Face Masks Harmed Care Home Residents in Ways No Health and Safety Apparatchik Can Ever Understand

As a self-employed social care consultant and former care home inspector I visit over 100 care homes each year to conduct mock Care Quality Commission (CQC) inspections. During the COVID-19 epoch, when face masks went on in care homes, I witnessed a dramatically negative shift in atmosphere, spirit and human connection. Something profound was lost and, as I told the makers of the documentary Masking Humanity, despite what the guidance may have suggested, it wasn’t safety we gained in return.

In March 2020 there was fear and uncertainty everywhere in social care. The arrival of COVID-19 in care homes was coincident with excess death rates. I recall one 56-bed home in Northwest England that saw 50% of its residents die within in one month. A few weeks later the senior team looked like they were experiencing PTSD symptoms. At this time the use of masks was not mandated, the prevailing view amongst politicians and their advisors being they were ineffective. Nevertheless, when panic strikes any straw will be grasped and it seemed to many masks ‘just might’ be effective and were ‘worth a try’. As a result, and understandable within a context of widespread anxiety, care homes strove to procure masks and other PPE as best they could.

From June 2020, probably partly to create an appearance of action, the guidance issued by infection control teams made a U-turn. Masks became ‘mandated’ and care home staff wore them diligently. The summer months went by with few or no COVID-19 cases, and care staff, perhaps wanting to connect their efforts with the good results, began to believe it was the masks and assorted PPE that were keeping COVID-19 away. We now know that, unsurprisingly, there were very few COVID-19 cases nationally at that time and this apparent success was a mere coincidence.

With the perception that masks were working having taken root, when set against their apparent life-saving qualities, concerns and complaints about the downsides of masks seemed to be of low importance, often being ascribed to stupidity and selfishness on behalf of the sceptics raising them. Then, in the winter, during the second wave of COVID-19, it became clear the supposition that masks were keeping people safe was on very shaky ground indeed.

To take just one example among many that I witnessed across UK care homes, there was a 50-bedded nursing home in the East of England that had recorded no deaths from COVID-19 in the first wave. From June 2020 staff had been wearing masks, visors, gloves and aprons – all day, every day. Then in December 2020, within three days of the first positive PCR result, 35 of the residents had tested positive and 23 later died. This was the typical pattern: care staff were diligent in their use of masks, yet the positive tests kept occurring and people kept dying, leaving me convinced of the masks’ ineffectiveness.

The first vaccines were rolled out in care homes from around December 2020 to February 2021. Whether as a result of vaccination or the natural resilience of those who survived the earlier waves, from March 2021 onwards the death rate plummeted, including in the very elderly and compromised. The risk to life had clearly reduced and, with no appreciable benefit, there seemed to be little point in continuing with mask wearing. They didn’t work in reducing the spread and it was now unclear what harms wearing them was even trying to prevent.

Despite the picture painted often in the press, many care homes are happy, joyful, cheerful places where people go to live with purpose at the end of their lives. From Spring 2020 to the end of 2022, despite everyone’s best efforts, the joy largely disappeared. Having witnessed these times it could not be clearer to me that the wearing of masks had an awful effect upon the lives of residents and the morale of care staff. Many residents in care homes are hard of hearing. Masks made communication almost impossible. Care home managers commented repeatedly that residents who struggled to communicate seemed to deteriorate and die faster than would normally be the case. It is not possible to prove this in numbers, but it is an almost universally held view among care professionals – a ‘known truth’.

I also cannot overstate how important smiles are in dementia care. The simple act makes both carer and resident feel happier. Staff wearing masks permanently prevented a significant amount of reassurance and genuine joy being spread. The fear of the early days of the panic was replaced with an ongoing joylessness. Vulnerable people could not receive a reassuring smile or grin, not to mention a hug. One person said to me, “When you can’t see people’s faces you don’t know who they are. So you feel isolated. They could be robots for all I know.” Care staff experienced pain, discomfort and oxygen deprivation from physically wearing masks, and emotional frustration at their futility. The superpower of a carer is to be a purveyor of joy and reassurance. This superpower was severely compromised due to masks, to the benefit of nobody.

In December 2022 mask mandates were lifted and the usual care home joy returned. I received many messages from care home managers. Without exception, they described the positive reception of the news. My favourite message read, “I went into the lounge and told the residents we could take the masks off. They all clapped and cheered. Then some of them cried. And then I cried. It was so wonderful and such a relief.” One experienced care home manager said, “I hate it when people in infection control departments say things like it’s only a mask, what’s the downside. They clearly have never worked here or they wouldn’t say something so unbelievably stupid.”

The Cochrane review showed no evidence that masks work in preventing the spread of respiratory diseases. However, my experience tells me that the key arguments against masks should focus not just on their technical ineffectiveness, but also on the significant harms they cause.

Care delivered by masked people is frightening for the vulnerable. It is literally faceless, whereas care delivered with smiles is wonderful. I have seen this first hand, felt it, witnessed it, sensed it, experienced it, lived it and come to understand it through observing thousands of examples. The harms I’ve described cannot be presented on a spreadsheet or an abacus. It’s experiential, intuitive and emotional. It’s a deeper, more humanity-focused understanding than any mathematical proof.

During the COVID-19 period of fear and anxiety we experienced a world where the infection control officers and health and safety managers were firmly in charge. That is not a world I ever want to live in again. From observing the operations of hundreds of care homes I believe that not only did masks not save lives, but that they probably cost lives. Many who work in social care also believe this, however they work for corporations and so cannot easily speak out against the accepted line. But that is a different issue for another day.

Simon Cavadino is Director of the Woodberry Partnership and is interviewed for the Smile Free documentary, Masking Humanity.