Cheryl Man is usually the only one wearing a face mask on her New York City subway train. She notices this, but other people on the train notice, too. Usually she just gets odd stares from other commuters. But on Tuesday morning, when she was walking to school, a group of teens jeered at her and coughed in her direction.
“I felt very humiliated and misunderstood,” says Man, a 20-year-old student and research assistant who is ethnically Chinese.
Man also feels the stigma at her workplace, where she keeps her mask on. None of her colleagues wear a face mask, and some of them have asked her if she is sick.
“Why do they think it’s about me? It’s a civic duty,” she says. “If I have a mask on, and if—touch wood—I’m infected, I could cut the chain off where I am. That could save a lot of people.”
That’s what health experts in Hong Kong, where Man was born and raised, say, and it’s advice she trusts. Nearly everyone on Hong Kong’s streets, trains and buses has been wearing a mask for weeks—since news emerged of mysterious viral pneumonia in Wuhan, China that was later identified and named COVID-19. The Hong Kong government and leading health experts also recommend wearing masks as a way to help prevent the spread of the coronavirus, which the WHO declared a global pandemic on Wednesday.
While wearing a face mask has become the norm in many places in Asia, the mask frenzy has hit nowhere as hard as Hong Kong. At the height of COVID-19 panic, residents lined up overnight outside drugstores to buy face masks. South Korea, Singapore and Japan have distributed face masks to residents. Taiwan and Thailand have banned the export of masks to meet soaring local demand.
Yet, in the U.S., wearing a face mask when healthy has become discouraged to the point of becoming socially unacceptable. The U.S. government, in line with World Health Organization recommendations, says only those who are sick, or their caregivers, should wear masks.
A tweet from Surgeon General Jerome Adams sums up the argument: “Seriously people- STOP BUYING MASKS! They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk!”
Coronavirus disease 2019 (COVID-19) is a virus (more specifically, a coronavirus) identified as the cause of an outbreak of respiratory illness first detected in Wuhan, China.
Two schools of thought, not enough research
As COVID-19 continues to spread globally, it has become clear there are two schools of thought in regards to face masks for the public.
On the one hand is the view shared by Dr. William Schaffner, a professor in Vanderbilt University’s Division of Infectious Diseases, who says that medical masks commonly worn by members of the public do not fit snugly around the nose, cheeks and chin.
“And if there’s a general recommendation that people wear face masks, we won’t have enough supply for healthcare workers,” he says, adding that his colleagues have already been reporting shortages. “The priority should be face masks to use in the healthcare environment, rather than in our community.”
He calls the evidence supporting the effectiveness of the general public wearing masks “scanty.”
But, David Hui, a respiratory medicine expert at the Chinese University of Hong Kong who studied the 2002 to 2003 outbreak of severe acute respiratory syndrome (SARS) extensively, says it’s “common sense” that wearing a mask would protect against infectious diseases like COVID-19.
“If you are standing in front of someone who is sick, the mask will give some protection,” Hui says. “The mask provides a barrier from respiratory droplets, which is predominantly how the virus spreads.”
He also says that the role of a face mask may be especially important in the epidemic due to the nature of the virus. Patients with COVID-19 often have mild or even no symptoms, and some researchers believe it can also be transmitted when patients are asymptomatic—meaning patients can be contagious and don’t know they’re sick.
Hui adds that the lack of solid evidence supporting the effectiveness of masks against the virus is no reason to dismiss its use, because there may never be definitive scientific proof. A properly controlled study would be impossible to conduct ethically, he explains. “You can’t randomize people to not wear a mask, and some to wear a mask, and then expose them all to the virus,” he says.
Joseph Tsang, an infectious disease specialist who also worked as a consultant for the city’s Hospital Authority, says the purpose of wearing a mask is two-fold. “Wearing a mask is not just for protecting yourself from getting infected, but also minimizing the chance of potential infection harboring in your body from spreading to people around you,” he tells TIME.
Tsang says the three layers of a surgical mask filter help reduce the risk of contact with droplets, through which the virus is transmitted. “Whenever you foresee to have someone within two to three meters (6.5 to 10 feet) apart, then it’s better to wear a mask,” Tsang adds.
Different cultural norms
But even before the coronavirus outbreak, masks were a common sight across East Asia—worn for a variety of reasons. It’s common for people who are ill and want to protect the people around them to wear masks. Others wear masks during cold and flu season to protect themselves.
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In Japan, people wear masks for non-medical reasons ranging from wanting to hide a swollen lip or a red nose during allergy season, to keeping warm during the winter, says Mitsutoshi Horii, a sociology professor at Japan’s Shumei University, who works in the United Kingdom. Masks in Japan come in cloth and printed variations, and can also be worn for style. They can also be seen on the streets of Hong Kong.
The difference in perception of the mask comes down, in part, to cultural norms about covering your face, he says. “In social interactions in the West, you need to show your identity and make eye contact. Facial expression is very important.”
Japanese trainee teachers he hosted at the U.K. campus where he works at had a first taste of the cultural difference when they arrived. Horii says the university explicitly advised them not to wear face masks when teaching at local schools.
