Avoiding mass lockdowns – students should wear masks in halls

Tena Thau reviews the advice from SAGE to government and concludes that students should be advised to wear masks in halls of residence to break the cycle of transmission and avoid lockdowns.

The UK government’s Scientific Advisory Group for Emergencies (SAGE) report, “Principles for Managing SARS-CoV-2 Transmission Associated with Higher Education,” published 3 September, 2020, said this on masks:

Face coverings are not likely to be beneficial in shared accommodation as there are multiple interactions between people including substantial sharing of surfaces in kitchens/bathrooms etc” (p. 20).

The statement is not supported by the evidence. Given what we know, face coverings in shared student accommodation are likely to be a beneficial tool against Covid. Not only that, it seems plausible that wearing a face covering in communal living spaces could be the one of the most beneficial actions that students can take to reduce their risk of spreading and contracting Covid – and so reducing what could be a long cycle of mass halls “lockdowns”.

Evidence

First, there is strong evidence, at this point, that face masks significantly reduce the spread of Covid, by protecting others, as well as the wearer. So our presumption – in the absence of some extremely compelling piece of evidence or argument to the contrary – should be that wearing face masks in shared accommodation reduces the spread of Covid there too.

Next, let’s consider SAGE’s rationale for why face masks, though generally helpful, would not be helpful in student households. They reason, in the above quote, that wearing a face covering would probably be futile, because housemates share so many surfaces – so they’re inevitably exposed to eachother’s Covid germs. This rationale might have been plausible several months ago, when it was thought that contaminated surfaces were a main vector of transmission. But it is not credible any more, now that it appears that the transmission of Covid via contaminated surfaces occurs quite rarely (if at all).

Then let’s consider some other conclusions that SAGE reaches in this report, which directly contradict the quoted one. On the very next page of the report, it states, “in shared houses or halls of residence with shared communal areas”…“face mask use before a primary case has symptoms…[is] shown to be protective.” That sentence includes a citation of a study on household transmission of Covid in Beijing, which concludes that its findings support “universal face mask use … not just in public spaces, but inside the household with members at risk of getting infected.”

Elsewhere in the report, SAGE recommends “a good level of environmental hygiene in [shared] accommodation, including cleaning and ventilation.” But if SAGE’s earlier statement – that housemates will inevitably be exposed to eachother’s germs through ubiquitous shared surfaces – is correct, then what would be the point?

Besides the faulty rationale, the fact that SAGE’s claim is undermined by other statements in the report, and all of the evidence that face masks are effective, there is a further reason to reject SAGE’s claim that face masks in households aren’t beneficial: even when masks do not prevent transmission completely, they might still be life-saving by reducing viral load.

For all of these reasons, face masks do seem likely to be beneficial in shared accommodation. Moreover, wearing face masks (when talking with others) in communal living areas could plausibly be the most beneficial precaution that students can take, short of moving into a single-occupancy residence. 70% of Covid transmission occurs within households. If wearing a mask could help curb this, then it could be the most valuable tool in our fight.

Too much to ask?

Separate from the question of whether household mask wearing would be effective is the question of whether students would actually do it – and whether it would be an unjustifiable imposition to ask them to.

I imagine that many students would choose not to wear a mask during certain household interactions (e.g. when in their room with a close friend or romantic partner) but would be comfortable with generally wearing a mask when talking indoors with members of their household. Masks can still be really beneficial even though they won’t be worn by everyone, all of the time.

I also suspect that students’ willingness to wear a mask in shared accommodation will increase once they understand how helpful this precaution could be. Many students probably aren’t aware that household transmission accounts for such a large proportion of cases. And – given how slow public health experts have been in acknowledging the issue – we should expect that many students are underestimating the role of airborne transmission, too.

And while household mask-wearing might be too burdensome to recommend as a long-term measure, it could still be useful for the precarious moment that UK universities are facing right now. Once cases come down, and universities develop the capacity for universal and frequent testing, guidance could be relaxed.

Given the draconian measures that some universities are now employing – like whole household isolation, and lockdowns of entire accommodation buildings – the guidance that I am suggesting – that universities say to students, “we encourage you to consider wearing a mask when talking with members of your household indoors” – is comparatively easy to justify. And – if household mask-wearing is indeed effective at helping reduce the spread of Covid at universities – then it would reduce the instances in which these more draconian measures are imposed.

Bursting the bubble

Universities’ re-opening plans were based around the concept of a household unit: a group of students (who share a flat, or live on the same floor an accommodation block) that could socialize indoors together, without needing to social distance or wear a mask. (At Oxford, households can be as large as 12 people, but will typically consist of 6-8.) The hope was that as long as students do most of their hanging out in their assigned household bubbles, maybe the virus could be kept at bay.

But the reality that universities are now experiencing is that these ‘bubbles’ are quickly merging into unmanageably large blobs. The virus is sweeping through not just households, but entire residence halls. Universities with residency requirements should waive them immediately (as Brian Wong has convincingly argued). And for those students who choose to return to campus, we should dispel the myth that indoor, mask-free interactions with their dorm-mates are safe.

Universities should move away from the “household” concept, and promote the message that wearing masks when talking with others indoors is always a helpful precaution – regardless of who’s in what “bubble”.

2 responses to “Avoiding mass lockdowns – students should wear masks in halls

  1. Agree with author that there is a compelling justification for encouraging mask wearing indoors. Author makes a strong case that the “cure” (wearing a mask) is not worse than the disease.

  2. The challenge that many of us face is in understanding the rationale for decisions that have been made about safety on campus. It would be useful to know how many universities have published risk assessments on their websites, and how comprehensive these are. Do we know, for example, what position has been taken about the relative significance of the various transmission routes?

    The rationale can be difficult to understand where, for example, face coverings are required in corridors but not, say, in a teaching room where the ventilation may be poor and there is prolonged contact with a group of, say, up to 15 or 20 individuals. There is, of course, much that we don’t know about the virus and its transmission – and this ought to shape the measures that are taken to reduce the risk of transmission. This is a useful chart of the risks (and in citing it, I add that I have no connection with the authors):
    https://www.bmj.com/content/bmj/370/bmj.m3223/F3.large.jpg

    Reducing the risk of transmission was always going to be a challenge in student accommodation where, for example, there is poor ventilation and much common and communal space through which students must pass. Indeed, so many of the design and build features of the tall, purpose built student accommodation blocks, hamper attempts to reduce transmission. Wearing face coverings in such settings makes sense, as the author rightly argues.

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