argumentative essay about mandatory wearing of face mask

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If We Must Wear Masks Again, We Need a Smart Approach

argumentative essay about mandatory wearing of face mask

By Jennifer B. Nuzzo and Beth Blauer

Dr. Nuzzo is an epidemiologist at the Johns Hopkins Bloomberg School of Public Health. Ms. Blauer is the executive director of the Johns Hopkins University Centers for Civic Impact.

Despite hopes of a summer free from Covid-19 worry, the Centers for Disease Control and Prevention is now recommending that vaccinated people wear masks in certain areas. While masks are important for protecting against infections, the United States must proceed carefully.

Health officials spent months assuring vaccinated Americans that they didn’t need to mask up against Covid-19 because they were protected from illness and were unlikely to spread infections to others. A return to masking for everyone could be interpreted as moving the goal posts or as a signal that experts are no longer as confident as they were in the vaccines — especially if new masking rules are not tied to specific metrics like vaccinations or if masking rules are in effect in places where hospitals are not dealing with crisis-level admissions.

There is a better way to carry out masking recommendations, by closely linking them to three specific factors:

Is Covid-19 spreading in areas where mask mandates are in effect?

Requiring everyone to wear masks may seem as if it can’t hurt, but experts shouldn’t waste time and credibility enforcing measures if they won’t have an impact.

Bringing back masks for everyone will be most effective if a significant amount of Covid-19 transmission is occurring in public spaces like grocery stores and dance clubs. But health officials haven’t shared sufficient data showing this is the case, and that’s a problem.

State and local health agencies need to have a better understanding of which activities are driving local transmission and tailor policy accordingly. For example, earlier in the pandemic , contact tracing revealed that high levels of transmission were happening at family and friend gatherings in people’s homes — like for holidays and birthdays — where masks are less common. If this remains true, then mask mandates alone will not be enough to cut back on rising cases.

Also earlier in the pandemic, case control studies — which look for differences in behaviors between people who catch Covid-19 and people who haven’t been infected — found that people diagnosed with Covid-19 were more likely to have reported dining at restaurants than uninfected people. If this remains the case, then other measures like limiting occupancy at restaurants and bars might need to be considered in addition to masking, since diners can’t wear masks while eating or drinking.

Genetic sequencing can also help provide clues as to how the coronavirus is spreading. With the increase in resources provided by the Biden administration to enable state agencies to use genetic sequencing to track variants, health agencies should embrace this technology as much as possible to identify large clusters of cases that share transmission patterns.

Do local disease and vaccination rates support mask wearing by vaccinated people?

The C.D.C. recommends that vaccinated people wear masks in areas “of substantial or high transmission” of Covid-19 to avoid getting infected and possibly spreading the virus to others.

To know exactly where those areas are, it’s important to look at local conditions. But in the past few months, most states have scaled back on the amount and frequency of Covid data they share with the public.

For example, Florida, which last week accounted for more than 20 percent of Covid-19 cases reported in the United States, has reduced its case reporting to once a week and no longer shares testing data or deaths broken down by county. The C.D.C. has a map that shows a summary of Covid-19 data for the nation, but it is less detailed than what states have typically reported.

At this stage of the pandemic, state and local governments should present more data, not less. At a minimum, they should publish the frequency and demographic breakdown of cases, tests, hospitalizations and deaths, as well as vaccinations. And they should do so daily.

County-level data is useful, but ZIP code or census tract level data is even better. Los Angeles County, for example, has been able to vaccinate more than 70 percent of eligible adults, but this statistic hides the fact that some parts of the county have much lower vaccination coverage. Highly localized data will help people understand the specific risks where they live and work and the need for mask recommendations more clearly.

At the same time, health officials should continue to provide data that shows the benefits of vaccines. Without it, experts might inadvertently send the signal that masks are a suitable alternative to getting a vaccine. Breakdowns of cases and hospitalizations by vaccination status should be regularly reported. This will also help experts monitor how well the vaccines are continuing to prevent severe illness.

When can masks come off?

Local experts should provide people with metrics they are using — like infections or vaccinations — to decide when masks will no longer be needed. Doing so underscores why the masks are back in the first place and provides hope for those who don’t like to wear them.

Since vaccines offer durable protection against serious illness, tying masking requirements to reasonable vaccination coverage goals and acceptable hospitalizations levels will provide a clearer view of progress than case numbers, which can fluctuate.

Everyone is weary of the pandemic. Vaccines offer the way out, but the United States has not convinced enough Americans of this. The nation cannot simply revert to the broad tactics employed during previous surges and expect compliance. It must be made explicitly clear to the public how measures like mask mandates will cut transmission and can be used to incentivize vaccinations.

Jennifer B. Nuzzo ( @JenniferNuzzo ) is an epidemiologist at the Johns Hopkins Bloomberg School of Public Health and a senior fellow for global health at the Council on Foreign Relations. Beth Blauer ( @biblauer ) is the associate vice provost for public sector innovation and the executive director of the Centers for Civic Impact at Johns Hopkins University. They are on the leadership team of the Johns Hopkins Coronavirus Resource Center.

The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips . And here’s our email: [email protected] .

Follow The New York Times Opinion section on Facebook , Twitter (@NYTopinion) and Instagram .

Jennifer B. Nuzzo is an epidemiologist and senior scholar at the Johns Hopkins Center for Health Security. @ @JenniferNuzzo

Coronavirus

Why Wearing a Mask is Important Argumentative Essay

We have all seen this newly everyday item no matter where we are or who we’re with. Masks. Because of the Corona Virus people have been wearing mask everyday but yet some still don’t. These people don’t under stand that masks will bring down the amount of Covid cases because its covering you mouth and nose, and its protecting others as well from getting the virus.

The first reason on why I believe its important to wear mask is because, masks will bring down the amount of Covid cases because its covering you mouth and nose. The article “5 Reasons To Wear a Face Mask” by AARP states “A few studies highlight the power of widespread community use of face coverings. A report published in Health Affairs, for example, found that states with face mask mandates had a greater decline in daily COVID-19 growth rates compared with states that did not issue mandates. The authors estimate that these mask policies may have prevented as many as 450,000 coronavirus cases in the U.S.”People really need to understand that by wearing mask will eventually lead to not needing them. For example Places like New Zealand barely have to wear masks anymore because they took the mask mandate very seriously.

The second reason on why I believe its important to wear masks is because wearing a mask will help protect others. The article “5 Reason to Wear a Face Mask” by AARP states “The primary way the coronavirus spreads is from person to person by respiratory droplets produced when an infected person coughs, sneezes or talks. Face masks, however, can block these droplets. They act as a barrier to keep virus-containing particles from escaping an infected individual and landing on another person.” How would you feel if one of your loved ones got infected with Covid-19 and get ill all because they either didn’t have a mask on, or someone around them didn’t have a mask on.

Now some people might complain that masks are to uncomfortable to wear and are useless. But as uncomfortable they are you are saving lives by wearing it, and you are also protecting yourself. The fact that people would rather catch a deadly virus that wear a mask is REALLY lame honestly. People have to come to terms that the Corona Virus is real, and that wearing a mask is important and should be done.

In conclusion is is very important for everyone to wear a mask because wearing a mask will help bring down the amount of COVID cases because its covering your mouth and nose, and because wearing a mask will help protect others from getting the virus. I understand that wearing a mask can be itchy and uncomfortable, but it’s very important that you wear one.

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Argumentative Essay Writing

Argumentative Essay About Wearing Mask

Ready, Set, Argue: Craft a Convincing Argumentative Essay About Wearing Mask

Published on: Mar 3, 2023

Last updated on: Jan 31, 2024

What Do We Mean By an Argumentative Essay?

An argumentative essay is a type of writing that presents an opinion or stance on a certain issue and supports it with evidence.

In this case, the main goal is to convince your readers why wearing masks is important and why they should be required in certain situations.

To do this, your essay should contain evidence that supports your argument and clear explanations of why masks are beneficial.

Purpose of Writing an Argumentative Essay About Wearing a Mask

The purpose of writing an argumentative essay about wearing a mask is to persuade your readers that masks are essential for protecting public health and safety.

It's important to provide evidence-based facts and research in order to make your argument clear and convincing.

A Few Arguments For Wearing A Mask

When writing an argumentative essay about wearing a mask, it's important to provide evidence-based facts and research that support your opinion.

The following are some of the key arguments for why masks should be worn:

Masks Reduce The Spread Of Infectious Diseases, Including Covid-19

Masks can help prevent the spread of infectious diseases, including COVID-19.

According to the Centers for Disease Control and Prevention (CDC), wearing a mask is an important preventive measure against respiratory illnesses, such as flu and coronavirus.

Check out this informative video about wearing masks!

Masks Protect The Wearer From Airborne Particles That May Contain Harmful Viruses And Bacteria.

Masks provide a barrier against airborne particles, such as viruses and bacteria.

When worn properly, they help filter out contaminants that may cause infections or illness if inhaled.

This means that masks can help protect the wearer from potentially harmful viruses and bacteria.

Wearing a Mask In Public Can Help Reduce Stress And Anxiety Associated

Being around people who are not wearing masks can be stressful and anxiety-provoking.

Wearing a mask in public is an important way to show that you care about protecting yourself and those around you, which can help reduce stress levels.

Additionally, by wearing a mask, you can help create a safer environment for everyone in the community, especially during the covid-19 pandemic.

Best Arguments For Not Wearing A Mask

The following are some of the key arguments for why masks should not be worn:

Wearing A Mask May Cause Physical Discomfort

Some people experience physical discomfort while wearing a mask, such as headaches or breathing difficulties.

Masks Are Not 100% Effective At Preventing The Spread Of Viruses

It's important to remember that masks are not 100% effective at preventing the spread of a virus.

While masks can help reduce the risk, other measures such as social distancing should also be taken to minimize the risk.

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Wearing A Mask May Give People A False Sense Of Security

Some people may mistakenly believe that wearing a mask alone is enough to protect them from contracting a virus, but this is not the case.

It's important to remember that masks should be used in combination with other preventive measures, such as social distancing and frequent handwashing.

Arguments Against Masks In Schools

When writing an argumentative essay about wearing a mask in schools, it's important to look at the potential arguments against masks.

The following are some of the key arguments against masks in schools:

Wearing A Mask Can Be Disruptive And Uncomfortable For Students

Many students may find wearing a mask to be disruptive and uncomfortable .

This can create a barrier to learning, as students may become distracted or frustrated with the discomfort of wearing a mask all day.

The Use Of Masks In Schools Could Lead To Decreased Social Interaction

Wearing a mask in school settings could limit students' ability to interact socially and express themselves. This could have a negative impact on their education and development.

There Is Limited Scientific Evidence To Support The Use Of Masks In Schools

While masks are proven to reduce the spread of diseases, there is still limited evidence to support their effectiveness in school settings.

Examples Of Argumentative Essays About Wearing A Mask

At CollegeEssay.org, we have many examples of argumentative essays about wearing a mask that you can read for free.

Our essays are written by experienced writers who specialize in crafting original content on a wide range of topics.

Argumentative essay about wearing a face mask pdf

Why wearing a mask is important essay

Essay about wearing a face mask is a must

Why wearing a mask is still important

Persuasive speech about wearing a mask

The benefits of wearing a face mask in public

Check our extensive blog on argumentative essay examples to ace your next essay!

We can see from the above arguments that wearing a face mask is an important preventive measure.

We should all take it seriously in order to protect ourselves and others from the spread of infectious diseases.

Doing so can help you understand the many arguments for and against masks, as well as the potential implications of wearing one in various settings.

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Our team of skilled writers specializes in crafting custom essays that meet your specific requirements and academic standards.

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Argumentative Essay

Argumentative Essay About Wearing A Mask

Last updated on: Apr 9, 2024

Crafting an Argumentative Essay About Wearing a Mask: Examples and Tips

By: Barbara P.

10 min read

Reviewed By: Melisa C.

Published on: Mar 10, 2023

argumentative essay about wearing a mask

Many students find it challenging to write an argumentative essay about wearing masks. They are unsure of where to begin or how to present convincing arguments.

The lack of clarity and guidance surrounding this topic often leads to frustration and confusion.

In this blog, we aim to provide a practical solution by offering a comprehensive guide on writing an argumentative essay about wearing masks.

We will delve into compelling arguments both for and against mask-wearing. We will also equip you with examples and tips to construct a compelling argumentative essay on your own.

Let’s get started.

On this Page

What is an Argumentative Essay?

An argumentative essay presents both sides of an argument on a specific topic. It attempts to convince the reader to accept one point of view over another.

They often include evidence collected from research, personal experiences, opinions, statistics, and other sources of information.

The goal is to present a convincing argument that encourages readers to agree with your point of view.

In argumentative essays, it's important to make sure all your claims have evidence to back them up. This will help establish credibility and encourage readers to agree with the argument you're presenting.

Need help to make convincing arguments? Our argumentative essay guide has you covered!

Purpose of Writing an Argumentative Essay About Wearing a Mask

The purpose of writing an argumentative essay about wearing a mask goes beyond expressing personal preferences.

Here are the key purposes behind writing such an essay:

Public Health Advocacy

The primary purpose of writing such essays is to advocate for public health and emphasize the importance of mask-wearing as a preventive measure.

It aims to educate and persuade readers about the potential benefits of wearing masks in mitigating the spread of infectious diseases.

Evidence-Based Arguments

By conducting research and presenting evidence, the essay serves to build a strong case for mask-wearing.

It involves analyzing accurate statistical data to demonstrate the effectiveness of masks and protecting both individuals and communities.

Counteracting Misinformation

The essay aims to address and counteract misinformation or misconceptions surrounding mask-wearing. It provides a platform to debunk myths and present accurate information about the benefits and limitations of wearing masks.

Promoting Responsible Behavior

Writing an argumentative essay about mask-wearing encourages responsible behavior among individuals.

It highlights the collective responsibility to prioritize public health. It also emphasizes how wearing masks can contribute to the well-being of society as a whole.

Encouraging Critical Thinking

Writing such essays promotes critical thinking skills. It requires evaluating different perspectives, analyzing conflicting evidence, and engaging in logical reasoning.

By engaging in this process, we can develop our ability to think critically, and navigate complex public health issues.

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Best Arguments in Favor of Wearing a Mask

As the argument over whether or not to wear a face covering continues, it’s important to look at both sides of this argument.

Here, we will examine the arguments for why you should wear a mask during these unprecedented times.

Let's analyze this argument in more detail.

Wearing a Mask Protects others Around You

When you wear a mask, you're not only protecting yourself, you’re also protecting those around you.

The Centers for Disease Control and Prevention (CDC) recommends wearing masks in public settings when social distancing isn't possible.

If everyone in your area wears a mask, it can help reduce the spread of the virus. It is especially important for those who are at higher risk for severe illness from COVID-19.

This includes older adults and people with certain underlying conditions like diabetes or heart disease.

Wearing a Mask can Help Reduce Stress Levels

It's no secret that living through this pandemic has been stressful for many people. One way to reduce stress levels is by wearing a mask when out in public.

Studies have shown that wearing masks can help reduce fear and anxiety associated with catching or spreading the virus. It can also help boost self-confidence when going out in public.

As you know you’re doing something proactive to protect yourself and those around you.

Wearing a Mask is Quick and Easy

One of the great things about wearing a mask is that it doesn't take much time or effort to do it right. All you need is an appropriate face covering.

Plus, there are plenty of fashionable masks available if you want something stylish!

Increases Compliance with Social Distancing Guidelines

Finally, one argument in favor of wearing masks is that it may increase compliance with social distancing guidelines.

If everyone is wearing masks while out in public, then it'll be easier to remember to keep at least six feet away from other people at all times.

Additionally, when everyone is covered up by masks, it'll discourage people from gathering together in large groups.

Best Arguments for not Wearing a Mask

While masks can help limit the transmission of the virus, there are some valid arguments against wearing them.

Let’s explore why some people may choose not to wear a mask during the pandemic.

Argument #1: Wearing a Mask is Uncomfortable

The truth is that for some people, wearing a face mask can be uncomfortable or even downright unpleasant. Masks can cause skin irritation and discomfort, especially when worn for extended periods of time.

They also make it difficult to breathe in hot or humid climates, which can be dangerous in itself.

Argument #2: Not Enough Scientific Evidence

There have been studies showing that masks can reduce transmission of certain viruses, such as influenza. There is still no definitive proof that they are 100% effective in preventing the spread of COVID-19 pandemic.

Without concrete evidence , some individuals may choose not to wear them at all times.

Argument #3: Civil Liberties/Rights Violation

Finally, some argue that wearing a face mask violates their civil liberties or rights as an individual.

This argument is especially prevalent among those who feel like their rights are being violated by mandatory mask policies.

Argument #4: Masks Reduce Oxygen Intake

One of the most common arguments against masks is that they can reduce oxygen intake. Masks can lead to health problems such as headaches, lightheadedness, and difficulty breathing.

While masks do filter air entering your nose and mouth, it's important to note that they don't completely block oxygen.

Argument #5: Masks Make People Fearful

The final argument against mandatory mask-wearing is that it can make people fearful of getting sick or catching the virus from others.

While this may be true for some people, it's important to remember that fear alone isn't enough to prevent the spread of disease!

Unlock the secrets of effective argumentative writing by viewing this video!

Arguments Against Wearing Masks in Schools

Some argue that masks are necessary to protect students and staff from the spread of COVID-19. Others argue that masks pose more risks than benefits.

Let’s take a look at some of the arguments against masks in schools.

Argument #1: Unnecessary Stress on Students

One argument against making masks compulsory in schools is that it can cause unnecessary stress and anxiety among students.

For younger children, the thought of having to wear a mask all day can be overwhelming and may even lead to behavioral problems.

Argument #2: Difficulty with Learning and Concentration

Another argument against mask-wearing is that it can make learning more difficult and impair concentration.

Additionally, being unable to see facial expressions clearly can impede communication between teachers and students. This will hindering the learning process even further.

Argument # 3: They Can Be an Unnecessary Expense

For families on tight budgets, buying enough masks for each person in the family every day could be an additional expense they cannot afford.

This could create an unfair financial burden on families who already struggle to make ends meet.

Writing an Argumentative Essay about Wearing Masks - 4 Easy Steps

Writing an argumentative essay about wearing masks can be simplified into four essential steps.

Let's delve into each step:

Thorough Research

Begin by conducting thorough research on mask-wearing, including its benefits, effectiveness, and potential drawbacks.

Explore scientific studies, reliable sources, and expert opinions to gather evidence that supports your viewpoint. Take note of key statistics, examples, and arguments that will strengthen your essay.

Introduction

Start your essay by grabbing the reader's attention with an engaging opening statement or a thought-provoking question.

Clearly state your thesis statement, which should express your position on wearing masks. It should also provide a preview of the main arguments you will present in the body paragraphs.

Body Paragraphs

Develop the body of your essay by presenting well-structured paragraphs that support your thesis statement.

Each body paragraph should focus on a single argument or point related to wearing masks. Start each paragraph with a topic sentence that introduces the main idea.

Support your arguments with relevant evidence, such as research findings, expert opinions, or real-life examples.

Consider addressing counterarguments and providing counterpoints to demonstrate a comprehensive understanding of the topic.

In the conclusion, restate your thesis statement and summarize the main points discussed in the body paragraphs.

Emphasize the significance of wearing masks and the importance of your viewpoint. Leave the reader with a lasting impression by providing a compelling final thought or a call to action.

Avoid introducing new information in the conclusion; instead, reinforce the key arguments and solidify your position.

Discover how to create a compelling outline for your essay by examining our comprehensive argumentative essay outline blog.

Examples of Argumentative Essay About Wearing a Mask

As the argument over whether or not to wear a face covering continues, it’s important to look at both sides of this argument.

Here, we have provided a few argumentative essay examples about wearing a mask in public settings.

Explore how to craft an argument and provide evidence to back it up.

Argumentative essay about wearing face mask pdf

Why wearing a mask is important essay

The benefits of wearing a face mask in public

Why wearing a mask is still important

The Importance of Wearing a Mask

Persuasive speech about wearing mask

Argumentative essay about wearing a mask in school

Need some more inspiration to get started? Look no further than our blog of argumentative essay examples !

Tips To Write an Argumentative Essay about Wearing Masks

Writing an argumentative essay about wearing masks requires careful planning and execution to effectively convey your viewpoint.

Here are some valuable tips to help you craft a compelling essay:

Clearly Define Your Position

Start by clearly stating your stance on mask-wearing. Are you in favor of it or against it? Make sure your position is well-defined and reflected in your thesis statement.

This will provide a clear direction for your essay and guide your arguments.

Conduct Extensive Research

Gather reliable and up-to-date information about mask-wearing, including scientific studies, expert opinions, and relevant statistics.

Understand the reasons behind mask mandates, the effectiveness of different types of masks, and their impact on public health.

Well-researched arguments will enhance the credibility and strength of your essay.

Present Strong Evidence

Use credible sources and compelling evidence to support your arguments. This can include scientific research, data from reputable health organizations, testimonies from experts, or real-life examples.

Be sure to cite your sources properly to maintain academic integrity.

Acknowledge Counterarguments

Address counterarguments to demonstrate your understanding of different perspectives. Anticipate opposing viewpoints and provide counterpoints to refute them.

This shows that you have considered alternative positions and strengthens your own argument by demonstrating its superiority.

Use Persuasive Language

Craft your essay using persuasive language and rhetorical techniques. Develop a convincing and authoritative tone.

Use logical reasoning, emotional appeals, and ethical arguments to appeal to readers' intellect and emotions.

However, ensure that your persuasive techniques remain grounded in factual information and reasoned analysis.

Maintain Clarity and Cohesion

Make sure your essay is well-organized and coherent. Use clear and concise language to convey your ideas effectively.

Avoid jargon or complex terminology that may confuse readers. Use transitional words and phrases to ensure smooth flow between paragraphs and ideas.

Stay Objective and Respectful

While advocating for your position, maintain objectivity and respect for opposing views. Avoid personal attacks or derogatory language.

Instead, focus on presenting logical arguments and reliable evidence to support your claims.

Conclude with Impact

End your essay with a strong conclusion that summarizes your main points and reinforces your position.

Leave readers with a lasting impression and a call to action, urging them to consider the importance of mask-wearing and the impact it can have on public health.

In conclusion, writing an argumentative essay about wearing masks requires careful research, thoughtful analysis, and persuasive writing skills.

By following the tips outlined in this blog, you can effectively present your arguments and contribute to the ongoing discourse on this important topic.

If you do not know where to start, our argumentative essay writing service is always at your disposal.

We have an experienced argumentative essay writer who can help you craft the perfect argumentative essay on this topic.

Our write my paper service offers limitless perks along with the best quality work.

So, why wait? Place your order with our essay writer today!

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Dr. Barbara is a highly experienced writer and author who holds a Ph.D. degree in public health from an Ivy League school. She has worked in the medical field for many years, conducting extensive research on various health topics. Her writing has been featured in several top-tier publications.

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The Ethics of Wearing (or Not Wearing) a Face Mask During the Coronavirus Pandemic

A mericans have not always done selfless well. The country’s vast landmass and frontier history have long made American culture one that highly prizes personal freedom—often at the expense of the public good. Enter coronavirus, enter the face mask, and all of that gets exacerbated.

What we don’t know about face masks is in some ways as great as what we do know. A properly fitted N95 mask can be extremely effective at protecting the wearer from being infected by others, as well as protecting others from being infected by the wearer. But simple surgical masks or homemade masks? The scientific research to date suggests they do a much better job of protecting other people from you than protecting you from other people. In the context of a pandemic, stopping the infection in both directions can be equally important in preventing a communicable disease from spreading, and official U.S. policy may be changing to reflect that.