“If they wear masks, the kids could get scared,” he says.
The shadow of SARS 17 years ago also helps to explain the prevalence of masks, especially in Hong Kong. Perhaps nowhere in the world was hit as hard as Hong Kong, where almost 300 died of the virus—accounting for over a third of official SARS fatalities worldwide.
“It was largely the shock of SARS that shaped this local etiquette,” Ria Sinha, a senior research fellow at the University of Hong Kong’s Center for the Humanities and Medicine, tells TIME. “Although the younger generation do not remember SARS, their parents and grandparents did experience the fear and uncertainty of a novel infectious disease, and the loss of daily normality.”
Wearing a mask, she explains, has become a “symbol and a tool of protection and solidarity”—even if research proving their efficacy is lacking. “Mask wearing is not always a medical decision for many people, but bound up in sociocultural practice,” she adds.
The social pressures of wearing a mask (or not)
But Man and others in the West are finding that wearing a masks represents can also draw unwanted attention, and even make them targets. Even as COVID-19 cases in the U.S. have surged to more than 1,300 (Hong Kong currently has 129 confirmed cases, about 100 fewer than the New York area), Man says about a quarter of her friends from Hong Kong, mainland China and South Korea won’t wear masks over concerns about racism and xenophobia that has risen with the virus.
And while most people in Hong Kong are masked up, there are outliers. Andy Chan, 29, says he thinks city-wide mask-wearing is fueling unnecessary panic.
“People look at me funny because I don’t wear a mask,” Chan says. “But I think the only thing that’s laughable is everyone buying into this excessive fear. People are being led by emotion, not science.”
Still, Charlotte Ho, a 55-year-old stay-at-home mother in Hong Kong, represents the majority view. She says she wouldn’t even leave her building to buy groceries without a mask. If she sees somebody not wearing a mask, she says she would stay away—”just in case.”
“Wearing a face mask is just common sense. It creates a barrier, so nothing can touch your nose and mouth. Why wouldn’t I wear a face mask?” Says Ho.
Courtesy of the Time.com
Wearing a face mask is certainly not an iron-clad guarantee that you won’t get sick – viruses can also transmit through the eyes and tiny viral particles, known as aerosols, can penetrate masks. However, face masks are effective at capturing droplets, which is a main transmission route of coronavirus, and some studies have estimated a roughly fivefold protection versus no barrier alone (although others have found lower levels of effectiveness).
If you are likely to be in close contact with someone infected, a mask cuts the chance of the disease being passed on. If you’re showing symptoms of coronavirus, or have been diagnosed, wearing a mask can also protect others.
So travel face masks are crucial for health and social care workers looking after patients and are also recommended for family members who need to care for someone who is ill – ideally both the patient and carer should have a mask.
What To Do if You Are Sick
Steps to help prevent the spread of coronavirus COVID-19 if you are sick
Follow the steps below: If you are sick with COVID-19 or think you might have it, follow the steps below to help protect other people in your home and community.
Stay home except to get medical care
Stay home: People who are mildly ill with COVID-19 are able to recover at home. Do not leave, except to get medical care. Do not visit public areas.
Stay in touch with your doctor. Call before you get medical care. Be sure to get care if you feel worse or you think it is an emergency.
Avoid public transportation: Avoid using public transportation, ride-sharing, or taxis.
Separate yourself from other people in your home, this is known as home isolation
Stay away from others: As much as possible, you should stay in a specific “sick room” and away from other people in your home. Use a separate bathroom, if available.
Limit contact with pets & animals: You should restrict contact with pets and other animals, just like you would around other people.
Although there have not been reports of pets or other animals becoming sick with COVID-19, it is still recommended that people with the virus limit contact with animals until more information is known.
When possible, have another member of your household care for your animals while you are sick with COVID-19. If you must care for your pet or be around animals while you are sick, wash your hands before and after you interact with them. See COVID-19 and Animals for more information.
on the phone with doctor
Call ahead: If you have a medical appointment, call your doctor’s office or emergency department, and tell them you have or may have COVID-19. This will help the office protect themselves and other patients.
Wear a face mask if you are sick
If you are sick: You should wear a facemask when you are around other people and before you enter a healthcare provider’s office.
If you are caring for others: If the person who is sick is not able to wear a facemask (for example, because it causes trouble breathing), then people who live in the home should stay in a different room. When caregivers enter the room of the sick person, they should wear a facemask. Visitors, other than caregivers, are not recommended.
Cover your coughs and sneezes
Cover: Cover your mouth and nose with a tissue when you cough or sneeze.
Dispose: Throw used tissues in a lined trash can.
Wash hands: Immediately wash your hands with soap and water for at least 20 seconds. If soap and water are not available, clean your hands with an alcohol-based hand sanitizer that contains at least 60% alcohol.
Clean your hands often
Wash hands: Wash your hands often with soap and water for at least 20 seconds. This is especially important after blowing your nose, coughing, or sneezing; going to the bathroom; and before eating or preparing food.
