.

Despite infection control successes in countries like Taiwan and advice from the WHO, no one from NHS England, the UKHSA or the government is recommending mandatory wearing of masks in healthcare – even as Covid rates rise.

In a letter from the Daily Mail dated December 20, 2023, addressed to Dame Ruth May, Chief Nursing Officer for England, Patricia Marquis, Director of the Royal College of Nursing for England, called for an urgent review of the National Infection Prevention and Control. Guide to the wearing of universal masks and respirators by healthcare workers, in accordance with WHO-supported guidelines. Similar letters were also sent to the chief nurses of Wales, Northern Ireland and Scotland,

As it stands, NHS England's failure to follow WHO advice in this current peak risks increasing the number of Covid cases and other respiratory diseases among staff and patients. It seems we haven't learned anything.