Face coverings and masks should be compulsory outdoors in cases where social distancing is impossible, the British Medical Association (BMA) has said. 

A range of stronger, clearer measures should be brought in quickly to halt the rapid spread of Covid-19 infections amid a second wave of the pandemic, the doctors’ union warned, adding that the public is in danger of losing faith in rules due to the government’s “inconsistent” messaging.

As the government prepares to unveil a new three-tiered system of coronavirus restrictions on Monday, the BMA has published a list of recommendations it says could reduce the nation’s level of infection while providing people with the confidence they need to go out safely and boost the economy.

The BMA’s suggestions also include modifying the rule of six so only two households can meet and making mask-wearing mandatory in all office. 

The union’s chairman, Dr Chaand Nagpaul, said the inconsistency of the government’s messaging once the first lockdown was lifted had played a part in the resurgence of the virus.

He said: “The infection has risen following rapid relaxation of measures and with the Westminster government letting down its guard – as recently as August, the government was encouraging people to travel, go to work and mix in restaurants and pubs.”

“The government has a duty to regain the public’s confidence and faith in measures being taken to get the spread of the virus back under control. It must also provide the financial support businesses need to enable them to make premises and settings Covid secure while providing clear rules on what ‘Covid secure’ means.”

Dr Nagpaul added there was “inconsistency” in directions relating to the wearing of facemasks and how and when to mix socially.

He said: “With admissions to hospitals for Covid climbing rapidly in parts of England, there is an opportunity for the Westminster government to bring in simple stronger restrictions alongside the introduction of its… three-tiered approach.

“We have drawn on a range of expertise from within the BMA to publish a set of recommendations which we feel, if introduced very quickly, could have a positive effect.”

The BMA’s recommendations include:

• Modifying the current Rule of Six with the rule that only two households can meet, and those should not exceed 6 people, ideally outdoors rather than indoors;
• Making the wearing of face masks mandatory in all offices and working environments, unless you are working alone;
• Making people wear masks in all outdoor settings where two-metre distancing is not possible;
• Providing financial support to businesses, retail and hospitality settings to enable them to make premises Covid secure and provide clear rules on what ‘Covid secure’ means;
• Providing medical grade masks, free of charge, to those who are over 60 or in a vulnerable group, as recommended by the World Health Organisation;
• Providing masks free of charge to those who are exempt from prescription charges and also at the entrance of all public settings if a person has not brought one;
• Adding more functionality to the NHS Test and Trace app to give people more detailed information on infection rates in their area including actual figures of rates of infection and trends.

Dr Nagpaul added: “We know that with the right public behaviour and renewed public confidence, the infection can be brought under control, given that we had less than 500 new cases a day in mid-July.

“We are having to swallow a very bitter pill of the infection continuing to spread at a perilous rate.

“Stronger measures brought in now could be a far sweeter pill in the long run for far more people.”

A spokesperson for the Department of Health and Social Care (DHSC) said the government’s measures have been guided by the advice of experts “at every stage” of the pandemic.

“We have been clear from the outset that public compliance with self-isolation rules and social distancing measures is absolutely crucial to preventing the spread of the virus.

“We have introduced financial support to help people self-isolate and simplified social distancing rules, through the rule of six and our ‘Hands. Face. Space’ campaign … our response ensured the NHS was not overwhelmed even at the virus’ peak, so that everyone was always able to get the best possible care.

They added nearly 700,000 people “who may otherwise have unknowingly spread coronavirus” have been contacted via NHS Test and Trace and told to isolate.