On April 3, President Trump announced that the U.S. Centers for Disease Control and Prevention (CDC) would now be recommending the use of cloth masks—including the do-it-yourself kind—to prevent asymptomatic people from spreading the virus. Whether the measure will be widely adopted is uncertain, at least in part because of how mask-wearing is perceived in the U.S. “We look at people wearing a mask as if they’re sick and we tend to stigmatize them,” says Jessica Berg, dean of the Case Western Reserve University School of Law and a professor of bioethics and public health. “In Eastern cultures people wear masks during flu season to protect others and then they come here and it’s startling and horrible to them that we don’t.”

It might seem that, if masks are scarce, they should go to the people most at risk of suffering significantly from COVID-19. Primarily, that means older people, and especially those with underlying health conditions. But, says Berg, if the purpose of a mask is really to prevent the wearer from spreading the virus, “Maybe in fact the right person to buy a mask would be your healthy millennial. They’re the people who would be walking around more. The people you want wearing masks are the people who are coming into contact with other people.”

Masks also can be a form of virtue-signaling. Bioethicist Nancy Kass, deputy director for public health of Johns Hopkins University’s Berman Institute, shares examples of social behavior that are admittedly anecdotal, but nonetheless telling. “A friend of mine who lives in an apartment building tells me that when he’s wearing a mask other people won’t get in an elevator with him,” she says. “Someone else told me, ‘I started to wear a mask when I go to the grocery store because other people stay away from me.'”

It’s not at all clear whether that happens because the mask wearers are inadvertently sending the signal that they are sick or sending a reminder that this is a time of social distancing, but Kass argues that it’s entirely possible it’s the latter, more selfless, reason. “These are healthy people, but they want to do their one-in-320-million-person part,” she says.

Getting your hands on a mask in the first place is another ethical conundrum. It is perhaps a positive sign that both Target and Home Depot came in for intense criticism in the last two weeks for stocking N95 masks—which are in short supply and desperately needed by health care workers—on their shelves. Target quickly pulled the masks and apologized for stocking them “in error.” Home Depot similarly ordered all of its 2,300 stores to stop selling the masks. The unexpected availability of the in-demand items was met at least partly with righteous public opprobrium.

“The ethical issue is that healthcare workers and other first responders really need medical-grade masks to protect themselves, but these kinds of masks are in short supply,” writes Suzanne Rivera, associate professor of bioethics and vice president for research and technology management at Case Western, in an email to TIME. “Those of us who don’t work in healthcare settings should stick to fabric masks, like the kind many people are sewing at home.”

Then there’s the ethical question of hoarding—which is really not a question at all. The universally accepted ethical rule is: Just don’t. In times of crisis, hoarding food, water, batteries, diapers, toilet paper and more is a natural impulse, but one that is both selfish and misguided—with the amount bought often exceeding actual need. That applies too to masks. “I would say that nobody could be faulted for obtaining one mask, particularly anyone who lives with an at-risk individual,” says Jonathan Haidt, professor of ethical leadership at New York University’s Stern School of Business. “Beyond the first mask, the cost-benefit calculation changes.”

Finally, there are the ethical burdens borne not by the average person, but the people in a position to make rules and impose policies: government and public health officials. The rule here is to be forthcoming. If you don’t know the answer, say so. If you get something wrong, own it and correct it.

“Officials need to be very, very careful that the recommendations they make have a reasonable amount of data behind them,” says Kass. “If we don’t have the data we have to say so.”

The new mask recommendations may be a sign that the government is trying harder to get things right, to follow those ethical dicta. Of course, the public’s response to the recommendations will be the true sign of whether Americans as a whole are as well.

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ORIGINAL RESEARCH article

Face masks during the covid-19 pandemic: a simple protection tool with many meanings.

$\nLucia Martinelli$

1 MUSE – Science Museum, Trento, Italy
2 Faculty of Croatian Studies, University of Zagreb, Zagreb, Croatia
3 Croatian Institute for Brain Research, University of Zagreb School of Medicine, Zagreb, Croatia
4 Institute for the Study of Science, Technology and Innovation, The University of Edinburgh, Edinburgh, United Kingdom
5 Business Information Systems, Cork University Business School, University College Cork, Cork, Ireland
6 Communication and Society Research Centre, University of Minho, Braga, Portugal
7 University Hospital Medical Center “Bežanijska kosa”, and University of Belgrade Faculty of Medicine, Belgrade, Serbia
8 Department of Health Economics, Faculty of Medicine, University of Szeged, Szeged, Hungary
9 Department of Political Science, Centre for the Study of Contemporary Solidarity (CeSCoS), University of Vienna, Vienna, Austria
10 Department of Global Health & Social Medicine, King's College London, London, United Kingdom

Wearing face masks is recommended as part of personal protective equipment and as a public health measure to prevent the spread of coronavirus disease 2019 (COVID-19) pandemic. Their use, however, is deeply connected to social and cultural practices and has acquired a variety of personal and social meanings. This article aims to identify the diversity of sociocultural, ethical, and political meanings attributed to face masks, how they might impact public health policies, and how they should be considered in health communication. In May 2020, we involved 29 experts of an interdisciplinary research network on health and society to provide their testimonies on the use of face masks in 20 European and 2 Asian countries (China and South Korea). They reflected on regulations in the corresponding jurisdictions as well as the personal and social aspects of face mask wearing. We analyzed those testimonies thematically, employing the method of qualitative descriptive analysis. The analysis framed the four dimensions of the societal and personal practices of wearing (or not wearing) face masks: individual perceptions of infection risk, personal interpretations of responsibility and solidarity, cultural traditions and religious imprinting, and the need of expressing self-identity. Our study points to the importance for an in-depth understanding of the cultural and sociopolitical considerations around the personal and social meaning of mask wearing in different contexts as a necessary prerequisite for the assessment of the effectiveness of face masks as a public health measure. Improving the personal and collective understanding of citizens' behaviors and attitudes appears essential for designing more effective health communications about COVID-19 pandemic or other global crises in the future.

To wear a face mask or not to wear a face mask?

Nowadays, this question has been analogous

to the famous line from Shakespeare's Hamlet:

“To be or not to be, that is the question.”

This is a bit allegorical ,

but certainly not far from the current circumstances

where a deadly virus is spreading amongst us ... Vanja Kopilaš, Croatia.

Introduction

The coronavirus disease 2019 (COVID-19) pandemic is currently perceived as one of the greatest global threats, not only to public health and well-being, but also to global economic and social stability. While the first two decades of the third millennium were characterized by crisis—most notably the economic downturn of 2008 and the looming climate change—the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus originating from China has given rise to most drastic societal and political responses. These included measures as severe as states forbidding citizens from leaving their homes and effectively shutting down all social and economic activities ( 1 ). In Europe, Italy was the first country to officially detect the presence of COVID-19 in its territory, and it swiftly adopted measures to contain its spread ( 2 – 4 ). Within a few weeks, the epidemic progressively spread across Europe. Because of the novel situation and the contradictory opinions of experts, including representatives of the scientific community and World Health Organization (WHO), the level of threat caused by the disease appeared unclear ( 5 ). The assessment of the perceived risks of the disease varied in the public discourse—some considered it just as “a stronger influenza”; others drew parallels with the very deadly Spanish Flu outbreak in the 1918–1920, and many were simply not sure what to believe. Nevertheless, most felt the novel and unpleasant feeling of being vulnerable to the invisible threat of the infection (i.e., to be the ones in danger) or to be contagious themselves (i.e., to be the danger).

A variety of public health and hygiene measures have been initiated; the most visually noticeable perhaps is the wearing of face masks. The medical research on the use of face masks as personal protective equipment (PPE) against SARS-CoV-2 transmission was interpreted very cautiously, and the initial guidance from health officials was conflicting ( 6 ). The WHO advice was conceived to avoid unnecessary paternalism and at the same time be comprehensive in discussing different medical aspects of mask use. However, it was updated several times, shifting from initial statements that face masks are not to be worn by healthy individuals toward gradual adoption of face masks as useful in slowing community transmission. In particular, “…WHO has updated its guidance to advise that to prevent COVID-19 transmission effectively in areas of community transmission, governments should encourage the general public to wear masks in specific situations and settings as part of a comprehensive approach to suppress SARS-CoV-2 transmission” ( 7 ). Gradually, face mask use has been recognized as a suitable measure within the scientific community ( 8 – 12 ), if nothing else due to the application of the “precautionary principle” in the face of an acute crisis ( 13 , 14 ). This has since been backed up by empirical observations ( 15 , 16 ).

Different, mandatory or voluntary, practices, and contradictory indications about the utility of face mask wearing were introduced across affected countries. Generally speaking, face masks have been adopted as one of the measures to reduce the COVID-19 spread across Europe, despite the fact that wearing masks in Europe is not common or familiar, and it is often associated with Asian countries ( 17 ). The social conventions and personal meanings of face mask use have received relatively little attention. Its use is deeply connected to social and cultural practices, as well as political, ethical, and health-related concerns, personal, and social meanings ( 18 , 19 ).

In this study, our aim was to address three aspects of face mask wearing—public policies, individual behaviors and attitudes, and the collective experiences of the affected communities. In order to develop insights into the wider meanings of face mask wearing beyond (just) preventing the spread of infection, we tapped into the expertise of a scholarly interdisciplinary network, the Navigating Knowledge Landscapes—NKL ( http://knowledge-landscapes.hiim.hr/ ), predominantly consisting of Europe-based scholars. The network is dedicated to furthering research on topics related to medicine, health, and society and comprises academics working across the disciplinary spectrum. We invited NKL members in May 2020 to provide their observations on the topic, also based on their professional experience. They were asked to describe the face mask usage in their countries and provide their subjective standpoints and/or those from their social environment. Subsequently, these testimonies within the specific time window (May 2020) containing narratives on face masks from the contributing experts were thematically analyzed using the method of qualitative descriptive analysis ( 20 , 21 ).

Materials and Methods

The invitation to write their views about face mask wearing was sent by e-mail to 97 experts, all members of the interdisciplinary research network Navigating Knowledge Landscapes (NKL; http://knowledge-landscapes.hiim.hr/ ). The invitation was sent on May 11, 2020, and the responses were collected until May 26, 2020 (over 16 days' period). The experts were asked to contribute a single-page narrative structured in four parts, framed as follows:

• Part 1: What are the rules adopted in your country about face mask wearing? What would be the overall approach for use of the face masks in your community (government instructions, availability, the citizen compliance)?

• Part 2: What is your individual/personal attitude and practice in relation to face masks? If applicable, start with good practice and end with what you consider to be mistakes.

• Part 3: How do you judge the behavior of people you encounter? Face masks (or no face masks) and interpersonal interactions. Again, start with positive and end with negative.

• Part 4 (optional): free to say whatever you think is important to the practices of your community in relation to face masks.

Twenty-nine scholars responded (30% of those invited), providing 27 contributions (two contributions were coauthored). They were from 22 countries, 20 from Europe (Albania, Austria, Bosnia and Herzegovina, Croatia, Czechia, Estonia, Hungary, Italy, Ireland, Norway, Poland, Portugal, Romania, Serbia, Slovenia, Spain, Sweden, Turkey, Ukraine, and United Kingdom) and two from Asia (China and South Korea). The contributors belonged to the following academic disciplines: biology (2), economics (1), engineering (2), information systems (1), law (1), medicine (6), philosophy (5), psychology (1), and sociology (10).

The contributors as experts are all highly educated (Ph.D., holders or Ph.D., students), and most of them are employed in academic institutions and perform research activities in their respective disciplines. The authors of this study were among the contributors.

The testimonials were based on the aforementioned open-ended questions and narrative in style. “Face mask” was used as the umbrella term for all types of face coverings, from the custom-made cotton scarves to disposable surgical masks and medical-grade N95 respirators. This was done to preserve the authenticity of these narratives without going into detail about the medical or microbiological features of the different types of face coverings. In the same way, grammatical or vocabulary use of non-native English speakers was kept as it was. The contributions received were collected and published as a citable open-source dataset at Mendeley Data repository ( 22 ).

The contributions were thematically analyzed by employing a qualitative descriptive approach ( 23 ). We chose this method because it aimed to provide “rich descriptions about a phenomenon, which little may be known about” [( 23 ), p. 3] and was particularly useful for exploratory research such as our study. It is characterized by staying close to the empirical data, instead of seeking to provide a more conceptual interpretation of the phenomenon in question. Moreover, open-ended questions address different aspects of the same topic and allow formulating answers that could let respondents to frame face mask wearing according to their own personal views ( 24 ).

Concerning the thematic analysis, we divided testimonials in three categories. The first category captured the situation in the respondent's country; the subcategories we were interested in were the regulatory framework and the supply situation in each respective country. The second category captured experts' own use of masks. Here we focused in particular on whether and in which situations they reported to wear (or not wear) masks, what kind of face covering they used, and the meaning they ascribed to masks (e.g., mask wearing as a symbol of social cohesion). Third, we categorized the participants' accounts regarding the practices and attitudes of mask wearing they observed in others. We created an MS Excel file in which we collected the respondents' statements on these different categories. In a subsequent step, we analyzed the data for patterns and recurring topics. We looked for country-specific differences and similarities in regulations and practices. Moreover, we also paid close attention to how the experts made sense of their experiences with mask wearing and how the issues addressed were expressed (e.g., experts referring to folk stories, metaphors, or past incidents). When presenting our research results, we focused on the topics we identified as prevalent through our inductive analysis, and we contextualized it based on the published research.

The narratives analyzed in this study were given with the full consent of the people who wrote them and were made available for public access as an open-source repository for the research purpose ( 22 ). All the authors provided their consent that the narratives are published in the repository under their full name and affiliation and that they can be used for research purposes. The authors were cited here under their full names, recognizing their authorship of the narratives and their contribution to the dataset collection. The study received ethical approvals from the Ethical Committees of the University of Edinburgh, Scotland, UK and the University of Zagreb, Faculty of Croatian Studies, Croatia.

Face Mask Wearing From Medical to Public Settings

The use of a face mask—of various specifications according to the required degree of protection/function—is part of the PPE required in several professional activities, most noticeable in healthcare. One of the participants in this study, who works in healthcare, described her own experience in terms of the caring features of the face masks from medical to communal setting.

“ As an obstetrician–gynecologist, I am used with the mask, I feel it a part of my professional life, and I am trying to convince people that there is no way of considering the mask as an enemy but as a protection-like and umbrella against the rain, like a coat against the cold—and as a sign of civilization to protect our colleges and people around.” [Iuliana Ceausu, Romania]

The contextual transfer of face mask use from healthcare settings to public spaces is precisely the aspect of making the “outside world” closely resemble scientific apparatus. This includes measuring its success as a feature of the social power derived from the accuracy of the scientific prediction. For instance, Latour ( 25 ) specifically examines the public nature of Pasteur's demonstration of the efficacy of the process of animal vaccination by making a “prophecy” that vaccinated cattle on a pilot farm will survive, while other infected animals will perish. In the same way, the (anecdotally) apparent success of the use of face masks reinforces the belief in their utility and efficacy:

“ The people working in the shops would use the masks too… I see familiar faces of the employees all the times of lockdown, although they spend all time in the shop with many different customers, obviously they did not get sick. This was for me a major reassuring fact that the danger is not so high as it could be seen from the media.” [Srećko Gajović, Croatia]

It is worth remembering here the significant number of deaths of inadequately protected healthcare workers during the COVID-19 epidemic in various countries, mainly due to the lack of the appropriate PPE supplies ( 26 ).

The Politics of a Face Mask

Following initial confusion around the utility of face masks for slowing down the spread of COVID-19 pandemic, there is increasing scientific evidence to support citizens' wearing of face coverings, albeit the public health advice and legislation vary from country to country. A recent study in Germany indicated that a mandatory approach to face mask wearing achieved better compliance than voluntary one, and it was perceived as an effective, fair, and socially responsible measure ( 27 ).

In our study, accordingly, the reported country policies differed across rather a wide spectrum of approaches—ranging from legally mandated instructions to cover one's face in all public spaces reinforced by financial penalties (i.e., payable fines), to recommendations only, official indifference, or advice against this practice ( Table 1 ). We were interested how these policies related to the concurrent COVID-19 situation expressed as total number and increase of cases per million people in these countries during the period when experts made their contributions. We observed an obvious trend showing that the countries with more strict rules had better epidemiological situation than those not mandating the face mask usage ( Table 1 ).

Table 1 . Perception of the official policies on face mask usage in May 2020.

In some countries, face mask–related policies did not need to be prescribed as this was part of existing established habits; in the same way, no fines are necessary to get people to wash their hands. In particular, since the SARS epidemic in 2003, in many Asian countries, masks are customary wear used to protect against seasonal flu and the common cold. In China and South Korea, they are also employed to protect citizens from pollutants ( 17 , 29 ).

“ In South Korea, it is common to wear a mask to keep the cold from getting worse in the winter and to prevent the spread of cold to others. Also, as the yellow dust from China and fine dust became much severe, it was common for many people, especially children, to wear masks even before the corona crisis. For this reason, many families even had a lot of masks in their homes before the corona crisis. Personally, I'm familiar with wearing a mask, and I'd like to wear it in order not to harm other people, as I may be a potential patient.” [Jiwon Shim, South Korea]

In contrast, in the West, the use of face masks is rare in social settings. Hence, because of the public visibility of face mask usage, face masks became an ideological symbol in some countries, with divergent political mindsets governing their adaption or rejection ( 17 ). Political dividing lines were particularly apparent in the United States, where the President refused to wear a mask until the last days of July 2020, when the floundering poll numbers and the increasing numbers of COVID-19 cases prompted the need to recommend this health protection device ( 30 ). Thus, in the United States and elsewhere, face masks were used by citizens to express their opinions in public.

“ At the beginning of the pandemic, the use of masks had political connotations: since the government advised against their use, their wearing was even considered a form of political opinion.” [Iñigo de Miguel Beriain, Spain]

The public statement made by wearing (or not wearing) the face mask did not only address the political standpoints but have also been used to communicate various societally relevant statements, i.e., stating ethnical, religious, or cultural affiliations ( 31 ). For instance, many countries that before COVID-19 banned face coverings in public spaces are now mandating it, supporting the idea that the past bans were motivated on the basis of religious/cultural beliefs ( 17 ).

“ Ethical and moral dilemmas have already risen, especially in countries where Muslim minorities live. If you ban a burka covering the face due to security reasons, how would you deal with massive usage of face masks?” [Gentian Vyshka, Albania]

“ The decision to wear a face mask is not an easy one. Traditionally, face coverings are an indicator of political persuasion and religious belief. I perceive that the widespread covering of one's face in public is a significant cultural and social shift in Ireland.” [Ciara Heavin, Ireland]

“To Wear a Face Mask, or Not to Wear a Face Mask, That Is the Question…”

The collected narratives indicated that the contributors had a clear standpoint on their own face mask usage and developed arguments to support their decisions to wear or not to wear face masks.

“ As soon as I leave the house and find myself in the supermarket or in public places, I wear a mask. However, I do not wear a mask when I take a walk in the forest. I started wearing it even before it became mandatory. I think it is important to wear masks, especially to avoid endangering others, e.g., elderly people. I find it unspeakable when people who wear masks are ridiculed by those who do not wear masks. At least that's what happened to me in the beginning, before the mask duty… Many thought that the people wearing masks would want to protect themselves in particular. Very few thought that people wearing masks wanted to protect their social environment.” [Melike Sahinol, Turkey]

“ My personal view is that as long as the spread of the virus is under control (as it currently is), there is no need to make the masks obligatory. I personally have not worn a mask (have not purchased any either) with the exception of when I visited healthcare institution (provided by them). I must also say, though, that none of my family members are considered a vulnerable population. If my grandmother would live with us, I might think differently.” [Kadri Simm, Estonia]

What was exemplified in many narratives is that individual usage is not meant predominantly for an individual's self-protection, but the decision was based on people's relationship to others. The citizens' question “should I protect myself” evolved into “can I protect the others?”

“ I wear disposable masks, understanding they protect others from me, more than me from others. I wear them to demonstrate responsible behavior and attitude to benefit of society.” [Predrag Pale, Croatia]

The experiences of interaction with others in relation to face mask wearing were mentioned frequently, indicating the importance of the social context of individual behavior.

“ I experienced cases when my request to keep distance or to take on a mask properly was treated offensively or as a sign of mistrust…” [Christina Nasadyuk, Ukraine]

“ I put it on when I go to the grocery store because at the early stage of the pandemic, I was warned by the lady working at the counter that I am putting her life ‘in danger by not wearing a mask.' Obviously, I did not want to take chances with her life again, so I purchased one of those cloth masks.” [Vanja Kopilaš, Croatia]

However, many testimonies pointed out that masks have not been used properly. The health risks of incorrectly wearing a face mask represent an important argument against the use of face masks as a public health measure ( 32 ).

“ …25% wore masks improperly, on their necks, or covering only their mouths, but not noses. …They do not know how to put the mask on, and when they remove their masks, they touch the outside of the mask, which is inappropriate and wrong.” [Izet Mašić, Bosnia and Herzegovina]

“ Also, one can observe many cases of half-compliance or sham compliance. For instance, people do wear masks, but slide them down onto their chins or take them off completely while talking to someone on the street or speaking on the phone. And this is all a performance, keeping their masks somewhere within reach in case of the sudden emergence of police officers, who are indeed issuing fines for not wearing a mask.” [Aleksandra Głos, Poland]

This is even more complicated in situations when face masks were scarce (the stocks gradually improved through time in all examined locales).

“ During the early stages of disease progression, mask wearing was not a common practice, mainly due to the complete absence and highly inflated prices in stores.” [Rostyslav Bilyy, Ukraine]

“ I do not use face mask. In the early stage of the COVID-19 epidemic in Norway, my understanding was that available masks should be reserved for people in the health and caring sector.” [Anna Lydia Svalastog, Norway]

“ I think the biggest concern is that the mask has been in short supply for a long time, and that its trade has not been subject to official pricing, so prices have been uncontrolled… The mask was in short supply when emergency was announced, but it is now available in many places and can be obtained at the checkout of almost every grocery store if someone started shopping without it.” [Norbert Buzas, Hungary]

The shortage of masks ignited a burst of creativity in producing homemade masks, with a proliferation of tutorials for their production on the Internet and social media.

“ Nowhere was possible to come to the face masks. Typical situation: the government did announce decree, but it did not provide the means for its implementation. We as ordinary citizens need to improvise with needlework of masks at home as well. Taking in regard that immediately rapacious war profiteers did appear by selling masks the needlework of masks at home was even not the worst solution.” [Franc Mali, Slovenia]

“ Although during the first weeks there was lack of masks and respirators, it was great how many people proved their creativity. It concerned not only the textile reusable masks, but also design and development of respirators with higher level of protection. They were mostly printed on 3D printers. Later on, some of the approved types were taken by larger producers, and mass production started.” [Lenka Lhotska, Czechia]

Mask Wearing at the Interface of Personal and Social Responsibility

Besides being shaped by public discourse and social norms, risk perception also has a strong personal element. Some people seem like they do not care; others are quite relaxed, and some are more cautious. As for COVID-19, conflicting perspectives and emotions and even the psychological entrapment syndrome known as “cabin fever” (i.e., referencing long winter isolation in a small cabin) have been reported ( 33 ). Here, restricted microenvironments and quarantine are felt as secure places. The additional challenges were noticeable during the shift from the lockdown phase and the beginning of the so-called “phase 2” or “reopening” when people were allowed to leave their home again.

