Should we mask our intentions?

From a certain distance, everything seems entirely normal on this sunny Saturday in Oslo, the 3rd week of the virus “lockdown.” The streets and trails of Oslo are perhaps a little busier than usual, with steady throngs of people and whole families out and about, jogging, biking, walking their dogs. Shops and stores are mostly open as well though not many people seem to be actually shopping except for necessities.

When you enter a grocery store, the only immediate indication that we are fighting a pandemic is a sign asking you to wash your hands before and after. Yet as you make your way through the aisles, you soon feel that things are a little different. People are keeping their heads down, avoiding eye contact, moving a little awkwardly. There’s a palpable uneasiness underneath what could be described as everyone’s attempt to keep things as normal as possible.

People getting some much-needed fresh air in Oslo last weekend.

Norwegians in general are taking the virus seriously but “social distancing” is practiced to varying degrees in various situations. There are no hard and fast rules other than keeping 2-meter distance which is impossible to pull off all the time, especially in a small store. Everyone is left to make their own judgements about what is safe (e.g. “is it OK if I pet your dog?”). The general sentiment I get is: let’s keep our distance and take precautions but not get too carried away, too hysterical, too ridiculous. And it really doesn’t take that long to find a small group of people that are too close or forgetting to use gloves when handling common things, etc. Of course, teenagers are a lot more casual and reckless. In Norway as I assume is the case everywhere, far too many think all this fuss is mostly about very old people.

The terrible and deadly corona virus (COVID-19) is now a global phenomenon that has spread to almost every country on the planet. No one alive today has witnessed a pandemic of this scale and speed. And in one unique respect, COVID-19 is a vast experiment illustrating, in daily updates to morbid infection and mortality numbers, how different cultures and governments are managing the very same crisis. Some countries have been fast to act. Others have been caught flat footed or have lacked the political will to muster a coherent response. Still others have tried to minimize immediate economic impacts and pursued a middle of the road strategy. And then there are those bucking the experts that have attempted something like a just-let-it-rip strategy.

By now we have enough data to see some patterns and identify and what has worked or not worked thus far. And surprise surprise – the health and pandemic experts have been remarkably accurate with respect to both their recommendations and their projections about what is needed to avoid overwhelmed hospitals and millons of severely ill. It’s clear now that an early, coordinated response to identify both those infected and those at risk are key as is governments’ preparedness and ability to mobilize necessary resources and equipment. And then of course there's the X factor - the willingness of citizens to respect guidelines and procedures from authorities.

Find the differences: A White House press briefing last week and President Xi Jinping of China

There has been quite a bit of speculation about why some countries, particularly China, South Korea, Singapore, etc., have had comparably better success thus far in flattening the curve, versus Western countries that have had less success. The consensus opinion in Western media seems to be that some Asian countries are more authoritarian, thus enabling them to martial resources and command populations to behave in certain ways. While that is the case in a country like China, however, it’s obviously less true in countries like Japan, South Korea and Singapore. Clearly there are important cultural differences playing a significant role.

Generally speaking (and I will not attempt to give such a big topic justice here), Western cultures tend to be more individualist, and Asian countries like Japan, India or China tend to be more collectivist. Western societies tend to value the individual and personal welfare over the group and personal success over group achievement. This is somewhat true in varying degrees across Western cultures (e.g. the U.S. is perhaps the pinnacle of individualism while Scandinavian cultures are much further away on that sort of spectrum). Whether a person thinks of themselves primarily as independent and self-contained or interlinked and interconnected with the other people around them has a profound impact on one’s worldview as well as how society functions. There are pros and cons of course to each and benefits from both in a global fight against a pandemic (we need heroes, innovators and risk takers as well). In this first phase, however, where success is all about getting individuals to act in concert to limit and slow infection rates, group-welfare-first thinking is a huge advantage.

Cultural visualizations from the artist Yan Liu who was born in China and has been living in Germany since the age of 14.

One of the things I noticed my first few days and weeks as a young expat in Japan many years ago was that Japanese people would often wear cloth or surgical masks while out in public or in the office. I would, for example, see a businessman on the train or a cab driver wearing a mask. I learned that the masks were to protect others from the illness that the mask-wearer was suffering (most often a common cold or mild flu). At the time I found this a bit surprising, but it was a clue to some of those cultural differences I would learn more about later.

What role do masks play in helping to flatten the curve?

By now it has become common knowledge that everyone is donning a mask in China, South Korea, Japan. It’s remarkable for several reasons, one of which is that these countries prioritized the increased production of simple surgical or cloth masks – more interesting if you believe these masks to be of little protection against a microscopic virus. And also, because here in the West we have more or less ignored the humble mask as a public health weapon in this fight. At least until now.

While there was an initial rush on masks of various types (including the heavy-duty N95 mask), we have been told in the West from the first days of the outbreak that we should not rely on masks for the following reasons:

  • Most masks are no real protection from the tiny corona virus which can pass through easily.
  • Most people don’t know how to use masks effectively.
  • Masks can give people a false sense of security. Washing hands, social distance and other measures are much more important.
  • If everyone ran out and bought masks, it would deprive healthcare workers and others who need them most.

And then there’s the cultural aspect. People in the West are unaccustomed to wearing masks in public. While you might find an elderly person here and there wearing a mask in Norway, most people don't use them - a mask is still seen as going a bit overboard.

“Masks are not to protect yourself. It’s to protect people against the droplets coming out of your respiratory tract.”

Yet it’s a fact that even simple masks can help reduce pathogens entering the air. Viruses are carried in air droplets, so a mask can mechanically inhibit the flu virus from reaching other people. Particularly if someone is contagious and doesn’t know it, a mask offers some dampening effect on transmission. While I haven't yet run across hard data indicating that wearing masks has a material impact on actual transmission rates, we can observe that places where mask wearing is the rule are doing better on the stats overall.

Masks are also a powerful symbol of solidarity and intention. When everyone is wearing masks, it sends an obvious signal that there’s a contagion and that we all need to be more careful. Masks help remind people that something is different and we need to behave differently. In other words, masks can help us overcome inclinations to resist the kinds of behavioral changes we need to make in a pandemic (perhaps even teens).

All that being said, no one should rush out and buy a bunch of masks in Western countries because we simply don’t have enough for the people that really need them. The window of opportunity for ramping up production was back in December (probably much earlier). Still, one of our software developers reported from his home in Prague that the Czech Republic has now made masks mandatory when in out in public. Apparently, any sort of mask will do, so people are making their own. And perhaps that's what we should all be doing.

As it happens, I have been wearing a mask outside since mid-December, at least when I’m walking my dog, riding my bike or jogging. Last year I developed some kind of cold-induced asthma and my doctor recommended that I wear a mask when outside during the winter months. It’s not uncommon for cross-country skiers here to wear a mask while training but to this day people react when they see me wearing one around town. It’s simply not a thing here yet to wear masks in the fight against this virus.

While no one should take a random blogger's opinion over the advice of the WHO or public officials, it could be that the time has come for everyone to start wearing masks. Those should be homemade for now and there are lots of helpful suggestions online. We need to keep as many people safe and healthy as possible and for business to return to something approaching normal sooner rather than later. If wearing a simple mask can help us get there, I say let's all mask up. #masksforall

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