To Wear or Not to Wear
March 28, 2020
Public health professionals around the world can agree on a few key ways to stem the spread of the Coronavirus: wash our hands, avoid touching our faces and practice social distancing.
Putting on a face mask, however, isn’t one of them. Months into the pandemic, social media continues to be flooded by a deluge of articles by medical experts arguing both sides of the debate. While some insist that only sick people and healthcare workers need masks, others urge everyone to put one on to “flatten the curve.” At a time when misinformation is spreading as fast as the virus, the unsettled issue over that flimsy, cyan-colored rectangular piece of fabric has left us scratching our chins.
Nowhere is that debate more acute and divisive than here in Hong Kong. On one hand, the surgical mask has been universally adopted by the local population as soon as the first case was confirmed in January. The 2003 SARS outbreak has transformed local behavior and attitudes toward public health. These days you’ll be hard pressed to find an unmasked face at the bank, in the supermarket or on the street. From clothing boutiques to barbershops, many local businesses only serve masked patrons. Whether it’s for the public good or self-preservation, mask-wearing has become second nature to us—like covering our mouths when we sneeze or removing our shoes before entering a home.
On the other hand, the expatriate community appears slow to jump on the bandwagon. In expat enclaves like Midlevels, Sheung Wan and Discovery Bay, many Westerners can be spotted bare-faced. At lunch time in Central when office workers of all ethnicities head out for a quick bite, the contrast between locals and foreigners is so stark that it feels like the two communities are living in parallel universes.
Earlier this week, I was interviewed by a Wall Street Journal reporter to explain the phenomenon. I was quick to point out the danger of making generalizations about any specific demographic. To be fair, many foreigners have started wearing a mask and, from what I can tell, the adoption rate continues to rise with each passing week. There’s also an element of statistical bias in that Westerners stand out in a crowd and so whether or not they wear masks tends to get noticed more.
When I shared those observations with my expat friends, many of them said I was being far too politically correct. Liz, a Californian who has been living in Mui Wo for the past 15 years, said point blank that there’s no question a sublet of her community has shunned the mask. By her own estimate, at least one in four foreigners doesn’t wear one for reasons that are practical (“I can’t talk wearing one of those things”) or philosophical (“I just don’t believe in them”).
Liz agrees, however, that not all expats think alike. Opinions on the mask debate range from mild skepticism to outright rejection on one end of the spectrum and slow adoption to open-armed acceptance on the other. Paul Zimmerman, the Dutch-born District Councilor, has become a staunch advocate for mask-wearing urging foreign residents to get with the program.
“It’s NOT just about protecting yourself directly from the virus (although it helps),” Paul wrote in a Facebook post earlier this month, “it’s about reassuring others that you’re not infecting them or any surfaces they may touch.” Underneath his plea was the front page of The Apple Daily, the leading local Chinese language newspaper, with a fiery headline: “Unmasked Westerners Roam Free.” News reports like that, along with images of foreigners hanging out at bars in large groups, have added to perceptions that the expat community isn’t taking the outbreak seriously enough.
I asked my friend Joel, who moved to Hong Kong from Paris five years ago, to explain the seeming resistance to masks. “I admit I was slow to warm to the idea myself. Many of us weren’t in Asia during SARS and we didn’t go through that painful, shared experience,” he wrote to me via WhatsApp. “Also, most of us get our news from overseas and we aren’t tuned in to the local press. In the beginning, I followed expert advice in the West that only sick people need to wear a mask. Of course, they have to say that because in many countries there aren’t enough masks to go around for doctors and nurses.”
A recent op-ed in The New York Times corroborated with Joel’s views. In her article, Professor Zeynep Tufekci, an information science expert, pointed out that government officials like the U.S. Surgeon Genera tell people that masks aren’t necessary simply because there’s a shortage. In other words, the message is motivated by inventory control instead of science.
Professor Tufekci puts it bluntly: “[T]he public [was told] simultaneously that masks weren’t necessary for protecting the general public and that health care workers needed the dwindling supply. This contradiction confuses an ordinary listener. How do these masks magically protect the wearers only if they work in a particular field?”
So perhaps we can all agree on one fact: wearing a mask helps, if you can get your hands on one. To be sure, if the supply of protective gear is scarce, like in northern Italy, Spain and the United States, priorities should be given to frontline medical workers. But if access isn’t a problem—in the case of Hong Kong, mask supplies have largely returned to normal after an initial shortage and they’re now widely available at local pharmacies as well as online—then there’s no reason not to wear one in public.
“There’s another explanation for the different messaging from Western governments,” Joel said. “We should bear in mind that Hong Kong is much more densely populated than other places. It makes sense for locals to embrace masks more readily than people in the U.S. and Europe.”
Indeed, the disparities in population density may explain the ways different cultures look at masks. During a visit to Paris earlier this year, I brought up the subject with a few Parisians. I learned that many local pharmacies don’t stock surgical masks because the French don’t normally wear them. When people see someone wearing one on the street—which is rare—they assume the person has some sort of serious respiratory disease and try to stay away from him or her. This has stigmatized mask-wearing and in turn discouraged healthy people from doing so whether in their home country or abroad.
What Joel said about population density triggered still another thought. Few foreign families have aging parents living with them in Hong Kong. By contrast, a typical local household may have three generations crammed into a small space. Since elderly people are most at risk in the current outbreak, the local population needs to be that much more vigilant in ensuring that they don’t bring germs home and get their parents and grandparents sick.
That vigilance is critical considering that the Coronavirus is different from other diseases like SARS and Ebola. Patients can be without symptoms for many days, which means most infected individuals don’t know they’re sick and won’t ask to get tested. Wearing a mask can be the most effective way next to complete isolation to lessen the chances that those “silent carriers” will infect others. To borrow (and paraphrase) a line from Avengers: Endgame: “If there’s a small chance that we can stop this, we owe it to everyone to at least try.”
So to the skeptics who haven’t gone through the public health rite of passage in 2003 or who still question the science of mask-wearing, I say please put one on for the sake of their families and their fellow residents. If none of what I said has convinced you, then consider this: in life, we are sometimes asked to do things we aren’t used to or fully on board with, for no other reason than respect and a show of solidarity. This is one of those occasions.
This article was published in Hong Kong Free Press under the title “Should I wear a face mask? How the debate puts Hong Kong’s expat community on the spot.”