“ ‘Convivere,' i.e., ‘live together with' the virus is the expression used by experts and media, to describe the phase 2, but this narrative could result quite distressing: how glad would someone be when living with a submicroscopic entity, that is such dangerous?” [Lucia Martinelli, Italy]

During this second phase, going back to living with “the others” demands new social behavior/etiquette combined with increased safety measures. The face masks start to be part of the new everyday rituals of saying hello, having a coffee together, and protecting each other. The role of peers in shaping the behavior of others is significant. People not committed to wearing mask can feel peers' pressure to comply. Moreover, “a collapse between the status of being at risk and being a risk ” was noted ( 34 – 36 ).

“ The face mask, I realize, signals both positions, at the same time as it doesn't provide a definite answer: are you the risk object or the object at risk? Saying this, my individual attitude toward face masks cannot be pried apart from the social acceptance and use of the same. As long as the nonuse of face masks constitutes the norm, I will most likely interpret the usage as deviant and worrying. On the other hand, if the vast majority of the Swedish population would wear face masks, I would most likely start wearing a face mask as well. Here, the mass effect kicks in.” [Jennie Olofsson, Sweden]

“ The massive use of the masks among Albanian citizens… has become a normal well-adopted ritual of surviving, implemented as of a social significance for ‘not letting the virus in.' This social cohesion on the intrapersonal view as ‘to scare the virus” and ‘fear of an enemy' comes close to a group approach of ‘control and stability.' This ritual of social cohesion vis-à-vis the ‘fear of death' or ‘fear of the unknowing' is a similar to a psychological regression, when the individual survival depended largely from the herd.” [Gentian Vyshka, Albania]

“ For me, unlike other measures to contain the spread of the virus, the wearing of masks is predominantly a symbol of social cohesion and complying with the rules and not so much a measure to effectively protect myself and others from infection. The few times I saw someone without a mask entering a supermarket or the metro, my first thoughts were about social deviance and the arrogance of ignoring a commonly agreed-upon practice, and not about the risk of infection.” [Mirjam Pot & Barbara Prainsack, Austria]

Individual and collective responsibility and trust in the institutions and in the official assessment of risks and recommendations as to the adopted measures are crucial to build up a degree of epistemic agreement ( 37 ). However, this is perhaps more challenging in a contested environment of “recommendation trust” ( 38 ), which likely depends on communicating certainty ( 39 ), of which very little has been seen during COVID-19 pandemic. Hence, the acceptance of official advice varied among countries, cultures, and political contexts, with some degree of contradiction.

“ In general, there seems to be a relatively wide acceptance of government recommendations, but a very patchy uptake. Though the Scottish Government advice is trusted more than that from the UK Government, significant generational and cultural differences can be seen as to its implementation… in a multicultural society such as Scotland, there are some subtle differences between people from different cultural backgrounds and traditions who are either more accustomed to follow stricter government instructions, or from cultures where face mask wearing is more commonplace.” [Matjaž Vidmar, Scotland, UK]

“ Finally, as an anecdote, I would mention the recent case of expelling an opposition MP from the Assembly because he did not have a mask on his face, although the Prime Minister who warned the MP did not have a mask either.” [Zoran Todorović, Serbia]

The pandemic also seems to have reminded many people about the responsibility of humanity toward the preservation of all the living organisms and, as recognized by the Centers for Disease Control and Prevention ( 40 ), that our health is closely connected to the health of whole environment.

“ We should see ourselves as the most important participants and the biggest beneficiaries of public health, so we should take expert advice—wear mask. In other word, under this special situation, we need to work with medical experts, government to co-build a safe, harmonious and orderly living world with ‘One Health' concept, rather to resist or despise it.” [Bie Ying Long, China]

The Face Mask: A New Barrier Affecting Social Relations?

If we assume that in the near future we will be used to living with the pandemic, or even a series of pandemics, we are currently developing new norms for social interaction. Being with other people and enjoying their company are essential for our mental and physical well-being. How do these interactions include face mask usage? What will socializing look like in the era of physical distancing (i.e., “keeping a safe space between yourself and other people who are not from your household”) ( 41 )? These issues are being recognized as particularly challenging.

“ We must reinforce the message that face masks do not remove (or even reduce) the need for social distancing as well as excellent hand and respiratory hygiene. We need to avoid a situation where face masks become a weapon that could negatively impact our fight against this invisible enemy.” [Ciara Heavin, Ireland]

“ I believe the benefits of face masks may be overestimated and lead us into a false sense of security in which we take unwarranted risks—such as touching more objects and neglecting handwashing or going outside when suffering from a cough or cold. Therefore, my preference would be to give greater attention to other steps such as providing screens and visors for workers in public facing roles and reinforcing protective mechanisms around social distancing.” [Helena Webb & Sue Ziebland, England, UK]

“ Since the use of a mask started to become widespread, people seem to feel safer and unfortunately are more at risk, for example, not maintaining physical distance, making appointments with extended family and friends, etc.” [Helena Machado, Portugal]

Not all evidence is in support of above assessments that face masks bring about a (false) sense of security. In a recent study conducted in the Italian Venice metropolitan area, wearing a mask has proven to be a visual factor strengthening physical distancing as a public health measure ( 3 ). Between February 24 and April 29, 2020, distances have been measured by an operator wearing an exclusive sensor-based “social distancing belt.” They were interchangeably “unmasked,” “masked,” “do it yourself (DIY)-masked,” “goggles masked,” and “goggles DIY-masked.” Results show that people tended to stay closer to an unmasked person, while mask wearing tended to increase the physical distance. This paradox is explained by considering humans' intrinsic social nature that favors social vs. antisocial behaviors ( 3 ). Wearing a mask thus can turn unconscious social behavior into conscious antisocial behavior.

“ I believe that due to the extraordinarity of wearing face coverings in public spaces in Scotland, these do not encourage an undue feeling of ‘safety' by their use, rather the reverse. Hence, with full awareness that the evidence for being protected by this measure is not there, rather, I hope that by wearing a face covering, I may remind (or even deter) others from breaking social distancing rules.” [Matjaž Vidmar, Scotland, UK]

Marchiori's study ( 3 ) also suggests that distance increases with face mask wearing, thus supporting the importance of visual stimuli as a signal of danger. This fact recalled in the mind of our colleague, Bie Ying Long, the ancient Chinese tale of “The Blind Man Who Lights a Lantern While He Walks in the Night,” which proposes a “wise” interpretation of action as interplay of altruism and self-interest ( 42 ). When people asked a blind man for the reason why was he carrying a large lantern when he traveled at night, he replied that while day and night were not different to him, carrying a lantern while walking in the night was for the sake of everyone. For him, the lantern provided protection from other people, allowing them to avoid bumping into him. For others, carrying a lantern shone a light on them and let them walk more securely.

“ In the present, we should learn the kind of survival wisdom of the blind man in the story. To wear a mask proactively does not mean ‘I'm infected with the virus,' rather to protect my own health. At the same time, it is a reminder to others that we are still in a time of crisis; we need to pay highly attention to our health and life safety very seriously.” [Bie Ying Long, China]

However, face mask use may have adverse systemic effects, as well:

“ The use of a mask is seen as an act of responsibility and altruism. However, I notice that people with masks tend to avoid personal interaction and to decrease the time they talk to each other. They avoid looking at others.” [Helena Machado, Portugal]

“ The syntagm social distancing is problematic because it symbolically transforms the rule of physical distance into the subversion or deconstruing of social ties. Face masks are strongly related to this implicated meaning. The human estrangement as a part of the ‘COVID-19 regime' is the reason I have been more annoyed by some people strongly emphasizing the need for masks and physical distance than by those exhibiting the lack of interest for the personal protection against the infection.” [Renata Šribar, Slovenia]

In this framework, institutional health communication plays a crucial role in motivating citizens to wear face masks and use them properly (i.e., how to handle it and how to cover one's mouth and nose), as well as to respect physical distancing and hygiene procedures. Here, the choices of narratives by public health system officials play a crucial role. Accordingly, the expression “social distance” tends to be avoided nowadays. “Physical distancing” has been adopted by the WHO, which they define as keeping a distance and avoiding spending time in crowded places or in groups ( 43 ). More distressing expressions such as “avoiding all unnecessary contacts” and “unnecessary contacts with the others” are used in some official advices ( 44 ). These messages may appear authoritarian, by intruding in the personal space of what is “unnecessary” and about who are “the others” when considering social contacts and human relations.

Conversely, an interesting example for motivating the correct use of face masks is the communication campaign “Per tornare tutti insieme a sorridere” [To get back to smiling together] by the Italian Health Ministry ( 45 ). This message designed to stimulate feelings of mutual protection and solidarity among relatives, as well as among strangers. Motivation is crucial because, as we have demonstrated, a face mask can be perceived as both a physical and psychological barrier, particularly in countries where covering one's face is not a common habit.

Wearing a face mask, in fact, makes it hard to recognize if someone is smiling at you and to acknowledge non-verbal communication and emotions shared with facial expressions. This limitation has been noticed in the interactions with older, fragile, and cognitively impaired persons/patients, communication with whom strongly relies on body language ( 46 ). Not only in these contexts, but also in relation to day-to-day activities, especially with strangers, new communication skills are necessary, such as direct eye contact ( 47 ) and body gestures. Moreover, to communicate with those with hearing loss, special transparent masks have been proposed ( 48 ). As the fear of infection makes us more distrustful of strangers and even of friends and family members, to achieve the social interaction we were used to before the pandemic, a new demonstration of care and affection should be conceived.

“ When I walk and nobody is around me, I do not have my mask on the mouth and nose; however, when I'm approaching people, I pose it in the proper way and smile (with my eyes): I consider this a sort of ‘greetings and courtesy nod,' a way to say ‘I care for your health, do not be afraid by me, we will help each other.' I consider it as a message of solidarity.” [Lucia Martinelli, Italy]

Although a “simple” face mask may not be considered in or of itself a sophisticated technological artifact, its systemic use in healthcare settings, its past adopted use in certain social contexts, and the current significant expansion of its application to public health measures (as evidenced through the testimonies and literature outlined above), it can be understood as a facet of a substantial technoscientific project. Importantly, face mask use in the case of COVID-19 has an obvious medical/healthcare connotation, even though face masks are used in many professions to protect the workers against inhaling dust or harmful substances. In fact, many mask types worn during the pandemic come from non-medical supplies (the standard “filtering face-piece” or FFP1 and FFP2 models). However, it is the medical-grade masks that serve as a reference point for all other (varieties of) face coverings.

Face mask wearing can be conceived within the practice of extending the medical science into the “outside world,” by making the behaviors and rituals of the society/culture more alike the scientific (laboratory) practices ( 25 ). The ideological repertoires used in doing so, however, depend critically on cultural differences among societies being thus transformed, and understanding them can help contextualize the political and social dimensions of implementing this public health measure. Such understanding can also serve as a resource for the introduction of other measures, as well as the uptake of face mask wearing in environments where it has not yet been adopted. In short, face masks are being recognized as boundary objects mediating between different individual and collective ideologies ( 31 ) and are as such artifacts with distinct politics ( 49 ).

The aim of this exploratory study was to understand face mask wearing in terms of public policies, individual behaviors and attitudes, and the collective experiences of the affected communities. The main results of our study highlight that the societal and personal practices of wearing (or not wearing) face masks are influenced by ( 1 ) individual perceptions of infection risk, ( 2 ) personal interpretations of responsibility and solidarity, ( 3 ) cultural traditions and religious imprinting, and ( 4 ) the need of expressing self-identity.

First, even for individuals who might not be concerned for their personal health and safety, the wearing of a face mask often indicates a level of care and respect toward others. The decision about wearing a face mask is mediated by standpoints on utility of face masks based on scientific knowledge and/or in the absence of scientific consensus also on political beliefs ( 17 ).

Second, the behaviors of others were described in the collected testimonies in terms of societal responsibilities and rituals of social interaction, highlighting the role of peers in shaping the individual behavior. The narratives shine a light on the perceived balance between protecting oneself and social responsibility, reasserting the notion “If the people wearing masks are protecting you, isn't it right that you should protect them in return?” ( 17 ). However, this leads to inherent contradictions in the behavioral change required. The interchangeability of being at risk and being a risk is particularly striking ( 34 – 36 ), making face mask wearing both an act of self-interest as well as altruism ( 42 ). In a similar vein, what could be perceived previously as anti-sociable behavior may now be beneficial for societal well-being (protection against the pandemic) and, in fact, preferred ( 3 ).

Third, our analysis highlighted that many countries, specifically those in Europe, that previously banned face coverings in public spaces are now mandating them. Face mask wearing has enjoyed varying levels of acceptance across different cultural, governmental, and religious environments; however, even in our study, we could show that the strict rules correspond to the better epidemiological situation ( 50 ). Moreover, the voluntary policy and insufficient compliance can be perceived as less fair allowing individuals to compromise epidemiological measures, while a mandatory policy appears as an effective, fair, and socially responsible ( 27 ). Although the mask can become a symbol of the fight against the virus or of neglect, it remains controversial who and when should have the control on the use of the symbol ( 51 ).

Fourth, the use of face masks preventing the spread of the virus is complemented or even upgraded by the use of face mask as a visual communication tool during times of lockdown and isolation providing a new way to communicate during a pandemic. This covers both political statements in relation to states' public health measures, as well as personal expression of raising awareness, collective solidarity, or just as a part of new pandemic-related esthetic.

We hope that this research will help develop new frameworks to guide a more holistic approach to understanding and enabling behavioral change among citizens, as well as enabling new models for non-verbal communication, noting specific challenges such as disability ( 46 , 48 ). Recent articles highlight the need to develop new ways to communicate while wearing face masks through body language, particularly in terms of using eye contact to communicate emotion ( 52 , 53 ). Also, there is an opportunity to develop new ethical frameworks to guide collective and individual decision making around face coverings. For health policy makers, our study highlights that public messaging plays a crucial role in institutional health communication and that in-depth knowledge of various cultures and ethics concerning health habits are relevant to informing and developing reliable information resources and policies for citizens during a global health pandemic.

However, this study was not without limitations. We acknowledge that our sample is yet representative of a group of intellectuals with a higher level of education, and therefore, the data cannot be generalized to the whole society. The methods we applied for data collection and analysis, however, fit the aim of our research: to explore the broad range of personal and social meanings of mask wearing in different countries. Furthermore, our sample combines the professional and personal observations by health and other experts providing a unique interdisciplinary perspective on face masks. Although we asked standard questions, we let people answer them in freestyle. We did not ask our authors to alter, explain, or correct their narratives in any way.

As shown by the narratives, during the COVID-19 crisis, inconsistent information may influence citizens' level of perceived risk, thus resulting in excessive fear or denial of the reality of the pandemic ( 54 ). The credibility and the source of the information may be crucial to promoting citizen compliance and best practice of face mask wearing. Here, the need to better communicate the complexities of (un)certainty ( 39 ) may be a useful lesson for public health officials and experts building “recommendation trust” in their advice ( 38 ).

From a purely medical perspective, the effectiveness of measures to contain the spread of the virus is independent of the geographic area where these measures are implemented. From a social scientific perspective, however, individual and public health is always embedded, in particular social, cultural, and political contexts. Because of these influencing factors, health measures and devices are imbued with particular meanings that differ across countries. The specific meaning of a device, such as a mask, acquires also shapes how people deal with it and how they integrate it (or not) into their everyday routines and practices ( 55 ). Ultimately, this implies that studying the personal and social meaning of mask wearing in different contexts is also necessary for the assessment of the effectiveness of face masks as a public health measure.

In conclusion, our study points out the need of an in-depth understanding of the various social, cultural, religious, and ethical considerations on health habits and attitudes in a time of pandemics. Additional knowledge about the variety of personal and collective understanding of face mask wearing is essential for designing more effective health communication during and beyond the COVID-19 pandemic.

Data Availability Statement

The datasets presented in this study can be found in online repositories. The names of the repository/repositories and accession number(s) can be found below: http://dx.doi.org/10.17632/9s6fm7vdbc.1 ( 22 ).

Ethics Statement

The studies involving human participants were reviewed and approved by Ethical Committees of the University of Edinburgh, Scotland, UK and the University of Zagreb, Faculty of Croatian Studies, Croatia. The patients/participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.

Author Contributions

LM, VK, SG, CH, HM, NB, MP, and BP: designed the study. LM, VK, and SG: performed data acquisition, organization and analysis and wrote the first version of the manuscript. VK, MV, CH, HM, ZT, NB, MP, and BP: contributed to the interpretation of the results and critically revised manuscript. All authors approved the submission to the journal.

SG and VK acknowledge EU European Regional Development Fund, Operational Programme Competitiveness and Cohesion, grant agreement No.KK.01.1.1.01.0007, CoRE—Neuro, and awarded to University of Zagreb School of Medicine for financial support.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

We are grateful to the University of Zagreb, Faculty of Croatian Studies for covering Ph.D. tuition fees for VK. We thank Navigating Knowledge Landscapes Network for providing the framework for the study.

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Keywords: COVID-19, face mask, physical distancing, health communication, personal protecting equipment

Citation: Martinelli L, Kopilaš V, Vidmar M, Heavin C, Machado H, Todorović Z, Buzas N, Pot M, Prainsack B and Gajović S (2021) Face Masks During the COVID-19 Pandemic: A Simple Protection Tool With Many Meanings. Front. Public Health 8:606635. doi: 10.3389/fpubh.2020.606635

Received: 15 September 2020; Accepted: 27 November 2020; Published: 13 January 2021.

Reviewed by:

Copyright © 2021 Martinelli, Kopilaš, Vidmar, Heavin, Machado, Todorović, Buzas, Pot, Prainsack and Gajović. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Srećko Gajović, srecko.gajovic@hiim.hr

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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California mandated masks. Florida opened its restaurants. Did any of it matter?

Which Covid-19 restrictions really worked — and which ones really didn’t?

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A person in a mask pushes a shopping cart past signs in a store window that read, “Everything must go! All stock reduced! Store closing!”

After a partial lockdown in the spring of 2020, Florida and Texas were among the states that most aggressively reopened their economies. Most businesses were allowed to resume operations in May or June of last year. Florida never instituted a public mask mandate; Texas was the first state to revoke its mask mandate this spring.

California and New York , on the other hand, have been more cautious. They didn’t let some businesses, like movie theaters and gyms, reopen until months after their more conservative counterparts had already done so. Their state mask mandates are still at least partially in effect.

And yet, looking at the case and death numbers since the coronavirus pandemic began, it’s not obvious which states were cautious and which were not. New York, the original epicenter of the outbreak, has endured the second most deaths per capita behind New Jersey (271 per 100,000). Florida and Texas, despite much criticism of their laissez-faire approaches, rank right in the middle among states (26th and 24th, respectively) in the number of deaths per 100,000 people. California fared only marginally better, sitting at 30th.

After a year of debates over mask mandates , lockdowns , and school closures , that mixed evidence might suggest a certain fatalism: Did none of these state policies really matter? Or was the virus going to spread no matter what states did? Was it all for nothing?

Which interventions actually work is one of the most important lessons the US could learn from the Covid-19 pandemic. There will be more outbreaks in the future and, after the current response was marked by indecision and inconsistency , this is an opportunity to separate what policies and interventions are most effective from those that are a waste of time.

But it’s also a maddeningly difficult question to answer.

“State policies mattered,” Jen Kates, director of global health policy at the Kaiser Family Foundation, told me. “But it is hard to know and we may never know whether policies made at the state level were able to overcome all the other challenges of this pandemic.”

Once the US lost control of the virus, mitigation was the only realistic path forward; fully eradicating Covid-19 was out of the question. According to the available research and interviews with experts, one policy, the requirement to wear masks indoors, appears to have successfully slowed transmission. But others, namely school closures, don’t appear to have had nearly as much of an effect on case rates.

The pandemic was constantly evolving, which adds to the difficulty in figuring out which policies worked and which didn’t. And while early on, some lockdown measures — especially stay-at-home orders and closing restaurants and bars — seemed to limit Covid-19’s spread, they may have become less effective over time, in part because states abandoned them and in part because Americans’ behavior had become more politically polarized and some people stopped following those rules.

For all of these reasons and more — the unpredictable nature of the virus’s spread, the structural differences between states, and the American tradition of federalism that delegated most policy decisions to state governments — the nation’s response was a policy morass.

Still, the variation has one potential upside: With the benefit of hindsight, experts told me we can begin to deduce whether certain interventions were more effective than others. It’s a start.

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It’s hard to figure out how effective social distancing policies actually were

If you look at a list of states by their number of Covid-19 deaths per capita, it’s hard to discern much of a pattern. States in the Northeast, where the virus first arrived and where states were most aggressive in restricting people’s activities, rank at the top: New Jersey, New York, Massachusetts, and Rhode Island go first, second, third, and fourth.

But after that, the picture becomes more confused: Mississippi, Arizona, Alabama, and South Dakota — where the virus didn’t land until later and which were some of the most relaxed states in their policy responses — are also in the top 10.

The coronavirus arrived in different places at different times. The first wave of cases in New York peaked in mid-April. California and Florida didn’t see their first peak until the back half of July. States also have immutable characteristics — climate, population density, population health, and so on — that affected their experiences during the pandemic.

“A surface-level analysis of Covid-19 outcomes and state-level policies misses many other factors that differed across boundaries and over time that also had an influence,” Joshua Michaud, associate director of global health policy at the Kaiser Family Foundation, said. “It’s so hard to disentangle effects. We’re often left trying to draw firm conclusions about whether certain policies worked or not from data that can’t tell us that.”

The different timelines are one of the biggest reasons it’s hard to decipher which policies were effective.

Most of the country locked down in March and April 2020; 40 states issued stay-at-home orders in those first two months. But while Covid-19 was raging in New York at the time, it had hardly touched the Midwest or the South.

That gave those regions a false sense of security. Many states lifted their stay-at-home orders and other business restrictions starting in April, before their own outbreaks really got going — and some of them never reestablished those policies once cases did take off.

Florida, for example, rescinded its stay-at-home order and reopened most businesses starting on May 18. When cases started to accelerate there in late June, Gov. Ron DeSantis closed bars specifically but otherwise declined to put any restrictions back in place.

Most states had also implemented a whole slate of closures and restrictions at the same time during the initial lockdown period, making it even harder to isolate the effect of a single policy. How do you distinguish whether it was school closures, restaurant closures, both, or neither affecting caseloads if they were all enacted at once?

“Given that most states enacted multiple policies to encourage social distancing over a short time period, it is not possible to estimate the independent effects of individual policies,” the authors wrote in a study published this month in Nature , which did conclude that social distancing policies collectively reduced spread.

Complicating matters further, different places within a state may have implemented different strategies if the local governments were more aggressive than the state. (And then some states, including Florida and Texas, sought to block those local restrictions. The policy landscape was a mess.)

Compliance with mandates and restrictions also waned. From the beginning, there was some geographic variation in how much people’s behavior (as measured by mobility data) changed after state stay-at-home orders. And over time, the response to the pandemic became even more politically polarized. In spring 2020, Democrats and Republicans were about equally likely to say that the coronavirus was a serious threat. But by late summer, opinions had diverged sharply . That same polarization showed up in polls about wearing masks and, eventually, in a person’s willingness to take the Covid-19 vaccines.

Policy doesn’t matter as much if people don’t adhere to the government’s requirements.