Hand sanitizer: If soap and water are not available, use an alcohol-based hand sanitizer with at least 60% alcohol, covering all surfaces of your hands and rubbing them together until they feel dry.
Soap and water: Soap and water are the best option, especially if hands are visibly dirty.
Avoid touching: Avoid touching your eyes, nose, and mouth with unwashed hands.
Avoid sharing personal household items
Do not share: Do not share dishes, drinking glasses, cups, eating utensils, towels, or bedding with other people in your home.
Wash thoroughly after use: After using these items, wash them thoroughly with soap and water or put in the dishwasher.
cleaning a counter
Clean all “high-touch” surfaces everyday
Clean high-touch surfaces in your isolation area (“sick room” and bathroom) every day; let a caregiver clean and disinfect high-touch surfaces in other areas of the home.
Clean and disinfect: Routinely clean high-touch surfaces in your “sick room” and bathroom. Let someone else clean and disinfect surfaces in common areas, but not your bedroom and bathroom.
If a caregiver or other person needs to clean and disinfect a sick person’s bedroom or bathroom, they should do so on an as-needed basis. The caregiver/other person should wear a mask and wait as long as possible after the sick person has used the bathroom.
High-touch surfaces include phones, remote controls, counters, tabletops, doorknobs, bathroom fixtures, toilets, keyboards, tablets, and bedside tables.
Clean and disinfect areas that may have blood, stool, or body fluids on them.
Household cleaners and disinfectants: Clean the area or item with soap and water or another detergent if it is dirty. Then, use a household disinfectant.
Be sure to follow the instructions on the label to ensure safe and effective use of the product. Many products recommend keeping the surface wet for several minutes to ensure germs are killed. Many also recommend precautions such as wearing gloves and making sure you have good ventilation during use of the product.
Buy a surgical face mask, disposable gloves and hand sanitizer.
Can wearing a medical face mask protect you against the new coronavirus? It’s a question many people are asking, including pet owners who are putting canine face masks on their dogs.
If it’s a regular surgical face mask, the answer is no, Dr. William Schaffner, an infectious disease specialist at Vanderbilt University in Tennessee, told Live Science.
A more specialized mask, known as an N95 respirator, can protect against the new coronavirus, also called SARS-CoV-2. The respirator is thicker than a surgical mask, but neither Schaffner nor the Centers for Disease Prevention and Control (CDC) recommend it for public use, at least not at this point.
That’s because, in part, it’s challenging to put on these masks and wear them for long periods of time, he said.
Specialists receive retraining annually on how to properly fit these respirators around the nose, cheeks and chin, ensuring that wearers don’t breathe around the edges of the respirator. “When you do that, it turns out that the work of breathing, since you’re going through a very thick material, is harder. You have to work to breathe in and out. It’s a bit claustrophobic. It can get moist and hot in there,” Schaffner said.
“I know that I can wear them when I need to for about a half-hour,” he added. “But then, I have to go out of the isolation room, take it off and take some deep breaths, kind of cool off, before I can go back in.”
While it still might be possible to snag an N95 respirator online, Schaffner advised against it. If too many people unnecessarily stockpile respirators, a shortage could put the health of medical workers and those who need them at risk, Schaffner said.
The thinner surgical mask is intended for surgeons, because these products do a good job of keeping pathogens from the doctor’s nose and mouth from entering the surgical field, Schaffner said.
In some Asian countries, such as Japan and China, it’s not uncommon to see people wearing surgical masks in public to protect against pathogens and pollution. But those masks don’t help much in the context of a virus, Schaffner said. “They’re not designed to keep out viral particles, and they’re not nearly as tightly fitted around your nose and cheeks” as an N95 respirator, he said.
“Could they be of some use? Yes, but the effect is likely to be modest,” Schaffner said.
He noted that some people wear surgical masks because they are sick with a cold or the flu and they don’t want to get other people sick. But if you’re sick, it’s best just not to go to public areas. “That’s the time to stay home,” Schaffner said.
People sick with COVID-19, however, should wear face masks to reduce the risk of infection to people around them, according to the CDC. Health care workers and those “taking care of someone infected with COVID-19 in close settings (at home or in a healthcare facility),” should also wear face masks, the CDC reported.
People wearing surgical masks should dispose of them after each use, the CDC added.
Otherwise, the best way to avoid getting the coronavirus is to, first and foremost, postpone any travel to places with known outbreaks. You can also thoroughly wash your hands with soap; avoid touching your eyes, nose and mouth with unwashed hands; avoid close contact with people who are sick; and disinfect frequently touched objects and surfaces, the CDC recommends.
As for pet owners putting face masks on their dogs, a Pomeranian dog in Hong Kong tested positive a “weak positive” for COVID-19. That dog is now in quarantine, but is not showing symptoms of the disease, according to a March 5 piece in the South China Morning Post. However, it’s unclear how the dog was tested for the illness. What’s more, it doesn’t appear that pets can transmit the virus to humans, and experts told people with pets not to panic.
Rather than put face masks on pets, the CDC advises that people ill with COVID-19 avoid animals, just as they would other people.