The one Covid-19 intervention that definitely worked was mask mandates

The evidence on lockdowns may be dicey, but the science on masks is clear: They work . Even experts I spoke with who think harsh lockdowns may have been counterproductive say indoor mask mandates were clearly effective.

“Indoor masking guidance was proven to be effective,” Amesh Adalja, senior scholar at the John Hopkins Center for Health Security, told me. “When you look at it all, I think that is probably going to be the one that shows the most effect. ... Most things can be done safely if people socially distance and wear a mask indoors in an unvaccinated setting.”

The available research supports that conclusion. In a study published in March 2021 , CDC researchers examined case and death rates at the county level after mask mandates were put into place and found the mandates were associated with slower transmission.

“Mandating masks was associated with a decrease in daily Covid-19 case and death growth rates within 20 days of implementation,” they concluded, and the effect grew the longer the mandates were in place.

An earlier study, published in June 2020 in Health Affairs , had reached the same conclusion. Its authors estimated that mask mandates had averted some 200,000 Covid-19 cases by mid-May; at the time, the US had counted less than 2 million cases, indicating that the mask mandates had a meaningful effect in slowing the virus down early in the pandemic.

Some commentators have questioned why dire warnings about what would happen when Texas lifted its mask mandate for good in March 2021 never materialized . But the mandate’s rollback took place in a very different context from the spring of 2020.

For one, many more people now have protection from the virus, between vaccinations and prior infections. More widespread immunity was already an obstacle for the virus.

But on top of that, because the pandemic has become so politicized, people have already sorted themselves into their different camps, experts indicated — and so a state mandate might not have changed behavior. By now, you are already either a mask-wearer or you’re not. A government mandate probably isn’t going to affect someone’s behavior in June 2021 as much as it would have a year ago, especially after enforcement has been nonexistent.

Other lockdown measures were effective early but lost value over time

The Texas story is a good example of one clear takeaway on state policies: Early interventions did help slow down Covid-19, but the longer the pandemic dragged on, the less effective they were.

Some states were victims of bad timing, with the virus spreading rapidly before any of these policies could have an effect; I would put New York and New Jersey in that bucket. But other states that would also eventually see among the most cases and deaths per capita — some of those Southern and Midwestern states — may have suffered because compliance fell off, a pattern potentially driven by their states’ lax policies as well as their political makeup.

Researchers have been trying to figure out for a year whether the lockdowns actually worked. Aaron Yelowitz, a University of Kentucky economist, and his colleagues were some of the first to publish such a study in the July 2020 edition of Health Affairs . They concluded that stay-at-home orders and closing bars and restaurants did slow down Covid-19’s spread. The data on school closures and bans on large gatherings was less convincing.

I asked Yelowitz whether he thought that conclusion still held up. He told me he believed it did — but that the value of those mitigation measures had started to deteriorate in the later stages of the pandemic.

“During the initial phase of the pandemic ... there was large overall compliance and buy-in with public health initiatives,” he said. “Mobility fell dramatically, and that slowed the spread of the virus.”

But then states relaxed their policies, and local outbreaks spiraled from there. Almost every state relaxed some restrictions by May or June 2020; the differences were a matter of degree. Republican-led states tended to drop all or most of their policies; Democratic-led states were more gradual. But the true lockdown period in the US was actually quite brief, and as states were reopening in the summer, the virus had more opportunities to spread.

At the same time, Donald Trump was casting doubt on the seriousness of the situation and the summer protests were driving controversy about whether the lockdown measures were being fairly applied. Some public officials were also discovered to not be living by the same rules they were setting for everyone else.

Public support weakened, and in many places, the restrictions of the spring never came back. Even if they had, they might not have been as effective as they were at first. Policies lose their power when a lot of people won’t abide by them.

“During the remainder of 2020, had such measures remained in place, they would have impacted the spread of Covid-19,” Yelowitz said. “But not nearly as much due to lower ‘buy-in’ from the public and increased polarization.”

More recent analysis, notably the new study in Nature from researchers at Google and Boston University, also supports the conclusion that social distancing measures did affect Covid-19’s spread early on.

States started to see an effect when they declared a state of emergency; the amount of time people spent away from home dropped by nearly 10 percent. That effect grew with one additional social distancing policy or more (another 25 percent drop in mobility) and a shelter-in-place or stay-at-home order (a 30 percent decline).

Less mobility correlated with fewer Covid-19 cases, the authors wrote: “A 10% reduction in mobility was associated with a 17.5% reduction in case growth two weeks later.”

They cautioned about the difficulty in deducing which specific policies had the most impact, given that most places implemented multiple restrictions at once. However, they made an attempt by focusing on states that initially put only one social distancing measure into place.

That secondary analysis indicated closing bars and restaurants was more effective than school closures or bans on large gatherings. Yelowitz and his colleagues had reached the same conclusion a year earlier. A third study published in January 2021 had similar findings. There is a growing body of evidence supporting certain interventions more than others.

But slowing transmission through (partial) lockdowns only goes so far — and the US didn’t take advantage of the time it had bought.

The US missed the chance to beef up its response during its partial lockdown

All of this comes with a catch: Certain restrictions may have been effective in limiting Covid-19’s spread initially, but there was likely no policy that would have eradicated the virus entirely. The virus spread too widely, too quickly.

On top of that, America did not actually lock down very hard or for very long. The US version of “tight” Covid-19 restrictions was not the same as lockdowns in some European and Asian countries. Even progressive US states were relaxed by comparison.

People continued meeting in private settings, even if the gatherings were technically limited to 10 people or fewer. And all of these policies were more voluntary than mandatory; the US did not charge exorbitant fines for breaking lockdowns the way some other countries did.

“The pandemic would have sustained itself no matter what,” Adalja said. “This is a highly transmissible respiratory virus. It’s not something that could be eradicated or eliminated.”

There is an alternative timeline where the guidance focused on masks and other harm reduction techniques, he argued, instead of punitive and indiscriminate lockdowns that laid the seeds for their own backlash.

“We went into this abstinence-only mode, which we don’t do with any other infectious disease because it’s been discredited,” Adalja told me, “And I think that’s what caused this backlash and all of the acrimony over masks and whatever it might be.”

Making matters worse, the United States didn’t actually take advantage of the opportunity it had created for itself through the lockdowns.

Even if eradication was out of the question, America could have conceivably set up a system for testing, tracing, and isolating Covid-19 contacts that would have prevented small clusters of cases from spiraling out of control. That was the approach taken in global Covid-19 success stories like South Korea . A test-trace-isolate program is easier to set up when cases are still limited, as they were during the lockdown period of spring.

Instead, the US government failed to scale up its testing or contact tracing capabilities . As states relaxed their policies and the virus started spreading again, America was ill-suited to track it. The window that these early lockdowns had briefly opened was closed.

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An Ontological Argument against Mandatory Face-Masks

Face-coverings were widely mandated during the Covid-19 pandemic, on the assumption that they limit the spread of respiratory viruses and are therefore likely to save lives. I examine the following ethical dilemma: if the use of face-masks in social settings can save lives then are we obliged to wear them at all times in those settings? I argue that by en-masking the face in a way that is phenomenally inconsistent with or degraded from what we are innately programmed to detect as human likeness, we are degrading the social quality of our relations. Drawing on my previously published proof that Self is socially reflexive (mutually mirrored) rather than monadic in its constitution, I conclude that any widespread en-masking is also deleterious to humanity and therefore unethical.

Related Papers

Culture & Psychology

The pandemic of COVID-19 has brought to the front a particular object: the face mask. I have explored the way people make-meaning of an object generally associated with the medical context that, under exceptional circumstances, can become a presence in everyday life. Understanding how people make meaning of their use is important. Using cultural psychology, I analyse preferences toward different types of face masks people would wear in public. The study involved 2 groups, 44 Norwegian university students and 60 international academics. In particular, I have focused on the role of the mask in regulating people affective experience. The mask evokes safety and fear, it mediates in the auto-dialogue between “I” and “Me” through the “Other”, and in the hetero-dialogue between “I” and the “Other” through “Me” The dialogue is characterized by a certain ambivalence, as expected. Meaning-making is indeed the way to deal with the ambivalence of human existence.

Text and Performance Quarterly

Jennifer B Spiegel

2020 may well become known as the year of the mask, harkening to an omnipresent threat of molecular contagion and trans-corporeal intermingling. This article traces the ways in which bodies materially relate and co-constituted one another over the course of the first year of the Covid-19 pandemic. Highlighting the role of a virus in reshaping human social interaction and "self"presentation, "everyday performance" with face-masks is posited as a way of simultaneously altering material processes of contagion while making perceptible the ethical relations and commitments that shape these processes.

The Ethics of Mandatory Masks

Carlos F Obregon

Why so much resistance to mandatory masks? The explanation is several fold. It has to do with the initial mistaken recommendations of the CDC and the WHO of not wearing masks, which were made with no scientific evidence to support them. It has to do with the WHO´s lack of study of more than forty years of successful Asian experience with mask wearing. But it has also to do with a Western prejudice related to covering the face. The conclusion of this manuscript is that there are not ethical justifications to deny mandatory masks. Therefore, it is the ethical duty of all the political leaders of the world to make masks mandatory in public places. The sooner they are made mandatory; the more lives will be saved.

International Journal Of Community Medicine And Public Health

Varsha Narayanan

Coronavirus 2019 (COVID-19) has been spreading across the globe in 2020 with most countries being affected significantly in terms of the number of infected cases, morbidity and mortality, as well as health care and economic burden. Currently the most important individual and community measures for curtailing disease transmission are social distancing, hand sanitization and wearing of masks in public. It is important to advocate wearing masks in an effective and balanced manner and dispense supportive scientific evidence as well as practical guidelines and information in the community. Till the event of mass vaccination for COVID being available, improving the awareness, compliance and acceptance of the people towards proper wearing of a face mask when in public places, can be the most effective way for several countries to control transmission of COVID.

Journal of Education, Innovation, and Communication (JEICOM)

Margarita Kefalaki

Since the time COVID19 made its appearance on an international level (March 2020), masks have become a personal and social identity tool. Nowadays (June 2021), we cannot still leave our house without wearing a mask. It really feels like the mask is now part of our face, covering its lower part, hiding our facial expressions. In this paper, we examine the place and use of masks as markers of personal and social identities, as well as social responsibility. More particularly, we observe the following three issues: a) the symbolic meaning of masks as an anthropological artifact, b) the dilemma of individual liberty balanced by social responsibility, produced through mask wearing, and c) the way we can create meaning through adaptation to a new "masked reality". In this article, based on personal experiences, observation and bibliographical research, we explore and reveal the symbolic meaning of masks. We make use of the social identity theory (SIT) that assumes that one part of the self-concept is defined by our belonging to social groups (Trepte, 2006). More particularly we are examining our identity's, personal and social, need to respond to the 'obligation' of mask wearing. We believe that finding or inventing meaning to the use of mask, can help us evolve and accept our new reality.

Akira Akabayashi

Do we have the right to wear masks during an infectious disease pandemic? If so, what is the underlying philosophical justification for this? During the COVID-19 pandemic, most people wore masks. Should the government be able to intervene to enforce mask wearing? It should be noted that the government’s encouragement to wear masks does not mean that people are encouraged to ignore them. In the field of public health ethics, many current debates boil down to establishing a balance between “individual freedom” and “the public good”. However, a clear definition of “the public good” has yet to emerge, which can make this debate difficult. Based on our philosophical analysis, we propose the following as a new right in the field of public health ethics: the “right to mask for self-protection”. Based on our proposed “right to mask for self-protection”, we offer a justification for the argument that all people have the right to wear a mask during an infectious disease pandemic or endemic.

Signs and Society

Cristina Voto

Building on the case study of the performative practice of voguing within ballroom culture among LGBTQIA1 communities, the aim of this article is to recognize a facial agency capable of putting into tension three thresholds of meaning: visibility and invisibility; identity and otherness; nature and artifice. On the basis of these tensions, interpretive habits concerning identity are incorporated into the face as a semiotic dispositif that negotiate sociocultural expectations and limitations. These habits, when agentively performed through the face, give shape to a communicative project that manipulates platforms of identity into biopolitical masks. The analysis will also give an account of how "worn" biopolitical masks reproduce and perform a facial monstrum, or warning, and how this specification warns others of the normativity of aesthetic and biopolitical appearance while activating an intentional transformation of identity.

Substack: Desiring a Better Country

Douglas Farrow

It is common these days to see people dividing humanity into 'maskers and anti-maskers', or 'the vaccinated and the unvaccinated'. Those categories, and the policies based on them, are more than misleading. They are dehumanizing, and they mask a multitude of sins: medical, scientific, political, legal, economic, administrative and, above all, moral. These errors and sins are beginning to come to light, as the so-called 'pandemic of the unvaccinated' turns, at Christmas 2021, into its opposite. A choice is being demanded of us, as Agamben already suggested over a year ago: the mask or the face. This article received more than 10,000 views in the first 24 hours of its posting on my Substack page. I am grateful to those, including Jordan Peterson, who drew it to the attention of a wider audience. I am reposting it here, alongside other (far less read!) pieces bearing on the culture of McGill University and of other universities like it.

The Risks of the Mask

Matan Shapiro

In this article we go beyond epidemiological models to make a case for a more holistic approach to the use of face masks as a risk mitigation factor in the context of the Covid-19 pandemic. We argue that while masking offers a measure of protection from infection, its moral, political, and affective implications produce two main collateral risks. These are: (1) the heightening of social boundaries, which thus increase the potential of conflict between different social groups; and (2) the impairment of normative interaction rituals followed by a dynamic of distancing, insulation, and social alienation. While we stop short from constructing a hierarchy of risks, we do argue that policy makers should consider these collateral risks as part of any large-scale Covid-19 risk mitigation and communication strategy. We thus provide some principled guidance on how that might be done.

Revista Portuguesa de Filosofia

Sarah Horton

In the midst of a pandemic, what does it mean to see the Other as Other and not as a carrier of the virus? I argue that in seeking a Levinasian response to the pandemic, we must be mindful of the implications of the mechanisms of surveillance and control that, presented as ways to protect the Other, operate by controlling the Other and rendering our relation to the Other increasingly impersonal. Subjected to these mechanisms, the Other becomes a dangerous entity that must be controlled, and the state that deploys them comes increasingly to mediate the relation between self and Other. The more we rely on such mechanisms for protection, the easier it becomes to regard the Other not as one who summons me to an infinite responsibility but as a vector of disease. Despite all differences between Levinas's and Foucault's approaches, reading them in conversation shows that the control and surveillance of the population functions within a discourse that medicalizes and objectifies the Other in favor of the centralizing power that uses those technologies. In defiance of Levinas's warning against imposing a narrative on the Other's suffering, this discourse coopts that suffering as a justification for biopower.

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Covid-19: should the public wear face masks?

Read our latest coverage of the coronavirus pandemic.

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Peer review
Babak Javid , principal investigator 1 2 ,
Michael P Weekes , principal investigator 2 3 ,
Nicholas J Matheson , principal investigator 2 3 4
1 Tsinghua University School of Medicine, Beijing, China
2 Cambridge University Hospitals, Cambridge, UK
3 Cambridge Institute of Therapeutic Immunology and Infectious Disease, Cambridge, UK
4 NHS Blood and Transplant, Cambridge UK
Correspondence to: B Javid bjavid{at}gmail.com

Yes—population benefits are plausible and harms unlikely

When covid-19 became a global health emergency, there was a visible contrast between the responses of citizens in east Asia and the rest of the world. In east Asia, wearing of masks was ubiquitous, and sometimes mandated by governments. In Europe and North America, concerned citizens were repeatedly told that masks were not recommended for general use.

Now, increasing numbers of agencies and governments, including the Czech Republic and the US Centers for Diseases Control and Prevention 1 are advocating that the general population wears masks, but others, such as the World Health Organization and Public Health England are not. In a linked article Greenhalgh and colleagues argue in support of the public wearing masks on the basis of the “precautionary principle” (doi: 10.1136/bmj.m1435 ). 2 So, what is the evidence? And what might be the downsides?

Transmission dynamics of SARS-CoV-2

Maximal viral shedding of SARS-CoV-2 (the cause of covid-19) occurs early in the course of the illness. 3 Patients may therefore be contagious before they develop symptoms or even know that they are infected. Transmission of SARS-CoV-2 by asymptomatic individuals has been clearly documented, and mathematical models suggest that 40-80% of transmission events occur from people who are presymptomatic or asymptomatic. 4 5 Sneezing and coughing may not be necessary; we know that patients with influenza shed substantial titres of infectious virions during normal breathing. 6 Together, these data support the idea that seemingly well individuals shedding high titres of SARS-CoV-2 may represent a substantial risk for onward transmission.

Healthcare workers usually wear masks to protect themselves from patients with respiratory infections. At the population level, wearing of masks by infected individuals may be more important, helping to retain contagious droplets, aerosols, and particles that can infect others and contaminate surfaces. Indeed, surgical masks substantially reduce emissions of influenza and (common cold) coronaviruses in exhaled breath, 7 and in one controlled experiment masks decreased transmission of tuberculosis from humans to guinea pigs by 50%. 8

Most studies in the real world have focused on the effectiveness of masks in preventing the transmission of influenza. Despite some positive results, several reviews (summarised by Greenhalgh and colleagues 2 ) as well as a recent meta-analysis 9 found no significant protection from either face masks or enhanced hand hygiene. Many studies in these reviews were underpowered, and most failed to measure adherence. In one cluster randomised trial, adherence to mask wearing significantly reduced risk of influenza-like illness, but under half of participants wore masks most of the time. 13

Adherence is likely to be higher during a serious pandemic, and modelling of an influenza pandemic suggested that substantial numbers of cases may still be prevented even if masks are only 20% effective at reducing transmission. 10 High quality controlled trials and modelling studies of face mask use during the covid-19 pandemic are urgently required. Nevertheless, Greenhalgh and colleagues state that an “absence of evidence” in this context should not be misinterpreted as “evidence of absence.”

In theory, wearing masks could instil a false sense of security and reduce adherence to other respiratory hygiene and social distancing measures. Likewise, contamination may occur when removing masks with imperfect technique. In practice, however, we don’t counsel against other non-pharmacological interventions with similar levels of evidence, 9 just in case they instil a false sense of security. And, as with recent handwashing campaigns, mass education about the safe use and removal of masks would be possible. Importantly, if a mask is contaminated at removal, it has (by definition) already protected the wearer from contagious droplets.

Cloth masks

One real concern is the shortage of medical grade face masks for frontline healthcare workers, for which evidence of efficacy is more robust. 11 For the general population, attention has therefore shifted to the use of makeshift or cloth masks. Can research findings from studies on medical grade masks be extrapolated to cloth masks? Although good quality evidence is lacking, some data suggest that cloth masks may be only marginally (15%) less effective than surgical masks in blocking emission of particles, and fivefold more effective than not wearing masks. 12 Therefore, cloth masks are likely to be better than wearing no mask at all.

Much remains unknown about the usefulness of population level mask wearing in the context of the covid-19 pandemic. Use of masks in healthcare settings is clearly essential to protect frontline workers, whereas the evidence supporting masks in non-clinical settings is both limited and of variable quality. Nonetheless, unlike stringent isolation and social distancing measures, which have substantial societal and economic costs, mass manufacture and use of cloth masks is cheap and easy, and may even facilitate economic activity.

Greenhalgh and colleagues argue that, given the gravity of the pandemic, indirect evidence of benefit combined with the low risk of harm should outweigh the absence of direct evidence supporting mask wearing by the general public. 2 We agree. As we prepare to enter a “new normal,” wearing a mask in public may become the face of our unified action in the fight against this common threat and reinforce the importance of social distancing measures.

Analysis, doi: 10.1136/bmj.m1435

The BMJ has judged that there are no disqualifying financial ties to commercial companies. The authors declare no other interests. The BMJ policy on financial interests is here: https://www.bmj.com/sites/default/files/attachments/resources/2016/03/16-current-bmj-education-coi-form.pdf .

Provenance and peer review: Not commissioned, externally peer reviewed.

↵ Centers for Disease Control. How to protect yourself. 4 Apr 2020. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fprepare%2Fprevention.html .
Greenhalgh T ,
Schmid MB ,
Czypionka T ,
Bassler D ,
Corman VM ,
Guggemos W ,
Ferretti L ,
Kendall M ,
Grantham M ,
Pantelic J ,
EMIT Consortium
Leung NHL ,
Dharmadhikari AS ,
Mphahlele M ,
Tracht SM ,
Del Valle SY ,
Offeddu V ,
Thompson KA ,
Kafatos G ,
MacIntyre CR ,
Cauchemez S ,

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The Coronavirus Crisis

Should we all be wearing masks in public health experts revisit the question.

Huo Jingnan

Allison Aubrey

Carmel Wroth

Even without symptoms, you might have the virus and be able to spread it when out in public, say researchers who now are reconsidering the use of surgical masks. Elijah Nouvelage/Bloomberg via Getty Images hide caption

Even without symptoms, you might have the virus and be able to spread it when out in public, say researchers who now are reconsidering the use of surgical masks.

Updated March 31, 8:25 p.m. ET

A few months ago, it may have seemed silly to wear a face mask during a trip to the grocery store. And in fact, the mainline public health message in the U.S. from the Centers for Disease Control and Prevention has been that most people don't need to wear masks.

But as cases of the coronavirus have skyrocketed, there's new thinking about the benefits that masks could offer in slowing the spread. The CDC says it is now reviewing its policy and may be considering a recommendation to encourage broader use.

At the moment , the CDC website says the only people who need to wear a face mask are those who are sick or are caring for someone who is sick and unable to wear a mask.

But in an interview with NPR on Monday , CDC Director Robert Redfield said that the agency is taking another look at the data around mask use by the general public.

"I can tell you that the data and this issue of whether it's going to contribute [to prevention] is being aggressively reviewed as we speak," Redfield told NPR.

And Tuesday, President Trump weighed in suggesting people may want to wear scarves. "I would say do it," he said, noting that masks are needed for health care workers. "You can use scarves, you can use something else," he said.

On Tuesday Dr. Deborah Birx, who serves as the White House's coronavirus response coordinator, said the task force is still discussing whether to change to the recommendation on masks.

Other prominent public health experts have been raising this issue in recent days. Wearing a mask is "an additional layer of protection for those who have to go out," former FDA Commissioner Scott Gottlieb told NPR in an interview. It's a step you can take — on top of washing your hands and avoiding gatherings.

In a paper outlining a road map to reopen the country , Gottlieb argues that the public should be encouraged to wear masks during this current period of social distancing, for the common good.

"Face masks will be most effective at slowing the spread of SARS-CoV-2 if they are widely used, because they may help prevent people who are asymptomatically infected from transmitting the disease unknowingly," Gottlieb wrote. Gottlieb points to South Korea and Hong Kong — two places that were shown to manage their outbreaks successfully and where face masks are used widely.

A prominent public health leader in China also argues for widespread use of masks in public. The director general of the Chinese Center for Disease Control and Prevention, George Gao, told Science that the U.S. and Europe are making a "big mistake" with people not wearing masks during this pandemic. Specifically, he said, mask use helps tamp down the risk presented by people who may be infected but aren't yet showing symptoms.

If those people wear masks, "it can prevent droplets that carry the virus from escaping and infecting others," Gao told Science .

The argument for broadening the use of face masks is based on what scientists have learned about asymptomatic spread during this pandemic.

It turns out that many people who are infected with the virus have no symptoms — or only mild symptoms.

What this means is that there's no good way to know who's infected. If you're trying to be responsible when you go out in public, you may not even know that you're sick and may be inadvertently shedding the virus every time you talk with someone, such as a grocery store clerk.

"If these asymptomatic people could wear face masks, then it could be helpful to reduce the transmission in the community," says Elaine Shuo Feng , an infectious disease epidemiology researcher at the Oxford Vaccine Group at the University of Oxford.

Given the reality of asymptomatic spread, masks may be a good socially responsible insurance policy, Gottlieb argues. "[Wearing masks] protects other people from getting sick from you," he says.

But there is still a big concern about mask shortages in the United States. A survey released Friday from the U.S. Conference of Mayors finds that about 92% of 213 cities did not have an adequate supply of face masks for first responders and medical personnel.

At this point, experts emphasize that the general public needs to leave the supply of N95 medical masks to health care workers who are at risk every day when they go to work.

And supplies are also tight for surgical masks, the masks used everywhere from dentists' offices to nail salons and that are even handcrafted.

"We need to be very mindful that the supply chain for masks is extremely limited right now," Gottlieb says. "So you really don't want to pull any kind of medical masks out of the system."

Given current shortages, it may be too soon to tell the general public to start wearing surgical masks right now. "We certainly don't have enough masks in health care," says William Schaffner , an infectious disease expert at Vanderbilt University. "I wouldn't want people to go out and buy them now, because we don't want to siphon them off from health care."

Where does that leave us? Some research has shown that cotton T-shirt material and tea towels might help block respiratory droplets emitting from sick people, even if the effect is minimal.

"Homemade masks, shawls, scarves and anything that you can conjure up at home might well be a good idea," says Schaffner. "It's not clear that it's going to give a lot of protection, but every little bit of protection would help."

But experts say homemade masks may not be effective if not constructed and handled properly.

That's why Gottlieb says the CDC should issue guidelines advising people on how to construct their own cotton masks. "Cotton masks constructed in a proper way should provide a reasonable degree of protection from people being able to transmit the virus," he told NPR.

There's no definitive evidence from published research that wearing masks in public will protect the person wearing the mask from contracting diseases. In fact, randomized controlled trials — considered the gold standard for testing the effectiveness of an intervention — are limited, and the results from those trials were inconclusive , says Feng.

But Feng points out that randomized clinical trials have not shown significant effects for hand hygiene either. "But for mechanistic reasons, we believe hygiene can be a good way to kill pathogens, and WHO still recommends hand hygiene," she says.

And those randomized studies were looking at how the face mask could protect the wearer, but what experts are arguing is that face masks may prevent infected but asymptomatic people from transmitting the virus to others. It's hard to come by data on this point. One meta-analysis reviewing mask use during the SARS epidemic found that wearing masks — in addition to other efforts to block transmission, including hand-washing — was beneficial. Another meta-analysis of mask use to prevent influenza transmission was not conclusive but showed masks possibly help.

The research may not be conclusive, but researchers we interviewed agreed that mask use is better than nothing. "There are some modest data that it will provide some modest protection," Schaffner says. "And we can use all the protection we can get."

Concern over presymptomatic spread in the community has also led some hospitals to change their policies and extend the use of masks to nonclinical employees and visitors. Last week, Massachusetts General Hospital in Boston took the unusual step of giving surgical or procedural face masks to all employees who go into the hospital to work, even if they don't provide care to patients, the hospital's Infection Control Unit associate chief, Erica Shenoy , told NPR.

"This runs very contrary to what we normally do in infection control," she says. "But we felt that with the unprecedented nature of the pandemic, this is the right decision at this time." She says if an employee were to get sick while at work, "the face masks would serve to contain the virus particles and reduce the risk of patients and others working at our facilities."

On March 29, the University of California, San Francisco, also started giving surgical masks to all staff, faculty, trainees and visitors before they enter any clinical care building within the UCSF system.

Feng cautions that if people do start wearing face masks regularly in public, it is important to wear them properly. She notes that the World Health Organization has a video on how to practice correct hygiene when putting on or taking off a mask.

Saskia Popescu , an infectious disease researcher and biodefense consultant, is skeptical that healthy members of the public need to start wearing masks regularly — she says people should follow current CDC guidelines. But she emphasizes that if you are going to wear a mask, "you have to wear it appropriately." That means, she says, "you have to discard it when it gets damp or moist. You want to stop touching the front of it. Don't reach under to scratch your nose or mouth."

Otherwise, she warns, wearing masks could give "a false sense of security."

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Arguments against mask requirements during the coronavirus (covid-19) pandemic, 2020-2021.

This page captures the main arguments that have been advanced against mask requirements during the coronavirus (COVID-19) pandemic. These arguments come from a variety of sources, including public officials, journalists, think tanks, economists, scientists, and other stakeholders. We encourage you to share the debates happening in your local community to [email protected] .

There are six main types of arguments against mask requirements:

Mask requirements are not necessary to stop the spread of coronavirus

Mask requirements give a false sense of security, mask requirements restrict freedom, masks present other health risks, mask requirements have harmful social consequences, mask requirements are unenforceable.

Click here to read about arguments in favor of mask requirements.

1.1 Claim: There is insufficient data to support that mask requirements effectively prevent the spread of coronavirus
1.2 Claim: The curve has been successfully flattened in areas without mask requirements
1.3 Claim: Mask requirements risk deemphasizing other necessary public health measures
2.1 Claim: Mask requirements disincentivize vaccinations
2.2 Claim: Mask-wearing mandates encourage people to pursue risky behaviors and activities that could spread COVID-19
3.1 Claim: Mask requirements are an overreach of government power and are unconstitutional
3.2 Claim: Mask requirements are a slippery slope and will lead to more government mandates, bureaucracy, and regulations
4.1 Claim: Wearing masks can cause other health risks
5.1 Claim: Wearing of masks can generate racist reactions
5.2 Claim: Mask wearing inhibits communication and children's social development
5.3 Claim: Mask mandates are immoral laws by government-imposed to control human behavior and personal development
6.1 Claim: Local mask laws with unclear enforcement mechanisms are ineffective, counter-productive, and potentially dangerous for employees
6.2 Claim: Mask mandates for businesses require employees to enforce laws
6.3 Claim: Colleges and universities should not ask students to report violations of Covid-19 rules
8 Footnotes

Claim: There is insufficient data to support that mask requirements effectively prevent the spread of coronavirus

Ashton Forbes, a plaintiff in a lawsuit challenging San Diego County's mask requirements ( The San Diego Union Tribune ): Ashton Forbes is the plaintiff in a lawsuit challenging San Diego County's mask requirements.

"With new evidence and data coming to light regarding the science and severity of this specific virus, it has become ever more prevalent the requirement to wear a facial covering is not effective in stopping the spread of COVID-19. As such, the requirement to wear a face mask is overbroad and violates fundamental rights of both the United States Constitution as well as the California Constitution." - " San Diego resident sues county over mask orders ," June 2, 2020.

Joseph A. Ladapo ( Wall Street Journal ): "While mask-wearing has often been invoked in explanations for rising or falling Covid-19 case counts, the reality is that these trends reflect a basic human need to interact with one another. Claims that low mask compliance is responsible for rising case counts are also not supported by Gallup data, which show that the percentage of Americans reporting wearing masks has been high and relatively stable since June. Health officials and political leaders have assigned mask mandates a gravity unsupported by empirical research." - " Masks Are a Distraction From the Pandemic Reality ," October 28, 2020.

Phillip W. Magness ( Wall Street Journal ): "Unfortunately, the IHME modelers’ findings contained an error that even minimal scrutiny should have caught. The projected number of lives saved, and the implied case for a mask mandate, are based on a faulty statistic. Using a months-old survey, IHME modelers assumed erroneously that the U.S. mask-adoption rate stood at only 49% as of late September, and therefore had plenty of room to increase to “universal adoption,” defined as 95%, or to a more plausible 85%. According to more recent survey findings, however, America’s mask-adoption rate has hovered around 80% since the summer. New numbers would completely alter the IHME study’s findings. If 80% of Americans already wear masks, a new mandate could add only a few percentage points to the mask-adoption rate instead of nearly doubling it. Additional gains would be small and certainly nowhere near 130,000 lives saved." - " Case for Mask Mandate Rests on Bad Data ," November 11, 2020.

Claim: The curve has been successfully flattened in areas without mask requirements

Andrew Cooper, the plaintiff in a lawsuit in Nashua, New Hampshire ( New Hampshire Union Leader ): Andrew Cooper filed a lawsuit against a mask requirement ordinance of Nashua, New Hampshire.

"The ordinance’s justification that ‘slowing the spread’ of the coronavirus is somehow still a societal objective also ignores the fact that the entire state of New Hampshire has been wildly successful at ‘flattening the curve’ since it never came close to reaching the capacity of its health care system." - " Nashua resident files lawsuit over city's mask mandate ," June 1, 2020.

Texas Governor Greg Abbott (R) ( The Dallas Morning News ): "After opening things 100%, effective March the 10th, with no masks, the numbers have just continued to drop." - " Abbott says Biden ’100% wrong’ on mask mandate and owes apology for ‘Neanderthal’ gibe. Who’s right? ," June 2, 2021.

Claim: Mask requirements risk deemphasizing other necessary public health measures

Group of doctors ( Reason ): A group of scientists and doctors sent a letter to the Editorial Board of the Proceedings of the National Academy of Sciences criticizing a study regarding the effectiveness of masks to slow the spread of the coronavirus and saying that the study's conclusions that "airborne transmission represents the only viable route for spreading the disease" and the ineffectiveness of social distancing, quarantine, and handwashing recommendations was misleading and harmful.

"While masks are almost certainly an effective public health measure for preventing and slowing the spread of SARS-CoV-2, the claims presented in this study are dangerously misleading and lack any basis in evidence." - " Prominent Researchers Say a Widely Cited Study on Wearing Masks Is Badly Flawed ," June 22, 2020.

Claim: Mask requirements disincentivize vaccinations

Marc Siegel ( The Wall Street Journal ): "A more effective strategy would be to relieve the public of ineffective draconian restrictions. The president should announce that all federal mask mandates will end effective May 28, in time for Memorial Day weekend, and he should encourage states, localities and private institutions to do the same. This would send a clear message to the vaccine-resistant: It’s your responsibility to protect yourself by getting your shots. The message to everyone: Vaccines work, and it’s time to get back to normal." - " End Mask Mandates to Spur Vaccination ," May 6, 2021.

Claim: Mask-wearing mandates encourage people to pursue risky behaviors and activities that could spread COVID-19

Allysia Finley ( The Wall Street Journal ): "The decision to wear a mask would seem to be cost-free, apart from minor discomfort. But absolutism about masks and disregard for scientific uncertainties may promote a false sense of security that encourages risky behavior—including massive political protests." - " The Hidden Danger of Masks ," August 4, 2020.

Claim: Mask requirements are an overreach of government power and are unconstitutional

Philip Mauriello, Jr., an attorney representing plaintiffs in a lawsuit challenging San Diego County's mask requirements ( The San Diego Union Tribune ): Philip Mauriello, Jr., is an attorney representing plaintiffs in a lawsuit challenging San Diego County's mask requirements.

"The requirement of Plaintiff to wear a facial covering in public when not in his residence restricts his right to travel within the County by forcing him to make a decision between wearing a facial covering which provides no medical benefit and in fact creates other collateral health risks, or remain a prisoner in his own home. Either choice violates essential constitutional rights of the Plaintiff." - " San Diego resident sues county over mask orders ," June 2, 2020.

Brantley Lyons, Montgomery City Councilmember ( AP ): "I think to make somebody do something or require somebody to wear something is an overreach." - " US virus outbreaks stir clash over masks, personal freedom ," June 18, 2020.

Claim: Mask requirements are a slippery slope and will lead to more government mandates, bureaucracy, and regulations

Molly McCann, Of Counsel with Sidney Powell, P.C. ( The Federalist ): "To take our freedom from us, people with anti-American agendas have to mobilize some initial quorum of consent from the population. Mandatory masking seeks to build that consent. In addition to extending the fiction that we are in an emergency sufficient to trigger the extra-constitutional authority of local and state executives, mandatory masking acts as a peer pressure-fueled signal that encourages conformity to our coming 'new normal." - " Mandatory Masks Aren't About Safety, They're About Social Control ," May 27, 2020.

Claim: Wearing masks can cause other health risks

Antonio I Lazzarino, medical doctor and epidemiologist ( The BMJ ): A letter to the editor of BMJ stated several side effects of wearing a mask.

"(4) Wearing a face mask makes the exhaled air go into the eyes. This generates an uncomfortable feeling and an impulse to touch your eyes. If your hands are contaminated, you are infecting yourself. (5) Face masks make breathing more difficult. For people with COPD, face masks are in fact intolerable to wear as they worsen their breathlessness.[5] Moreover, a fraction of carbon dioxide previously exhaled is inhaled at each respiratory cycle. Those two phenomena increase breathing frequency and deepness, and hence they increase the amount of inhaled and exhaled air. This may worsen the burden of covid-19 if infected people wearing masks spread more contaminated air. This may also worsen the clinical condition of infected people if the enhanced breathing pushes the viral load down into their lungs." - " Covid-19: important potential side effects of wearing face masks that we should bear in mind ," April 20, 2020.

Claim: Wearing of masks can generate racist reactions

Trevon Logan, an economics professor at Ohio State University ( CNN ): "This (wearing a homemade mask) seems like a reasonable response unless you just sort of take American society out of it. When you can't do that, you're basically telling people to look dangerous given racial stereotypes that are out there. This is in the larger context of black men fitting the description of a suspect who has a hood on, who has a face covering on. It looks like almost every criminal sketch of any garden-variety black suspect." - " Why some people of color say they won't wear homemade masks ," April 7, 2020.

Steven Horwitz and Donald J. Boudreaux ( Detroit News ): "In the same way that empowering politicians to solve pollution does not automatically produce the black-and-white results on the economist’s chalkboard, mask mandates might also have unintended negative consequences. By creating more opportunities for encounters between law enforcement and the citizenry, mask mandates create yet one more way for authorities to harass the relatively powerless. We’ve already seen that mandates are disproportionately enforced against people and communities of color." - " "Economics show why politicians' mask mandates don't work" ," August 26, 2020.

Claim: Mask wearing inhibits communication and children's social development

Yinon Weiss ( The Federalist ): "Masks dehumanize us, and ironically serve as a constant reminder that we should be afraid. People can now be spotted wearing masks while camping by themselves in the woods or on a solo sailing trip. They have become a cruel device on young children everywhere, kindergarten students covered by masks and isolated by Plexiglas, struggling to understand the social expressions of their peers. Face coverings are causing real harm to the American psyche, provide little to no medical benefit, and distract us from more important health policy issues." - " These 12 Graphs Show Mask Mandates Do Nothing To Stop COVID ," October 29, 2020.

Additional reading

" How face masks affect our communication " - BBC , June 8, 2020

Claim: Mask mandates are immoral laws by government-imposed to control human behavior and personal development

David Shane ( The Federalist ): "Accepting invasive rules that affect personal behavior in a low-risk environment conditions people to accept that kind of intrusion into their lives. This is one reason people are particularly against masking their children, who are especially prone to manipulation. If we do this, what kind of human are we helping to produce?" - " "The Moral Case Against Mask Mandates and Other COVID Restrictions" ," July 31, 2020.

Claim: Local mask laws with unclear enforcement mechanisms are ineffective, counter-productive, and potentially dangerous for employees

Manchester NH Alderman At-Large, Joe Kelly Lavasseur ( New Hampshire Union Leader ): "Honestly, this is the most unenforceable ordinance...It’s just amazing to me how many ordinances are being violated in this city on a daily basis that no one is being cited for them. We’re going to put something forward that has absolutely no teeth whatsoever." - " Some aldermen claim Manchester mask ordinance 'unenforceable' ," September 2, 2020.

Kyle Wingfield, opinion ( The Brunswick News ): "Not to get too paternalistic about government, but anyone who’s a parent, or a teacher, or who otherwise supervises children, learns this lesson very quickly: Only make rules you’re willing and able to enforce, or your ability to enforce any rules will weaken." - " How enforceable are local mask mandates? ," July 13, 2020.

Claim: Mask mandates for businesses require employees to enforce laws

The Wilson Times Editorial Board ( The Wilson Times ): "[NC Gov. Roy] Cooper deserves credit for taking criminal penalties off the table, but he’s wrong to order clerks and salespeople to do the state’s dirty work. He’s conferred responsibility without authority on thousands of people and made them the unwitting face of a controversial new policy." - " Our Opinion: Mask mandate drafts cashiers, clerks as Cooper's cops ," June 25, 2020.

Claim: Colleges and universities should not ask students to report violations of Covid-19 rules

Karen Levy and Lauren Kilgour, Cornell University ( The New York Times ): "Fighting the coronavirus is, to be sure, an all-hands-on-deck problem, but pitting students against one another in a high-stress time carries real risks, and colleges should be exceedingly careful about casting their students in the role of undercover coronavirus cops. Deputizing students to police their peers threatens to disrupt the interpersonal dynamics of student life, while also creating conditions to displace blame onto students should outbreaks occur. Universities need to be mindful of how peer surveillance systems might be misused, how they might burden different groups of students and the damage they may do to community trust." - " "Don’t Make College Kids the Coronavirus Police" ," August 12, 2020.

Arguments in favor of mask requirements during the coronavirus (COVID-19) pandemic, 2020-2021
Taxonomy of arguments about mask requirements during the coronavirus (COVID-19) pandemic, 2020
Documenting America's Path to Recovery
Coronavirus arguments by topic

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Open Access

Peer-reviewed

Research Article

Wearing a mask—For yourself or for others? Behavioral correlates of mask wearing among COVID-19 frontline workers

Contributed equally to this work with: Ankush Asri, Viola Asri, Baiba Renerte

Roles Conceptualization, Data curation, Formal analysis, Methodology, Project administration, Software, Writing – original draft, Writing – review & editing

Affiliations University of Konstanz, Konstanz, Germany, Thurgau Institute of Economics, Kreuzlingen, Switzerland

Roles Conceptualization, Data curation, Methodology, Writing – review & editing

Affiliations Spital Schwyz, Schwyz, Switzerland, Swiss Institute for International Economics and Applied Economic Research, University of St.Gallen, St.Gallen, Switzerland

Roles Data curation, Methodology, Writing – review & editing

Affiliations Kantonsspital Baselland, Liestal, Switzerland, University of Basel, Basel, Switzerland

Affiliation Kantonsspital Baselland, Liestal, Switzerland

Affiliations Spital Schwyz, Schwyz, Switzerland, University of Basel, Basel, Switzerland

Roles Conceptualization, Methodology, Supervision, Writing – review & editing

Ankush Asri,
Viola Asri,
Baiba Renerte,
Franziska Föllmi-Heusi,
Joerg D. Leuppi,
Juergen Muser,
Reto Nüesch,
Dominik Schuler,
Urs Fischbacher

Published: July 19, 2021
https://doi.org/10.1371/journal.pone.0253621
Reader Comments

Human behavior can have effects on oneself and externalities on others. Mask wearing is such a behavior in the current pandemic. What motivates people to wear face masks in public when mask wearing is voluntary or not enforced? Which benefits should the policy makers rather emphasize in information campaigns—the reduced chances of getting the SARS-CoV-2 virus (benefits for oneself) or the reduced chances of transmitting the virus (benefits for others in the society)? In this paper, we link measured risk preferences and other-regarding preferences to mask wearing habits among 840 surveyed employees of two large Swiss hospitals. We find that the leading mask-wearing motivations change with age: While for older people, mask wearing habits are best explained by their self-regarding risk preferences, younger people are also motivated by other-regarding concerns. Our results are robust to different specifications including linear probability models, probit models and Lasso covariate selection models. Our findings thus allow drawing policy implications for effectively communicating public-health recommendations to frontline workers during the COVID-19 pandemic.

Citation: Asri A, Asri V, Renerte B, Föllmi-Heusi F, Leuppi JD, Muser J, et al. (2021) Wearing a mask—For yourself or for others? Behavioral correlates of mask wearing among COVID-19 frontline workers. PLoS ONE 16(7): e0253621. https://doi.org/10.1371/journal.pone.0253621

Editor: Pablo Brañas-Garza, Universidad Loyola Andalucia Cordoba, SPAIN

Received: February 10, 2021; Accepted: June 8, 2021; Published: July 19, 2021

Copyright: © 2021 Asri et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: The data and the code for the analysis are available on the open science foundation web site osf.io/vg5j7.

Funding: The author(s) received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Introduction

The World Health Organization (WHO) declared the novel SARS-CoV-2 coronavirus disease 2019 (COVID-19) outbreak a pandemic on the 11 th of March 2020 [ 1 ], and face masks swiftly became one of the most visible symbols of the pandemic [ 2 , 3 ]. The emerging consensus is that mask wearing reduces the chances of both catching and spreading the virus and thus protects both the wearer herself and other people around her [ 4 – 7 ].

Yet, human behavior is central to how well masks work [ 8 – 12 ]. The studies on efficacy of mask wearing rely on the assumptions that people wear masks—and wear them correctly [ 13 ]. Meanwhile, COVID-19 provides different intrinsic motivations for mask wearing for different age groups, as older people face a considerably higher mortality risk from disease complications than younger people [ 14 ]. Accordingly, an intergenerational conflict in motivations for complying with the pandemic restrictions, including mask wearing, is likely to occur. We thus hypothesize that tailored strategies for communicating public health recommendations regarding mask wearing to the older and younger age groups are needed.

At the beginning of the pandemic, medical experts lacked evidence on how the virus spreads, leading to inconsistencies in public health recommendations from health organizations and political leaders [ 15 – 17 ]. For example, the WHO and the Swiss Federal Office of Public Health (FOPH) initially refrained from endorsing mask wearing, partly due to the lacking evidence and partly due to worries about depleting supplies for frontline workers. In March 2020, the WHO even stated that people who “are not ill or looking after someone who is ill” would be “wasting a mask” if they wore one [ 18 ]. The Swiss FOPH echoed this position stating that “healthy people should not wear hygiene masks (surgical masks) in public” [ 19 ]. This opinion changed in late April 2020, when the FOPH issued a recommendation to wear masks when physical distancing is not possible, and the WHO issued a similar recommendation in June 2020 [ 20 , 21 ].

Given these inconsistencies in public messages and intrinsic motivations, it is now more important than ever to develop an effective strategy for communicating public health recommendations regarding the importance of mask wearing. It is particularly important to understand how to motivate people of different ages to wear masks in public when mask wearing is voluntary. People could be motivated to wear masks either to benefit themselves by not catching the virus (risk preferences) or to benefit others by not transmitting it (other-regarding preferences). It is not yet established, however, which motivation dominates in which context. Given that masks can save lives in different ways, which benefits to rather stress in public messages to specific target groups—the reduced chances of catching or transmitting the virus?

In this study, we link measured risk preferences and other-regarding preferences to voluntary mask wearing habits outside work among COVID-19 frontline workers in two Swiss hospitals. Switzerland is well suited for our study due to the unique combination of two aspects—the varying rate of COVID-19 infections and the stringency level of government response. In terms of the infection rates, Switzerland was temporarily one of the most affected countries in the world (per capita on average) during the first COVID-19 wave of 2020 [ 22 ]. Due to Switzerland’s heavy reliance on cross-border workers, the central and less populous regions of Switzerland were significantly less affected than the border regions throughout the first wave [ 22 ]. Nevertheless, according to the Government Response Stringency Index [ 23 ], the Swiss FOPH has remained somewhat more lenient in terms of the anti-COVID-19 restrictions than its counterparts in the neighboring countries. For example, mask wearing was mandatory for general public only in the public transport and only starting July 2020. Although some regions of Switzerland either lifted or introduced some other measures to limit the spread of COVID-19 during the period of interest for this study, no significant policy changes took place in our regions of interest; see the Methods section for a detailed timeline.

Healthcare workers, as an exemplary population, are particularly suited for our inquiry for a number of reasons. First, all employees of Swiss hospitals were required to wear masks at work, such that they were used to wearing them on a daily basis and had easy access to mask supplies. Second, acting at the frontline of the COVID-19 crisis, they were comparatively well informed about the benefits of mask wearing and risks that follow from not wearing a mask. Third, potentially having been closer to people who have been infected with the SARS-CoV-2 virus, the hospital employees might have been exceptionally motivated to wear masks in public even if mask wearing rules were voluntary.

And yet, quite curiously, there is considerable heterogeneity in mask wearing habits even within this population. Previous studies have shed some light on the potential motivations and characteristics that could explain this variation. On the one hand, people who wear masks tend to be more empathic [ 24 ], more conform to societal norms [ 25 , 26 ], more reliant on reasoning rather than emotions [ 27 ], and more willing to re-establish a sense of control, as people reportedly feel relief from anxiety when wearing masks [ 25 ]. On the other hand, people who avoid endorsing or complying with prevention measures, including mask wearing, tend to be more risk-taking, callous and dishonest [ 28 , 29 ] and even exhibit more hypermasculinity [ 30 ] and so-called dark traits (e.g., psychopathy) [ 31 , 32 ]. While studies often focus on these motivations separately, it is not yet clear which motivations for mask wearing behavior dominates when comparing them for different age groups.

On the first glance, it might seem that the benefits for oneself comprise a stronger argument for compliance. However, previous studies that compare self-regarding and other-regarding motivations for health behavior provide mixed results [ 33 – 35 ]. Indeed, humans are social beings and have the willingness, need and ability to cooperate with others, even beyond own kin [ 36 – 39 ]. It is for this reason that people are reportedly motivated to restrict their everyday lives to protect others who belong to a COVID-19 risk group [ 9 ], and it is for this reason that appealing to people’s other-regarding motivations in the context of mask wearing might be the “stronger public health rationale” [ 40 ].

To address this question, we conducted a survey of Swiss healthcare workers right after the first COVID-19 wave of 2020 to examine the various motivations behind voluntary mask wearing. We focused on two hospitals of regional importance in two differently affected regions: one larger hospital with ca. 3500 employees in the northwest part of Switzerland, which was an area with moderately high COVID-19 incidence per capita during the first COVID-19 wave (henceforth “more-affected region”) and one smaller hospital with ca. 500 employees in the central part of Switzerland, where COVID-19 incidence per capita was relatively low (henceforth “less-affected region”); please refer to the Methods section for further details on COVID-19 prevalence in each region and the survey design. While mask wearing was compulsory within both hospitals throughout the whole data collection period in mid-2020, it was recommended but not compulsory outside of the hospitals (e.g., in supermarkets or other crowded places) in the respective regions over this time period.

Accordingly, as we will elaborate in the Results section, voluntary mask wearing habits had developed differently in the two regions, in that mask wearing is higher on average in the more-affected region compared to the less-affected region (in line with the literature on exposure [ 41 ], which suggests, e.g., that outbreaks lead to increased vaccination rates). We can thus examine how mask wearing motivations—for oneself or for others—differ given the two different equilibria in (i) the more-affected region where the social norm leans towards wearing masks and (ii) the less-affected region where the social norm leans towards not wearing masks. Our main variables of interest include a risk preference measure [ 42 ] and an other-regarding altruism measure [ 43 ], and we hypothesize that both higher risk aversion and higher altruism lead to more mask wearing, although their importance differs. Our main comparisons of interest include between-region and, given the specifics of COVID-19 risk, between-age-group comparisons.

Materials and methods

We carried out an online survey of employees from two hospitals in Switzerland—Spital Schwyz and Kantonsspital Baselland—to analyze behavioral correlates of compliance with COVID-19 preventive measures and prevalence of COVID-19 infections. Informed consent was obtained from all participants. Ethical approval for this study was waived by the Ethics Committee Northwest and Central Switzerland. Hospital employees were invited by mail to their home address to participate in the online survey. Overall, 840 hospital employees participated in the survey: 540 from the more-affected region and 300 from the less-affected region. The survey took place from the end of May 2020 to the end of June 2020 in the hospital in the less-affected region and from mid-June to mid-August 2020 in the hospital in the more-affected region; see the timeline in Fig 1 below. The online survey was in German, given that the working language in both hospitals is German and the hospital management confirmed that all hospital employees are sufficiently fluent in German.

PPT PowerPoint slide
PNG larger image
TIFF original image

(A) Development of COVID-19 in the less-affected and more-affected region relative to data collection periods, according to FOPH (B) Timeline of the study and COVID-19 policy milestones and debates in Switzerland.

https://doi.org/10.1371/journal.pone.0253621.g001

In the online survey, the hospital employees reported their voluntary mask wearing habits as well as answered general questions about the two competing preferences potentially motivating mask wearing: risk aversion and altruism. We analyze the data from both hospitals separately, considering the two hospitals as two different clusters. We use multivariate regression analysis to examine the motivations predicting mask wearing. The dependent variable is mask wearing . Survey respondents were asked “Do you currently wear a mask when you go to supermarkets or other crowded places?” and could respond “Yes”, “Sometimes” or “No”. For the main analysis, we code the binary dependent variable as 1 if the respondent says “Yes” or “Sometimes” and as 0 if the respondent says “No”. In addition, we perform robustness checks with different specifications and report these in the S1 Appendix . As the dependent variable is binary, we use linear probability models with heteroskedasticity-robust standard errors [ 44 ]. The unit of observation is the hospital employee i . The independent variables of interest are self-reported risk preference and self-reported altruism as measured in the online survey.

We start the empirical analysis by presenting how the percentage of people reporting to wear a mask varies by our variables of interest—risk preference and altruism—as well as the hypothesized moderating variable age. We then split the sample into younger and older employees to examine the mask-wearing rates among the younger and older employees for risk averse, risk seeking, altruistic and not-altruistic individuals.

From this regression, we obtain parameters β 3 and β 4 indicating the correlation of risk aversion and altruism with mask wearing for younger employees. The linear combinations β 1 + β 3 and β 2 + β 4 indicate the association between mask wearing and risk aversion for older hospital employees.

In line with the econometric literature on regressions for binary outcome variables, the linear probability model is the preferred specification [ 44 ]. We additionally provide the results from probit models with marginal effects and from a data-driven approach for the selection of covariates using Lasso regressions [ 45 , 46 ] in the S1 Appendix .

Below, we provide a description of the independent variables of interest. The measures for self-reported risk preference and altruism have been extensively validated in previous studies [ 43 , 47 , 48 ].

Self-reported general risk aversion

We use the well-established survey question from the German socio-economic panel: “How do you see yourself? Are you in general a person willing to take risks or as a person who tries to avoid risks?”. Respondents answer on a Likert-scale from 0 to 10 [ 42 , 47 , 48 ].

Self-reported altruism

We use the well-established survey question from the Global Preferences Survey. Respondents answer on a Likert-scale from 0 to 10 indicating how well a statement describes them as a person. For pure altruism, the statement is “I am willing to donate to good causes without expecting anything in return.” [ 43 ].

We examine what motivates frontline workers to wear a face mask in the public outside their workplace. We use the data of both hospitals, one located in the more-affected region (N = 540) and the other one located in the less-affected region (N = 300), but analyze the data from both locations separately considering both hospitals as two different clusters; please see Table 1 in S1 Appendix for the survey questions and Table 2 in S1 Appendix for summary statistics. We find that the relevance of the two competing motivations for voluntary mask wearing varies between the regions. Moreover, the importance of these motivations varies with age: While older people are motivated by risk aversion, younger people are also motivated by other-regarding concerns, and this comparison is more pronounced in the more-affected region.

First, we examine how the percentage of respondents reporting to wear a mask varies by the two variables of interest—risk preference and altruism—as well as by age. Overall, in the more-affected region, 60.9% of the survey respondents wear a mask. In the less-affected region, 19.3% wear a mask (p-value<0.001). As shown in Fig 2 , mask wearing varies by risk preference and altruism. Mask wearing is more common among risk-averse individuals than among risk-seeking individuals: 67.8% compared to 54.6% in the more-affected region (p-value = 0.00 2) and 26.1% compared to 13.9% in the less-affected region (p-value = 0.007). Similarly, altruistic individuals report wearing a mask more often than not-altruistic individuals: 66.7% compared to 57.4% in the more-affected region (p-value = 0.033) and 25.3% compared to 16.4% in the less-affected region (p-value = 0.068). As the motivations for mask wearing may vary by age, we further note that in general younger employees report wearing a mask less often than older employees: 54.9% compared to 69.7% in the more-affected region (p-value<0.001) and 12.5% compared to 29.0% in the less-affected region (p-value<0.001).

Risk aversion and altruism are binary variables standardized at median. “Younger” refers to up to 44 years of age and “Older” refers to 45 years of age and older.

https://doi.org/10.1371/journal.pone.0253621.g002

Splitting the sample by age now in each of the two hospitals shows descriptively that, for younger individuals, mask wearing varies both by risk-aversion and altruism, with the motivation stemming from other-regarding preferences appearing more pronounced in more-affected region than in the less affected region. In the more affected region, 61.1% of the young risk-averse individuals report wearing a mask compared to 49.4% of the young risk-seeking individuals (p-value = 0.037). A similar pattern is visible in the less-affected region with 19.4% of the young risk-averse individuals reporting to wear a mask and 7.7% of the young risk-seeking individuals (p-value = 0.020). Further, 65.1% of the young altruistic individuals report wearing a mask compared to 50.0% of the young non-altruistic people report wearing a mask in the more affected region (p-value = 0.012) and 17.3% compared to 10.5% in the less affected region (p-value = 0.214).

For older employees, mask wearing varies only by risk aversion and not by altruism, and the self-protecting motivation appears to be more pronounced in the more-affected region. Among the risk-averse older individuals, 77.1% wear a mask compared to 62.5% of the risk-seeking older individuals (p-value = 0.018) in the more affected region. The difference is insignificant in the less-affected region (p-value = 0.239). For older employees, mask wearing does not seem to vary with altruism (p-value = 0.687 in the more-affected region and p-value = 0.341 in the less-affected region).

We model the two potentially competing motivations—risk aversion and altruism—by regressing mask wearing as a binary variable on risk aversion and altruism standardized at median in an ordinary least squares (OLS) linear regression model; please see Tables 3 to 5 in S1 Appendix for further details. We further account for individual and situational covariates as predictors of mask wearing. As depicted in Fig 3 , both in the more-affected region and in the less-affected region, risk aversion and altruism are both positively correlated with mask wearing. In terms of significance and accounting for other predictors, risk aversion predicts mask wearing more strongly than altruism, suggesting—at least at the first sight—that risk preferences are the main drivers of mask wearing in the context of the COVID-19 pandemic. After controlling for individual and situational covariates, being risk-averse is associated with an increase in the likelihood of wearing a mask by 13.0 percentage points (p-value = 0.008) in the more-affected region and by 8.4 percentage points (p-value = 0.063) in the less affected region. In the more-affected region, being altruistic is associated with an increase in the likelihood of mask wearing by 9.6 percentage points increase (p-value = 0.023) but it is a not significant predictor once we account for individual covariates, neither when we focus on the frontline workers in the less-affected region. We summarize this initial finding as Result 1.

In this figure, we visualize the results from regressing mask wearing on the variables of interest risk aversion and altruism. The x-axis shows the estimate for the coefficient on risk aversion and the estimate for the coefficient on altruism first without covariates, then including only situational covariates, then including only individual covariates, and finally including both. The thin line represents the 95% confidence interval and the thick line represents the 90% confidence interval. Risk aversion and altruism are binary variables standardized at median. Situational covariates include having had COVID-19 symptoms, household size, using public transport, having had contact to a COVID-19 infected person at work, having had contact to a COVID-19 infected person outside work, belonging to a COVID-19 risk group, living with a household member who belongs to a COVID-19 risk group, having traveled internationally for at least 2 days since 1st of February 2020. Individual covariates include being a health worker (doctor or nurse), age group, education group (low, medium or high level of education), being native and gender.

https://doi.org/10.1371/journal.pone.0253621.g003

Result 1: People who are more risk-averse are more likely to wear a mask .

However, given the specifics of the known COVID-19 risks, Result 1 on the importance of risk aversion as the primary motivation behind mask wearing may neglect important differences between age groups. While avoiding the risk of getting infected may be the central motivation for older employees who tend to be more at risk of experiencing serious symptoms, younger employees might be less concerned about catching the disease themselves and instead more concerned about older people suffering from serious symptoms.

Given these differences, we use interaction terms of risk aversion and altruism with age to examine whether the two motivations, risk aversion and altruism, vary in their relevance for younger and older hospital employees. As shown in Fig 4 , in the more-affected region, risk aversion is associated with a higher likelihood to wear a mask for both younger and older hospital employees. Younger employees who are risk-averse are 12.5 percentage points (p-value = 0.043) more likely to wear a mask than their risk-seeing counterparts. Older employees who are risk-averse are 14.1 percentage points (p-value = 0.060) more likely to wear a mask than their risk-seeking counterparts. In the less-affected region, risk aversion is only associated with higher likelihood of wearing a mask for the younger hospital employees. Younger risk-averse employees are 9 percentage points (p-value = 0.068) more likely to wear a mask than their risk-seeking counterparts. Finally, we observe that other-regarding preferences, captured by altruism, influence mask wearing for the younger people in the more-affected region but not for younger people in the less-affected region. In the more-affected region, younger employees who are altruistic are 13 percentage points (p-value = 0.021) more likely to wear a mask than their non-altruistic counterparts. In other words, while older hospital employees tend to wear masks to protect themselves in the more-affected region, younger hospital employees are also motivated by altruistic motivations, but only in the more-affected region.

The presented estimates are from regressions with interaction terms between the variable of interest and being younger, controlling for all situational and individual covariates. Situational covariates include having had COVID-19 symptoms, household size, using public transport, having had contact to a COVID-19 infected person at work, having had contact to a COVID-19 infected person outside work, belonging to a COVID-19 risk group, living with a household member who belongs to a COVID-19 risk group, having traveled internationally for at least 2 days since 1st of February 2020. Individual covariates include being a health worker (doctor or nurse), age group, education group (low, medium or high level of education), being native and gender. See also the comments on Fig 3 .

https://doi.org/10.1371/journal.pone.0253621.g004

Result 2: In the more-affected region, younger employees who are more altruistic are more likely to wear masks. They are motivated not only by risk aversion but also by other-regarding preferences (altruism) .

Potentially, this result could be related to the two different equilibria prevailing in the more-affected region and in the less-affected region. While in the more-affected region, the social norm is to wear a mask at crowded places, in the less-affected region the social norm is not to wear a mask. Hence, other-regarding preferences are more likely to motivate people in the region where mask wearing is the norm compared to the region where mask wearing was not (yet) the norm.

Our results on how the motivations for mask wearing may change with age are robust to using continuous independent variables for risk aversion and altruism, considering the dependent variable for mask wearing as a three-level categorical variable, changing the functional form of the regression using probit regressions instead of linear probability models, and using a data driven approach in selecting the covariates using Lasso regressions [ 45 , 46 ] Please see Tables 6 to 16 in S1 Appendix for further details.

We have demonstrated the importance of ambidextrous strategies for communicating public health recommendations during the COVID-19 pandemic. We highlight different motivations for mask wearing for different subgroups of the frontline healthcare-worker population. Namely, both risk preferences and social preferences appear to play a role for the younger people, while predominantly risk preferences are related to mask wearing habits for middle-aged and older people. In our study, we have focused on a particularly important group of the population—hospital employees—for whom mask wearing is likely less affected by practical barriers, such as lack of access to mask supplies, lack of knowledge about the efficacy of masks or lack of experience with wearing masks. Accordingly, we argue that the effect of the different preferences in our study is less confounded by such additional factors.

Importantly, our analysis reveals that age is the only demographic measure related to significant differences in mask wearing habits—other measures like gender, education or occupation showed relatively minor differences. Our results thus align with the statistics on disease complications and mortality, by which older people are more likely to belong to the COVID-19 risk group. Our median cutoff for the younger and older subgroups also happens to coincide with the age group with 1% or higher COVID-19 mortality rate [ 14 ].

Our results hold also after we control for whether our respondents co-reside with a COVID-19 risk group member. We can thus conclude that the other-regarding preferences that we capture using our survey design apply to “others” beyond one’s own kin [ 49 ]. One useful extension of our study could thus include an investigation into further social motivations for mask wearing, including image concerns [ 50 , 51 ] and coordination [ 52 , 53 ].

We have measured general preferences, instead of focusing on exact messages [ 34 ], and contrast risk-related and altruism-related motivations as such. Accordingly, our research could also bring insights to situations that span beyond voluntary mask wearing settings. Previous research on the use of masks in non-healthcare settings relates to influenza-like illnesses and focus predominantly on the protection of the mask wearers themselves [ 54 ]. In the meantime, some studies argue that mass masking has not been more widely accepted because it provides moderate benefits to individuals and large benefits to whole populations [ 55 ]. Other examples of this paradox include, for example, vaccinations, which provide protection to oneself but require a high compliance rate to achieve herd immunity for others [ 56 ]. Aside from healthcare matters, also safe driving can be compared to mask wearing in this regard, in that other road users and pedestrians benefit from safe driving just as the driver herself does [ 40 ]. In general, our findings add yet another example for using social and behavioral science to support the COVID-19 pandemic response [ 57 ]. Yet, another useful extension of our study design could include other target groups of the population beyond frontline workers in the healthcare sector.

Supporting information

S1 appendix. the supplementary materials provided separately include all survey questions, summary statistics and regression tables for the analyses in the paper..

https://doi.org/10.1371/journal.pone.0253621.s001

Acknowledgments

We acknowledge the administrative and procedural support provided by Barbara Monstein, Sarah Kamber, Daniela Schmid, Yannick Paukner and Paul Gieringer.

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PMC10243888

Face mask is an efficient tool to fight the Covid-19 pandemic and some factors increase the probability of its adoption

Olivier damette.

1 BETA, University of Lorraine, France and CEC Paris Dauphine, Paris, France

Toan Luu Duc Huynh

2 University of Economics Ho Chi Minh City, Ho Chi Minh City, Vietnam

Associated Data

The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request and dat as well as main replication codes are available at https://dataverse.harvard.edu/dataverse/MaskCovid19 . A detailed SI Appendix is associated to the main manuscript with detailed informations about data and materials. The survey data come from the study performed by the University of Maryland and jointly conducted with the Facebook platform (see Fan et al. 29 , Barkay et al. 6 and Kreuter et al. 50 ) and are publicly available (see details in SI Appendix).

This study examines the dynamic impact of face mask use on both infected cases and fatalities at a global scale by using a rich set of panel data econometrics. An increase of 100% of the proportion of people declaring wearing a mask (multiply by two) over the studied period lead to a reduction of around 12 and 13.5% of the number of Covid-19 infected cases (per capita) after 7 and 14 days respectively. The delay of action varies from around 7 days to 28 days concerning infected cases but is more longer concerning fatalities. Our results hold when using the rigorous controlling approach. We also document the increasing adoption of mask use over time and the drivers of mask adoption. In addition, population density and pollution levels are significant determinants of heterogeneity regarding mask adoption across countries, while altruism, trust in government and demographics are not. However, individualism index is negatively correlated with mask adoption. Finally, strict government policies against Covid-19 have a strong significant effect on mask use.

Introduction

To confront the global Covid-19 pandemic and reduce the spread of the virus, we need to improve our understanding of the factors that influence its spread. Many governments and public health departments have promoted and imposed various mitigation measures to contain the spread of Covid-19 3 and 7 ; indeed, such measures were crucial when no vaccine were available and are still important since herd immunity with vaccination is far to be achieved. The heterogeneity in fatality rates across the globe reflects differences in how well countries have managed the pandemic 49 , the effectiveness of the various policies, and the extent to which they have been promoted by public authorities and adopted by populations.

One of the most widely debated of such policies, especially among the general public, is the wearing of face masks. While face mask use is encouraged by most governments, support for their use has been limited among general populations 90 . The effectiveness of masks in reducing the transmission of Covid-19 has been contested, and levels of self-reported mask use differ considerably between countries 34 . We also acknowledge the existing literature of Lu et al. 58 in terms of collectivism and mask-wearing behavior. Interestingly, the national data within the US could be aligned with our international scope. According to a study by English et al. 27 , almost everyone in China (up to 94%) wore masks during the first 14 days of the outbreak, which could be a reason why the number of cases in China decreased significantly 14-21 days later. The authors also discovered that higher levels of air pollution in the past were linked to quicker adoption of mask usage. This research supports the authors’ argument that there is a connection between air pollution and the use of masks. Although there are some existing empirical findings about cultural dimensions (collectivism), environmental conditions, and protective behaviors, these studies and this paper converged similar findings. Our study differs from these works based on the data scope. While the current work only focuses on a single country, our study expands the results internationally.

To the best of our knowledge, we present here the first statistical analysis of the effectiveness of mask-wearing to reduce the spread of Covid-19 at a global scale. 1) We compute dynamic panel econometric estimates to assess the impact of mask-wearing on both infections and fatality rates per capita. Although some data is available on the number of tests being conducted, no official data on mask-wearing exists. Previous studies used a dummy variable by considering the date of mandatory mask policy introduction and the duration variable 52 . For this study, we collected individual data from the Covid-19 World Survey Data API (v1.2) jointly conducted by the University of Maryland and Facebook 6 , 29 , 50 . We obtained estimates of the percentage of people in a given country that used face masks daily from April, 23 to July, 15, 2020. Concerning this last point, the use of Kreuter et al. study 50 from the University of Maryland also proved the tremendous potential of using social media platforms to obtain quick, large-scale population response and attitude toward social policy. By employing the available data from April, 23 to July, 15, 2020, implying the previous period before pharmaceutical intervention, we mainly focus on the first wave of the pandemic but after the peak of the number of Covid-19 cases and main lockdown policies in most of OECD countries took place. Our sample is in the vein of previous literature: Lyu and Wehby 59 used daily data between March 31 and May 22, 2020 while Chernozhukov et al. 15 used a dataset from March 7, 2020 to June 3, 2020. Two main other reasons might explain why this period should be taken into account. First, when the outbreak of the COVID-19 pandemic happened, there is an ambiguity in containing the spread of this deadly virus. People started wearing masks to protect themselves against the airborne despite having a controversial decision. We can observe that this action in the first wave is the only measure that people can deal with. Second, in the next waves, the government might carry several interventions such as severe lockdown, vaccinations, social distancing, and so forth. Thus, it is pretty challenging to disentangle the mask-wearing effect from other interventions in complicated interactions. Moreover, people are likely to update their beliefs after receiving much information regarding the COVID-19 pandemic, implying the human behavior changes in the next waves. Therefore, focusing on the first and foremost period could offer insights into the nature of determinants of wearing masks and their effectiveness. We developed a dynamic model that included lagged effects to control the epidemic’s dynamics over time, including delays between infection and case confirmation and incubation period. Our dynamic model indirectly accounts for potential simultaneous impacts of other determinants of the Covid-19 outbreak. We also included additional controls to directly account for certain factors that may have influenced viral transmission (e.g., mobility, temperatures). Finally, to preserve our causal identification from reverse causality bias, we controlled for the effects of other non-pharmaceutical mitigation measures during the studied period by adding the number of Covid-19 tests (testing policy) and a stringency index (reflecting all mitigation measures) as additional explanatory variables. 2) We then performed a cross-sectional statistical analysis to examine the socio-economic determinants of mask-wearing across countries. For this analysis, we examined a different set of determinants to understand the heterogeneities regarding mask adoption across countries and the factors that can increase the number of individuals that wear a face mask.

This paper contributes to the existing literature on two main pillars. First, this paper looks at the effects of wearing a mask on COVID-19 morbidity and mortality before having any pharmaceutical intervention such as vaccination or medical treatment 69 . Second, this study also explores the determinants of mask use, such as socio-economic factors, culture, population, etc. By doing that, we can disentangle the heterogeneity among countries since our study looks at the global database. More importantly, to deal with the problems during the pandemic, we need to understand the local (or country) context to generalize the global context, which suggests better public administration and governance.

Section “ Data and methods ” lays out our data and econometric methodology. Section “ Panel data and sample issues ” discusses our two main findings, such as (i) the effectiveness of wearing masks and (ii) determinants of wearing masks on a global scale with different models and approaches to ensure robust findings. Finally, Sect. “ Definitions of variables and data sources ” concludes.

Literature review

This absence of consensus among general populations can be explained not only by differences in individuals’ subjective concerns (Perotta et al., 2020) but also by conflicting national guidelines and public communication. The latter is a crucial area of concern since political leaders’ words and actions affect people’s behavior 1 ; people need official guidance 54 . However, public guidance has been subject to much fluctuation and is characterized by a lack of consistency among political leaders. President Trump in the US is a prime example of a leader whose opinions on this issue have been inconsistent. Likewise, the French government did not support face mask use last March 2020, considering it to be ineffective, but changed its guidance to support the wearing of face masks in late May. Even the World Health Organization initially advised against widespread mask wearing before changing its recommendation on June, 5, 2020 (Lefler et al. (2020), WHO 91 ). Beyond individual-level variations, heterogeneity between countries still exists; mask wearing has been recommended since the early stages of the pandemic by governments in East and South East Asia. It was only later recommended in many Western countries and is still not recommended at all in some Nordic countries. Policies on face mask use are also more strictly enforced in Asian countries. The rationale choice for this is that a voluntary policy would likely lead to insufficient compliance and would, hence, be less effective than a mandatory policy 9 .

More noticeably, the literature on determinants of wearing masks is still ongoing. Since the COVID-19 pandemic is known as the novel deadly virus without clear, responsive policies, different countries might follow their strategies, which leads to the divergence of health policies. Motivated by the partisan differences in Americans, the current empirical studies come into the agreement that there is a disproportionate correlation of partisanship and behavioral responses to the COVID-19 pandemic, such as social distancing 2 , mask-wearing 63 , and even the political voting 4 . An inconsistent public message could drive people’s attention to this deadly virus in different ways. Accordingly, President Trump and other Republican officials tended to underestimate the severity of COVID-19 in the beginning outbreak while the opposite side continually criticized and put more effort into sounding an alarm to the community. This case naturally exemplifies what happened in the United States while there is still a gap to understand for the worldwide scope.

However, the effectiveness of mask wearing policies to reduce the spread of the Covid-19 virus, especially when they go beyond the precautionary principle, has been the subject of much scientific debate (Perotta et al., 2020). Studies on the role face masks can play in mitigating the pandemic are scarce, particularly statistical and global-scale studies. This is partly due to limited data at the level of countries and the difficulty of conducting clinical trials (which may be regarded as exploiting vulnerable populations) at the individual level.

A very small body of literature has found that mandatory and voluntary mask policies should mitigate the transmission and, thus, the spread of the Covid-19 pandemic. The effects of face masks have been examined in a large survey 16 and a meta-analysis 16 . Both studies concluded that face mask use reduces the transmission of infected droplets in both laboratory and clinical contexts. In addition, public mask use is most effective in reducing the transmission of the virus when compliance is high and when there is a high level of trust in politicians 5 . While clinical masks are the best protective solution, surgical and comparable cloth masks have also been shown to reduce transmission, albeit in a less comprehensive way 16 .

Experimental studies on animals confirm the effectiveness of mask use: protected animals were found to be less infected and sick than their mask-free neighbors 13 . Results based on mathematical models 83 show that face mask use by the public could make a major contribution to reducing the impact of the Covid-19 pandemic. If masks were used in public all the time (not just from when symptoms first appear), the effective reproduction number could be reduced to less than one 83 . From a theoretical and mathematical perspective, face masks, even if they have only a limited protective effect, can reduce the total number of infections and deaths and delay the peak of the epidemic 90 .

A small number of recent statistical studies have confirmed these results. Based on linear correlation and projections exercises and using data from the US, Italy, and Wuhan city in China, one study concluded that wearing a face mask in public is the most effective means of preventing Covid-19 transmission 92 . However, potential biases, especially regarding the failure to control for other non-pharmaceutical policies, have been reported. Very recently, an econometric study demonstrated the positive results of introducing masks for employees in US states in April 2020 15 . Lyu and Wheby 59 conducted a quasi natural experiment for fifteen US states and show a reduction in the daily COVID-19 growth rate by 0.9 to 2 percentage points over time. Recently, Karaivanov et al. 48 confirm this result using Province-level data in Canada over January-July 2020 period. Likewise, in Germany, the introduction of mandatory mask wearing has reduced the growth rate of Covid-19 cases. The study from Mitze et al. 64 exploits the fact that the obligation to wear face masks in public transport, shops, and workplaces was introduced much earlier in Jena area (on 6th April) than in all other regions in Germany (around 20 days later). Generally, these findings are in agreement with the assumptions of epidemiologists and virologists regarding the benefits of reducing virus particle transmission by wearing a face mask 22 , 54 .

Little information is available on a global scale. However, an analysis of the socio-economic determinants of Covid-19 mortality across countries demonstrated that a longer duration of mask wearing by the public was negatively associated with mortality 52 . In this study, the effect of mask wearing is proxied by the delay between the first infected case and a government recommendation on mask wearing by the public. This study finds that ’in countries with public policies and cultural norms supporting public mask-wearing, per-capita coronavirus mortality increased on average by just 15.8% each week, as compared with 62.1% each week in other countries’.

Concerning the global cross-country determinants that influence attitudes to face masks, a small number of studies have been conducted on the level of individuals in Germany based on survey data 77 and Facebook Health Behavior Survey conducted in eight industrialized countries (Perotta et al., 2020). The first one found that worries about the current pandemic have the largest positive influence on mask wearing. Self-protection, protection of others, and perceptions of others’ judgment - especially for young people - have also been found to be significant drivers. Demographic factors (e.g., age, gender) were not found to be significant drivers. The aforementioned study found that self-reported mask use differed considerably across the eight countries considered. In contrast to previous findings, sex- and age-specific patterns about threat perception, confidence in the healthcare system, and the likelihood of adopting preventive behaviors were also documented 34 . Older individual-level studies on the severe acute respiratory syndrome (SARS) epidemic of 2003 in Hong Kong 85 reported that women, people in the 50-59 age group, and married respondents were more likely to wear face masks. Some other studies of different but related nature analysed the practices about face masks/N95 respirators utilization in Poland 31 whereas (Betsch et al.) investigated the social and behavioral consequences of mask policies face with the Covid-19 pandemic using 7000 German participants from April, 14 to May, 26, 2020. They reveal that mandatory policy is more effective than voluntary policy. The story is not only wearing the mask but also the appropriate usage 40 . Concomitantly, the single-country survey highlights that risk perception might correlate with the mask-wearing behaviors 41 .

Regarding culture and human behaviors, Gelfand et al. 32 shed a new light on the relationship between cultural tightness and historical rice farming cultures. In a study conducted by Gelfand et al. 32 , it was discovered that societies with strong cultural norms and strict rules had fewer COVID cases by October 2020. The authors of this study suggest that it would be valuable to investigate the cultural tightness scores before the pandemic as another factor in the adoption of masks and the reduction of COVID cases. According to a recent study by Talhelm 84 , historical societies that engaged in rice farming were more focused on prevention and were better equipped to respond collectively to the COVID-19 outbreak. During the initial year of the pandemic, rice farming societies across the globe had fewer cases and lower mortality rates. This provides additional evidence to support the idea that cultural practices like mask-wearing can play a role in preventing the spread of COVID-19. Therefore, our study sheds further light on cultural differences in COVID-19 outcomes.

To summarize our literature review, the synthesis of the literature on COVID-19 and public health admitted that wearing a mask could slow the speed of the spreading of coronavirus 62 . Although the strand of literature is growing on different aspects (for example, the politics of mask-wearing in the study of Kahane 46 ), our study has its value by exploring the role of an immediate solution by using masks to halt the deadly spread of coronavirus before any pharmaceutical intervention.

Data and methods

Panel data and sample issues.

We conducted an original empirical work based on a 96 countries dataset between the first of January and the 15th of July 2020, covering the entire “first wave” of the pandemic. As mentioned earlier, we only focused on the first wave to minimize the biases, which might be raised from updating beliefs from human behavior. In addition, we can disentangle the interference with other government policies, vaccination, and non-pharmaceutical policies since these regulations did not happen intensively and interactively. For the first section, we obtain a panel with 96 countries and around 7359 observations. We collected (1) the number of confirmed COVID-19 cases and deaths for the countries in our sample from the European Center for Disease, Control and Prevention between 1st January 2020 and July, 15th 2020, (2) the estimated population in 2019 from the World Bank’s World Development Indicators database, and (3) the mask-wearing variable from the Kreuter et al. study from University of Maryland using the Facebook platform 50 .

Our mask wearing variable is based on the Covid-19 World Survey Data API 29 and 50 . The surveys ask respondents how many people in their household are experiencing Covid-19-like symptoms, among other questions. These surveys are voluntary, and individual survey responses are held by University of Maryland and are shareable with other health researchers under a data use agreement. No individual survey responses are shared back to Facebook. Using this survey response data, we estimate the percentage of people in a given geographic region that use face mask cover. We use the smoothed weighted (two sets of sample respondents separately are used (CMU US and UMD global surveys)) percentage of survey respondents across an one week window that have reported use mask cover (see also https://covidmap.umd.edu/document/css_methods_brief.pdf for more details).

The descriptive statistics (average mask-wearing proportion, in SI Appendix) seem coherent with other sources from the literature. For example, data based on Health Metrics and Evaluation at the University of Washington in Seattle reported in the USA. While Fetzer et al. 30 and Van Bavel et al. 86 constructed weights that account for the differential sample size across countries, the mask-wearing variable approach is also consistent with the previous data processing. By doing this, the dataset can be eliminated the sampling bias from country differences.

The dimension of our panel (96 countries) has been constrained by data availability about our main interest ‘mask’ variable and a significant number of respondents to the mask adoption survey. The countries in our sample have not encountered the first wave of the pandemic quite in the same time and the responsiveness rate about the mask wearing variable can be different between high-income and development countries. Thus, we also used an alternative proxy for mask use as a robustnes check by computing a dummy variable taking 1 for periods since when the government of the country has instated a mask requirements policy, following Chernozhukov et al. 15 and Leffler et al. 52 .

Considering only European countries as a robustness check enables us to focus on countries with high responsiveness levels about the mask wearing variable to maximize the quality of the available information for this variable of great interest in our study. We also estimate our model on non European Countries and Asian countries separately (in SI Appendix). In addition, we have to take into account the fact that we have a panel of 96 countries with an important heterogeneity concerning the take-off Covid-19 periods (time with the first infected people) and so different Covid-19 dynamics over time: the first wave of Covid-19 epidemic has started later in Brazil than in Italy. Considering only homogeneous European countries is therefore a mean to test the presence of sample bias. We will show that results reported on European countries in our database are completely in accordance with the global results conducted on the global 96 countries sample.

Definitions of variables and data sources

The paper is divided into two parts. The first one deals with mask effectiveness using panel data, and the second one deals with mask adoption drivers using cross-section data. In the following subsection, we would like to depict our data features as well as the relevant literature for choosing these following determinants in our models.

Regarding the panel data group , there are seven main variables that we used to construct the panel data set to estimate the effectiveness of wearing masks on infected cases and deaths. To be more precise, we have Casepop and Deathpop presenting Covid-19 cases and deaths on a daily basis. In addition, N e w _ t e s t s and Masks demonstrate the daily number of new Covid-19 tests per thousand and the number of individuals reporting a mask use, respectively. Furthermore, Stringency was collected to perform as a proxy for responsive government policies with several sub-categories. More importantly, Temperatures and Mobility were employed to capture the daily average temperature in each region and changes in human mobility. The detailed description for each variable can be found in Appendix (section 1.1). The current literature also confirms that the stringent policies could predict the COVID-19 outcomes 76 , even the strengthened features of the political regime 47 . Additionally, there is a correlation between the number of tests and reported cases and deaths (per capita), implying a must to control the country’s policies to detect the infected cases 36 , 45 . More importantly, differences in average temperature could significantly correlate with the transition of the disease even in an empirical study 67 or meta-analysis with 517 papers 61 . The lower the human mobility, the lower the COVID-19 cases. These effects can be explained by the fewer social interactions 14 , 68 , 89 . To sum up, based on the previous literature, our estimations are designed rigorously and consider the previously updated literature to maintain reliable findings.

When it comes to the cross-sectional data , we constructed our data at the country-level to cover the socio-economic determinants. To be more precise, we capture the population features (Population density - Density ; the aging population - Age 65), environmental degradation ( CO 2), chronic diseases ( Diabetic and Overweight ), economic and educational status (economic status as GDP , school enrollment as School or reading ability PISA ), differences in cultural and behavioral dimensions ( Altruism index, Tolerance index, R i s k _ a v e r s i o n index, and political trust G o v e r n m e n t _ c o n f i d e n c e ). All variables’ descriptions can be found in Appendix 1.2. These determinants as mentioned above, were acknowledged in the extant literature. Accordingly, the effects of population characteristics, including density and aging, significantly correlate with the COVID-19 severity 10 , 65 . This relationship is very intuitive because the higher population density represents the greater proportion of people who gather in common places, which exposes the higher risk of transmission. In addition, Viscusi 87 contributes empirical evidence that the percentage of elderly people could positively predict the COVID-19 mortality rate per million population after controlling other factors such as the ranking of the health system, population density, economic freedom index, etc. for 180 countries. This finding is also consistent with the existing literature since the elder, known as those who are older than 65 years old, should be classified into the vulnerable group in society 38 , 56 . Since our cross-sectional data looks at the mask adoption drivers, environmental problems, proxied by the carbon emission level, should be included in the model. However, no study directly explores the inter-relationship between pollutants, mask-wearing, and COVID-19, the preliminary results of Persico & Johnson 72 highlight that environmental degradation could positively contribute to the severity to COVID-19 infections. Concomitantly, the theoretical framework of Gondim 33 admitted that several countries had the previous experience to deal with epidemics of respiratory diseases because of wearing surgical masks in public (See more at A quick history of why Asians wear surgical masks in public .). Therefore, we would like to control the environmental situation in our cross-sectional data. It is also worth mentioning that the large-scale survey from 49,968 participants across 67 countries of Van Bavel et al. 86 indicates that social identity and collective behavior could correlate with the non-pharmaceutical interventions. Motivated by this finding, we would like to acknowledge the role of socioeconomic status and behavioral factors in our models. Therefore, we further address why people wear masks from different perspectives with the diversity of control variables, even social and behavioral determinants 86 . SI Appendix (Table S22 and following one) shows more detail of our descriptive statistics for all variables. Overall, there is no perfect correlation among predictors, reflecting the characteristics of the worldwide COVID-19 situation.

To elaborate our motivation and rationale choices for these variables, this study attempts to extend the variables options from the English et al. 27 with the time dimension. By using a single country context (China), the study emphasizes that the number of days that could reduce the spread of the virus is around 14 to 21 days. Therefore, this study reapplies the evidence regarding the specific days for mask effectiveness. More noticeably, the literature review study of Howard et al. 39 pointed out the majority of determinants of mask-wearing effectiveness. Therefore, we put these factors into account the global scope.

The econometric panel model to assess mask effectiveness

To empirically test the effect of mask adoption on Covid-19 outcomes, we use a dynamic panel econometric model as follows:

Where the subscripts i and t represent country index and periods (days) respectively. The dependent variable, y i , t , can be the number of infected individuals (casespop) or deaths (deathpop) per capita (considering the population size) at time t . C i , t - p is a vector of variables depicting the effects of mask wearing in day t - p . A vector of controls X i , t - p is included to deal with omitted bias and endogeneity issues. Country-specific fixed effect, μ i , are included to control for time-invariant omitted-variable bias and ε i , t is the error term. δ t is a deterministic time trend that controls the deterministic dynamics of the epidemics over the studied period and captures some unobserved information about the pandemic common to all countries such as learning effects (see 24 about including time trend to capture time-variant unobservables in panel MG regressions). Hence, our model captures both deterministic dynamics (the ’natural cycle’ of the virus) via deterministic trends and stochastic dynamics via the AutoRegressive structure. In addition, lagged terms y i , t - k capture the stochastic part of the pandemic dynamics.

Considering lags in epidemic dynamics is crucial on an theoretical/epidemiological point of view but also for causal identification concerns. Previous literature (Karaivanov20, Greenhalg et al. (2020)) have identified that threat perceptions about the current crisis can change the mask adoption and so human behaviors leading to potential reverse causality concerns (i.e. the concern that causality flows from COVID-19 to face mask use rather than from face mask use to COVID-19). Including lagged values of the explanatory variable in our model is a mean to deal with potential reverse causality issues. However, the use of lagged explanatory variables is sometimes insufficient to create the exogeneity necessary for causal claims as pointed out by Bellemare, Masaki, and Pepinsky 8 or Leszczensky and Wolbring 53 .

In addition, there is a theoretical rationale for including lagged values of the independent variables in our model considering the epidemiological literature. In line with Chernozhukov et al. 15 and Damette et al. 21 , we assume that the Covid-19 policies and behaviors affect cases and deaths with time lags: two weeks between changes in behavior or policies, and changes in reported cases are considered. Indeed, we assume k equal to 7 or 14 lags/days in our baselines specifications. This delay, in the way of Chernozhukov et al. (2020), is related to the existence of incubation (the time from infection to symptom onset) and confirmation periods (the time between symptoms or/and infection and infection and when a person is tested and appears in our data). Siordia 81 show that the mean incubation time is estimated to around 3-9 days (see also Lauer et al. 51 ) whereas Cereda et al. 12 estimated an average of 7.3 days between symptom onset and reporting (a range between 1 to 20 days is considered in the literature) and Linton et al. 57 and Sanche et al. 80 estimated an average of 15-16 days from onset to fatality.

Moreover, for logical reasons, since the mask wearing do not immediately impact the Covid-19 spread, the mask wearing variables are also included in our model with a lag of order p . Indeed, there are delays between the time of potential avoided infection corresponding to mask wearing and the time of official counting of a potential infected individuals (or fatality). Therefore, when dealing with p , a minimum of 7 to 14 days is considered. A benchmark 28 lags (about one month) delay is considered when dealing with deathpop because of the more important lag length assumed between the infection and the deaths related to the Covid-19 virus. More longer delays of 42 and 56 days have been also considered in robustness checks to take into account the dynamic persistence of the pandemic (see also SI Appendix), the delay between the infection time and potential health problems and potential data reporting bias. casepop and deathpop respectively give a short-run and medium/long-run time perspective of the dramatic outcomes of the pandemic. Note that when y i , t is the fatality rate, we also add the ratio of infected cases per capita in our benchmark specification in order to account for the fact that the level of the pandemic can impact the fatality rate. The reason behind is to control for a level effect and a kind of saturation effect of the health system (too many infected individuals to manage is likely to finally increase the fatality rate).

Identification issues and endogeneity

Equation (1) can be estimated by the mean group (MG) estimator introduced by 73 . Both estimators are relevant for macro panels such as the one used in this paper: T is equal to 84 and is thus close to N = 96 (see SI Appendix). The Mean Group (MG) estimator consists in estimating each regression separately for each panel member i (country here) with a minimum of restrictions. All estimated coefficients are heterogeneous and are subsequently averaged across countries via a simple unweighted average (Pesaran and Smith, 1995; Eberhard and Presbitero, 2015; Samargandi et al., 2020). An intercept is included to capture country fixed effects as well as a linear trend. In the dynamic fixed effects (DFE), the slopes are homogeneous but the intercepts are allowed to vary across countries.

Although we apply appropriate macro-panel estimators to our data, several issues can nonetheless emerge. First, lot of dynamic models are vulnerable to the so-called Nickel bias. Here, this bias is very negligible, notably considering the important time length of our series. Second, panel regressions may be exposed to an omitted variables bias. It would be possible to include control variables such as other control measures (e.g. testing, travel controls) or structural determinants (e.g. population density and demographics such as the population over 65, tourists flows, GDP per capita, and measures of health infrastructures). Considering the so-called problem of ’bad controls’, our set of explanatory variables is assumed to be restricted to the mask variable in order to avoid an over-controlling problem 23 . In addition, considering data availability and the fact they are time-invariant variables, we capture these unobservables via the lagged term y i , t - 1 and above all with country fixed effects. Another identification issue is related to the potential reverse causality bias related to our Covid-19 variables: news about contemporaneous dynamics of the Covid-19 outbreaks and counts can change the human behavior in real time, the social distancing and mask adoption. This is the explanation why lags of dependent variables must be added in our model to control reverse causality bias. We also tried to add the policy stringency index and the number of tests to take into account confounding and simultaneity. Thus, our empirical work is able to properly make causal identification and not only correlation. In addition, we take into account the presence of some cross-sectional dependence following Chudik et al. 17 , Pesaran 74 and Chudik and Pesaran 18 and 19 . Indeed, MG estimator is consistent under the assumption of independent cross-sectional errors. This assumption is likely to be not plausible in our context since the pandemic might have triggered unobserved common shocks that led to cross-sectional error dependence. Thus, we test the weak cross-sectional independence suitable for unbalanced panels 74 and then relax cross-sectional error independence by following the existing literature and adding contemporaneous and lagged average variables (An alternative way would be to use a GMM estimator in the vein of Anderson and Hsiao, Blundell and Bond, or Arellano and Bond, but they are better suited for small time dimension panels.). Finally, persistence and multicollinearity are other usual issues in panel studies. We have controlled for both by computing autocorrelations LM (Lagrange Multiplier) tests and VIF/Tolerance ratios after each estimated regression. In Appendix, we also consider other robustness tests related to the specification of our econometric model, the choice of an alternative estimator, and several changes in the sample composition.

The Cross-section model to investigate face mask adoption

We collect data from different sources (SI Appendix) to estimate a very simple cross-section model of the following form at a country level:

where y i captures proportion of individuals declaring wearing a face mask on 15th of July, 2020 and X i is a set of control variables including population density, CO2 emissions (and squared CO2 emissions), GDP level (in logarithms), government effectiveness index, altruism index, individualism index, tolerance index, risk aversion index, trust in government index, Covid-19 policy stringency index, urban population percentage, education level, diabetic population percentage and overweight population percentage have been considered. We also assume that the dynamics of the epidemics proxied by the count of cases is also a potential driver of masks wearing propensity. We also test as a robustness check the same model with mask wearing data on April, 23, 2020 corresponding to the first available and oldest data from the Maryland survey. Other variables (overweight part of the population, testing, surveillance, travel restrictions and school closures policies) have been introduced (see in SI Appendix).

The mask adoption is effective on a global scale

We first conducted an econometric exercise for 96 countries for the period April, 23 to July, 15, 2020. To account for lags in epidemic dynamics, we collected data on infected cases and fatalities for a longer period from January, 1, 2020. Our global panel data covers all parts of the globe, but we narrow this down to European countries for robustness checks.

Our dynamic panel data estimates (Mean Group here) reveal that masks wearing has a clear ( P < 0.01 ) statistical negative impact on infected cases with a 7- to 28-day lag but that this negative effect disappears after 42 days (Table 1 ). The coefficients of the masks variable have been standardized (multiplied by 100,000) in Table 1 and Tables 3 , ,4, 4 , ,5 5 6 to facilitate the reading. The most significant negative effect is obtained after a lag of around 27 days (Fig. 1 ). For 32 days (the gray area in Fig. 1 ), the coefficient associated with the mask use variable becomes insignificant. It is noted that Fig. 1 shows the estimated impact of masks at some particular lag/day and not a sequence of dynamic mask effects.

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Dynamic effects of face mask use on infected cases case

Note The X-axis refers to the number of lags/days between the time people declaring wearing a mask and the Covid-19 infected cases number measurement and Y axis refers to the coefficient value with confidence interval in a linear model (not logarithm) with a 10e-08 unit. It is noted that Fig. 1 shows the estimated impact of masks at some particular lag/day and not a sequence of dynamic mask effects like in a Vector AutoRegressive (VAR) or Local Projection (LP) framework.

Masks effects on Covid-19 infected cases: linear model.

Standard errors are in (.) with *** p <0.01, ** p <0.05, * p <0.1. t - k denotes current time minus k days. As an example, ’ M a s k s ( t - 7 ) ’ is the one week lag variable about mask adoption (percentage of the population of a given country). In other words, how a mask adoption today (in time t) is likely to protect a person one week later ( t + 7 ) considering notably the incubation period. Similarly, ’ M a s k s ( t - 14 ) ’ and ’ M a s k s ( t - 28 ) ’ consider the response after 14 and 28 days respectively. The coefficients for Masks ’ have been multiplied by 100,000 for standardization purposes. ’ c a s e s r a t e ( t - 1 ) ’ is the reported number of Covid-19 infected people with a one-day lag. It enables to take into account inertia and persistent effects in the dynamics of the epidemics.

Masks effects on Covid-19 fatalities.

Standard errors are in (.) with *** p <0.01, ** p <0.05, * p <0.1. The coefficients about mask effects on fatalities for 7 days is not significant: -7.63e-10 (4.97e-10). The coefficients for Masks ’ have been multiplied by 100,000 for standardization purposes.

Masks effects on Covid-19 infected cases and fatalities by controling testing policy.

Standard errors are in (.) with *** p <0.01, ** p <0.05, * p <0.1. The coefficients for Masks ’ have been multiplied by 100,000 for standardization purposes.

Masks effects on Covid-19 outcomes by controlling other policies.

Masks effects on Covid-19 fatalities: parcimonious model and cross-sectional dependence.

Standard errors are in (.) with *** p <0.01, ** p <0.05, * p <0.1. Pesaran 74 cross-section dependence test: CD = 4.313 p value = 0.000. 2 and 5 lags of supra average variables have been included respectively. In the two first columns, ’(Cross)’ indicates that cross-sectional dependence has been taken into account by adding supra averages in MG regressions. The coefficients for Masks ’ have been multiplied by 100,000 for standardization purposes.

Note that the weak magnitude of the coefficients is explained by the definition - per capita - of the Covid-19 outcomes (cases and fatility rates) and the epidemiological dynamic panel model used (the AutoRegressive part and the deterministic trend(s) capture a high proportion of the variance of the Covid-19 outcome variable). We conducted the same analysis with a log-log econometric model to derive elasticity’s values (Table 2 ). The coefficients are -0.117 and -0.135 for 7 and 14 lags respectively; in other words, an increase of 100% of the proportion of people declaring wearing a mask (multiply by two) over the studied period lead to a reduction of around 12 and 13.5% of the number of infected cases (per capita) after 7 and 14 days respectively.

Masks effects on Covid-19 infected cases: log-log model.

Standard errors are in (.) with *** p <0.01, ** p <0.05, * p <0.1.

We also found a statistical negative impact of mask wearing on fatality rates with a longer lag. Here, we consider 14- and 28-day lagged variables for illustration (Table 3 ). We also document that the mask effects on deaths for 7 days after are not reported since this effect is not significant. This insignificance is a proof of credibility of our results since the mask has no effect on fatalities at a very short run horizon (Placebo test). The mask use effect on fatalities for a very large horizon (42 days) is also not significant.

As a consequence, the mask wearing effect is more important on infections in the short term (7 to 28 days), whereas the effect is greater on fatality rates in the medium term (14 to 35 days). This is consistent with the epidemiological rationale that mask protection today can reduce the probability of fatalities after approximately one month, which is based on the dynamics of the epidemic, the incubation period, and the length of time before infection, symptoms, and complications are declared. The lag is thus greater for fatalities than for confirmation of infections.

We conducted a variety of robustness checks showing that the negative effect of masks is negative and significant with a small magnitude of the coefficients. Considering the fact that the Covid-19 epidemic did not begin at the same time on all continents, we considered the case of European countries for which data set is available as a homogeneous and robust sample (in SI Appendix, Tables S5 – S6 and Tables S10 – S12 ). The robustness of the sample is supported by the fact that European countries report a particularly high number of Facebook panel responses for the mask wearing variable. We also estimate our model for non European Countries (Tables S7 and S8 in SI Appendix) and Asian countries (Table S9 in SI Appendix). The mask adoption is effective and reduces the number of cases and fatalities for credible horizons (7 to 28 days) for both European and non European countries. Surprisingly, this effect is not robust when only Asian countries are considered but this result could be explained by the strong heterogeneity among countries (Gulf countries, Russian countries, South-East Asian countries are blended in the same subsample).

We also accounted for potential omitted bias and collinearity between mask wearing and other mitigation measures, such as testing policies, school closures, and travel bans. We disentangled the effects of mask wearing from those of other mitigation measures (Table 4 ) and found a robust negative effect of mask use on the Covid-19 outbreak, taking into account the daily number of new tests per thousand of population and the policy stringency index. The mask wearing effect appears to be robust to the introduction of other controls (and potential omitted variables), such as the seasonality and the meteorological conditions by controlling the temperatures (see Carleton et al. (2021) or Damette et al. 21 about weather and Covid-19) and other mitigation measures, including Covid-19 testing policy and the Covid-19 policy stringency index to control for endogeneity/reverse causality issues (Table 5 ).

Furthermore, we tested a potential over-controlling problem by dropping some lags and keeping more parsimonious models (Table 6 ). Indeed, controlling for case rate (t-1) could lead to over-controlling issues. For example, given the uncertainty about the delay/lag between masking use and cases or fatalities, it is possible that case rate (t-1) could be affected by masks (t-7), and very likely that case rate (t-1) would be affected by longer lags associated to the masks variable. Finally, we take into account the presence of some cross-sectional dependence (Table 6 ) following Chudik et al. 17 , 74 , and Chudik and Pesaran 18 and 19 . The Pesaran 74 test (see the result of the notes in Table 6 ) indicates the rejection of the null hypothesis of weak cross-sectional dependence. The effect of masks use with a 28 days lag is always significant when lags overcontrolling and cross-sectional dependence are taken into account; however, the results with a 14 days lag are not completely robust. This result is however rationale.

We also considered individual mobility measures - see Weill et al. 88 and Soucy et al. 82 for relevant studies about Covid and mobility - from mobile device location pings (here, walking and driving indexes from Apple Trend Reports), see in appendix (Table S12 in SI Appendix). Finally, we check potential reporting bias in our masks variables based on survey respondents by testing a dummy variable as an alternative proxy of mask adoption. Dummy takes 1 when the country introduced a mask requirement policy and zero instead (see Table S24 in SI appendix). It means that our results hold robust when using other mask use proxies (for our benchmark 14 lags model), here a macro policy requirement index instead of individual declarations by respondents of the Facebook survey.

The main drivers of mask wearing

As demonstrated in the previous section, face mask use is negatively correlated with infections and fatality rates. The next question is why individuals in some countries are more likely to wear masks wearing than those in other countries. Since the main characteristics of the countries are fixed over time, it was only possible to conduct descriptive statistics investigations and cross-sectional regressions. Based on information from scatter plots, a correlation coefficients table, partial regressions (see Tables S22 and following ones in SI Appendix) and multivariate cross-section regressions, we can report some interesting insights.

First, we found that individuals appear to have implicitly understood the crucial role of mask wearing by themselves since we note a convergence to higher levels of mask wearing across countries over time. This is indicated in Figs. 2 and 3 by the fact that the distribution of the mask wearing variable moves to the right as we move from the initial period (April, 23 or 24) to the final period (July, 15). In other words, more and more individuals declared on Facebook that they had adopted mask wearing to combat the Covid-19 virus. The increasing dynamics of the pandemics, the communication (both public and private) on the role of masks in reducing transmission, and the changing of habits are potential explanations for this result.

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Distribution of masks wearing across countries on 23th April, 2020

Note The X-axis refers to the proportion (between 0 and 1) of individuals declaring wearing a mask on the beginning of our sample (23th April, 2020) and Y axis refers to the histogram (frequency). The normal distribution curve is presented as a benchmark.

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Distribution of masks wearing across countries on 15th July, 2020

Note The X-axis refers to the proportion (between 0 and 1) of individuals declaring wearing a mask on the last date of our sample (15th July, 2020) and Y axis refers to the histogram (frequency). The normal distribution curve is presented as a benchmark.

We then estimated the determinants of mask adoption on a global scale by screening a set of potential predictors. The cross-sectional results are presented in Tables 7 and 8 . We found that population density was positively associated (Fig. 4 , Tables Tables7 7 – 8 ) with the percentage of individuals wearing a face mask daily. This effect is generally robust ( P < 0.01 to P < 0.1 ). Mask adoption was highest in countries with a high population density and lowest in countries with a low population density. The literature shows that mask wearing is usually viewed as a complement to social distancing measures; therefore, using masks as a protective measure is more important in densely populated environments (e.g., urban areas, public transport, supermarkets, town centers) than in less densely populated regions (e.g., forests, rural areas). In state capitals and large cities, mask wearing is generally mandatory, especially on public transport. However, when we tested the urban population percentage variable directly, we found the results were less clear cut and that the associated coefficient was never significant. Population density in general seems to be more important than the urban population percentage.

Cross-crountry determinants of mask covering (1).

Standard errors are in (.) with *** p < 0.01 , ** p < 0.05 , * p < 0.1 .

Cross-crountry determinants of mask covering (2).

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Mask adoption versus population density

Note The X-axis refers to the mask adoption proportion: a 0.8 value means that 80 respondents over 100 declared to use a face mask. The Y-axis denotes the population density that is the number of people per squared km. ’maskfinal’ denotes the proportion of people using a face mask in the final observation of our sample (15th July, 2020). The red line refers to a simple linear fit. A positive correlation indicates that a higher mask use proportion is associated with a higher population density.

Another main driver of mask wearing on a global scale is the level of pollution. Indeed, pollution levels proxied by CO2 emissions were positively associated ( P < 0.01 in most cases) with the proportion of mask users only for high levels of CO2 emissions, but this effect was reversed for low levels of emissions (Fig. 5 ). It is probable that inhabitants of countries with high levels of pollution are more likely to wear masks to fight Covid-19 because they are in the habit of using them as a protective measure against harmful particles. Indeed, in some countries, face masks are used to reduce the negative effects of pollution in normal ‘non-Covid-19’ times. Thus, the marginal cost of adopting mask wearing behavior in those countries is low or null. No change of habits is required for individuals from these countries as they just continue to wear masks as they had done prior to the pandemic. Recent studies have also shown that mask wearing is especially necessary in highly polluted environments as Covid-19 fatality rates are exacerbated by high levels of pollution 20 .

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Mask adoption versus CO2 emissions

Note The X-axis refers to the mask adoption proportion: a 0.8 value means that 80 respondents over 100 declared to use a face mask. The Y-axis denotes the CO2 emissions (in log). ’maskfinal’ denotes the proportion of people using a face mask in the final observation of our sample (15th July, 2020). The red line refers to a quadratic fit.

The most important driver of the level of mask wearing in a given population was the Covid-19 stringency index. This index, compiled by 35 , measures the stringency of government responses to the Covid-19 pandemic across the world based on nine indicators: a higher score indicates a stricter government response, here on July, 15, 2020. This index was positively correlated with mask wearing, and this effect was particularly robust ( P < 0.001 ). In other words, when government responses are stricter, mask use is significantly higher (Fig. 6 ). If the results we report in the previous section are correct - that is, if increasing mask use reduces the negative consequences of the Covid-19 virus - the more stringent countries may obtain better results in fighting the pandemic. We also tested the lagged stringency index (one month lagged variable) and the growth rate of the index over the month previous to the date of variables counting (July, 15, 2020).

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Mask adoption versus policy stringency index

Note The X-axis refers to the mask adoption proportion: a 0.8 value means that 80 respondents over 100 declared to use a face mask. The Y-axis denotes the Stringency index. ’maskfinal’ denotes the proportion of people using a face mask in the final observation of our sample (15th July, 2020). The red line refers to a quadratic fit.

In addition, we tested whether the proportion of vulnerable individuals in a population affected the likelihood of individuals to adopt mask wearing to protect themselves and others. Linear partial regressions (see Appendix, Tables S14 and S16 in SI Appendix) show that a high proportion of diabetic individuals in a population is positively associated with mask wearing. However, this effect appears not to be robust in a multivariable framework. Similarly, results are inconclusive regarding the proportion of overweight individuals variable though the coefficient attached to this variable is significant in canonical regressions in a nonlinear way (see in SI Appendix).

Government effectiveness and GDP appear to be negatively correlated ( P < 0.01 in most cases) with the proportion of people wearing masks. This is surprising since we expected that rich countries would be more likely to make masks free of charge or subsidize part of the cost and that individuals in these countries would have higher incomes and, therefore, less economic constraints to prevent them from buying the required quantity of face masks to protect them in public and private areas. Regarding the government effectiveness variable, countries with a high level of government effectiveness are generally characterized by better policy formulation and implementation and higher credibility of government commitment, which is likely to increase the probability of mask wearing and higher compliance with government policy. Indeed, it has been found that strong public guidance is necessary to promote and enforce mask wearing 26 and also 9 . It should be noted countries with high a GDP and those with a high government effectiveness are likely to be similar (the correlation is around 0.81 between these two variables), which explains why both coefficients are moving in the same direction. To avoid multicollinearity issues, we alternatively added government effectiveness or GDP in the tested models.

We expected that countries with a high proportion of elderly individuals are expected would have a high level of mask wearing, based on previous findings from 85 . However, the sign of association between masks and the proportion of elderly individuals was negative in partial regressions (see SI Appendix) and not significantly robust in multivariable regressions. There are several possible explanations for this: countries with a high proportion of individuals aged over 65 are generally industrialized countries in Europe where, unlike in Asian countries with younger populations , mask wearing is not habitual. It is possible that older individuals, whose flexibility and capacity for adaptability are generally lower, are less likely to wear masks. Countries with a high proportion of elderly individuals are also likely to be more conservative and, thus, their inhabitants may take longer to subscribe to new habits and rules. In a letter, some authors underlined that socially responsible behaviors may not be intuitive and that behavior change takes time 66 . This is probably truer for countries with older populations . Our multivariate regressions results do not indicate any significant negative relationships, which suggests that demographics structure is probably not a key factor affecting mask wearing disparities across countries.

It is also crucial to consider how the current dynamics of the pandemic might influence the habits of individuals regarding mask wearing and the adoption of other social measures to reduce the transmission rate. Public information on the dynamics and intensity of the Covid-19 epidemic is probably an important driver of mask wearing, and this variable indirectly captures this effect. When the number of cases is increasing, individuals are more informed and aware of the epidemic’s negative consequences and are, therefore, probably more inclined to take control measures such as mask wearing and social distancing more seriously. The higher the rate of infected cases, the higher the probability that individuals will personally know infected individuals (e.g., neighbors, family members, work colleagues). This may make individuals perceive the virus as more frightening and lead to increasing levels of social responsibility, making individuals more likely to wear a mask and obey rules to reduce the transmission rate. We found that the link between the infection count (we used the official count on July, 15, 2020 but also tested a lagged variable) and mask wearing was positive but not always significant at high confidence levels (Table 8 ).

Finally, we attempted to evaluate whether individuals in countries with higher levels of altruism, solidarity, and tolerance were more likely to use masks. A scatter plot showed a very modest positive association between mask wearing and the recent (2018) altruism index of Falk and co-authors (Falk et al., 2020). However, we found no clear-cut correlation, especially in our multivariable analysis (Table 6 ). We also tested the effect of the tolerance index from the World Value Survey database. Tolerance level was significantly associated with mask use for countries with low to intermediate tolerance values, but the association was negative for countries with high tolerance levels. This effect may be due to the fact that Scandinavian countries, which are characterized by high levels of tolerance, have implemented liberal policies on mask wearing . We also test if the trust in politicians and government can affect the mask wearing proportion in line with 5 but do not find a clear significant relationship: in other words, we do not find that a high proportion of people that do not trust in government ’at all’ is associated to a weak proportion of mask wearing in the population but due to the limited number of observations, the inference work should be interpreted with cautious. More generally, note that the number of available observations for regressions including altruism and tolerance variables is limited (around 50 observations). Finally, we test the effect of individualism with a more larger data set (77 observations in column (5) from Table 8 ) in line with Ozkan et al. 70 who find a positive relationship between individualism (defined as preference of loosely-knit social framework from Hofstede Insights) and Covid-19 severity. We find evidence that individualism is negatively correlated to mask use (Table 6 ) as also shown by the Fig. 7 . This result is interesting, novel and imply that people in countries with high level of individualism are less likely to wear mask and maybe to respect social distancing rules.

An external file that holds a picture, illustration, etc.
Object name is 41598_2023_34776_Fig7_HTML.jpg

Mask adoption versus individualism index

Note The X-axis refers to the mask adoption proportion: a 0.8 value means that 80 respondents over 100 declared to use a face mask. The Y-axis denotes the Individualism index. ’maskfinal’ denotes the proportion of people using a face mask in the final observation of our sample (15th July, 2020). The red line refers to a quadratic fit.

Although we expected that education levels might affect the learning of useful hygiene rules and suitable behaviors to confront contagious diseases, education level (schooling variable from the World Bank or Pisa score) was found to have a non-significant negative effect on mask wearing (see SI Appendix, Table S18 in SI Appendix). Same result is obtained for the risk aversion (ambiguity index) computed by Ruieger (2015): the positive correlation between mask adoption and high risk aversion (Fig. 8 ) seems clear-cut and confirm that risk averse people are more prone to use face masks. Nevertheless, the positive coefficient turns to be insignificant when controls like population over 65 are included in the regression. However, note that the number of available observations is very very small (around 40-45 according to the specifications), so we need to take the econometric results with cautious.

An external file that holds a picture, illustration, etc.
Object name is 41598_2023_34776_Fig8_HTML.jpg

Mask adoption versus risk aversion index

Note The X-axis refers to the mask adoption proportion: a 0.8 value means that 80 respondents over 100 declared to use a face mask. The Y-axis denotes the risk aversion index. ’maskfinal’ denotes the proportion of people using a face mask in the final observation of our sample (15th July, 2020). The red line refers to a quadratic fit.

In sum, our results complement those of previous studies, extending them from the level of individual surveys to the country scale. While previous studies investigated factors such as age, gender, or threat perception, our study explores the role of country-level macroeconomic and socio-economic determinants in explaining the substantial heterogeneity across countries regarding the wearing of face masks.

Understanding the links between face mask use and Covid-19 is crucial since the effectiveness of masks has been widely debated and contested among the general public. Our panel econometric exercise demonstrates that the wearing of face masks is negatively associated with infections and fatalities at the country level. Therefore, mask wearing has an important role to play in controlling the spread of Covid-19. Given the effectiveness of mask wearing in significantly curbing the transmission of the airborne Covid-19 virus and, thus, reducing the number of infections and fatalities, it would be helpful for governments to focus more on promoting the use of masks than on invoking the precautionary principle. We document a process of convergence over time in favor of mask adoption by showing the increasing percentages of people wearing masks across countries. This is good news as it suggests that individuals have implicitly understood the substantial impact of mask use on fighting the Covid-19 pandemic. However, our data shows that the mean proportion of inhabitants wearing masks was only 56% on July, 15, with a large standard deviation. Even in countries with high levels of mask use, the number of individuals that avoid mask wearing is probably still too large.

Appropriate public hygiene and control policies would consist of mandatory mask wearing. Given the clear effect of mask wearing on infections and fatalities and the fact that a mandatory mask policy involves little economic disruption (Chernozhukhov et al., 2020) and is economically attractive, we also recommend extending mandatory face mask use even for children (over 6 years of age). Attitudes regarding altruism, tolerance, and solidarity do not appear to be sufficient to achieve the necessary levels of mask wearing. In contrast, individualism is negatively correlated to mask use. In addition, strict government responses significantly increase levels of mask use. In this respect, our results are in line with the findings of 9 , which show that a voluntary policy leads to insufficient compliance. In addition, since the absence of economic constraints that might prevent the purchase of masks in high-income countries seems not to be a key driver, the main reasons for not wearing masks appear to be subjective, cultural, or the result of a lack of legal sanctions. Legally requiring people to wear face masks, thus, appears to be an effective instrument 77 . Therefore, some countries could introduce stronger penalties for not wearing masks. Indeed, the only effective way of enhancing mask adoption and saving more lives appears to be to implement more stringent policies. Our policy implication is also drawing how to nudge people with the different norms due to the heterogeneity in the root of culture. For example, the East Asian countries could consider the calling action for the whole community, as known as collectivism. That’s why Vietnam is doing the good job at the early stage to call for everyone to fight against the pandemic as the national campgain 40 , 41 .

Limitation Since this is the first study that attempts to explore the effects of COVID-19 status by using the mask in the initial stage, the study has not taken into account the medical treatment or pharmaceutical intervention. Future studies could focus on the persistence of using the mask to stop the spread of the virus. Concomitantly, it would be essential to disentangle the separation between using a mask and other protective methods (such as vaccination or using medicines). More importantly, the country’s strategies are also important in shaping human behaviors in wearing a mask. For example, Vietnam has changed its policy from zero COVID to ’living with COVID’ 43 , which might significantly change the behavior of wearing a mask. Therefore, it would be a potential avenue indeed.

Supplementary Information

Acknowledgements.

Toan Luu Duc Huynh acknowledges the funding from University of Economics Ho Chi Minh City, Vietnam, with the registered number project 2023-02-23-1414.

Author contributions

T.H. Methodology-Equal, Validation-Equal, Writing—original draft-Equal, Writing—review & editing-Equal Olivier Damette Conceptualization-Equal, Data curation-Equal, Formal analysis-Equal, Funding acquisition-Equal, Investigation-Equal, Methodology-Equal, Project administration-Equal, Resources-Equal, Software-Equal, Supervision-Equal, Validation-Equal, Visualization-Equal, Writing—original draft-Equal, Writing—review & editing-Equal.

Data availability

Competing interests.

The authors declare no competing interests.

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The online version contains supplementary material available at 10.1038/s41598-023-34776-7.

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