Perhaps the biggest mistake in the Western world‘s flubbed response to COVID-19 was the bizarre mixed messaging on masks. On the one hand, people were told masks were scarce PPE needed by responders and doctors. On the other hand, people were told masks were useless; the virus particles were so small! What really mattered was compulsively washing your hands and not touching your face.
It was dubious, but influential, advice. And how were the authorities so sure? I’m not here to blame the World Health Organization or anyone else, but it is worth noting that many of the countries most successful at “flattening the curve” included public mask wearing as part of their strategy, such as the country where I live, Taiwan, which never even had to lock down, but did ban the export of masks and requisitioned a huge increase in local mask production.
Maybe they were onto something. Maybe masks were the key to success. Maybe we should examine this hypothesis more closely. Even the WHO finally changed its tune on June 5 and is now recommending globally, based on “evolving evidence,” that the general public wear masks whenever social distancing is difficult.
Well, I would say evidence doesn’t evolve; it just happens. Conclusions, however, do evolve, and in this case, they evolved much faster in some places than others. Prior to June 5, the WHO had not updated its advice on facemasks for two months. Up until April 16, the WHO website advised that ”you only need to wear a mask if you are taking care of a person with suspected 2019-nCoV infection” and that “masks are effective only when used in combination with frequent hand-cleaning.”
Many people, especially Westerners, got the idea that masks were somehow dodgy. They became controversial. People got punched for wearing them.
Even as a biology graduate, I was a skeptic myself well into January. It is easy to fall for propaganda. It took a lot of reading and thinking, and living in the safest locale on Earth, but this is what I believe now: We need to learn to love the mask. As countries around the world attempt to reopen and reboot their economies, I would suggest that a single recent news story from Taiwan is especially convincing. It illustrates, if not proves, just how great a benefit widespread mask use is able to confer.
By mid-April, Taiwan had COVID-19 almost totally under control. The public was still wearing masks on the street, however, and masks were mandatory in public buildings and on public transit.
Then, on April 18, three Taiwan navy sailors tested positive for the coronavirus. Three days later, the tally was 27, eventually reaching 36. Over 700 sailors immediately went into quarantine.
Twenty-three million people froze in their shoes. The president made a public apology. People I know received text alerts from the government telling them they had spent significant time in the same restaurant, gym, train carriage or bus with one or more of the infected sailors.
Of great concern was that the sailors were likely in a highly contagious state considering the overall timeline of the cluster, which happened on a ship apparently delivering highly coveted PPE to Palau, one of Taiwan’s few diplomatic allies. (For the record, a government probe concluded the cluster originated in Taiwan, not Palau.)
These sailors had practically been on walkabout. They were on shore leave. At the time, Taiwan was probably the safest and most comfortable place to be in the whole world then, and it probably still is. They went to supermarkets; they went to gyms; they rode the high speed train; they took the bus, even as such activities were banned or severely restricted in most countries.
But the government had preemptively recorded their motions in a presumably benevolent database, hence the text alerts. While contact tracing has raised privacy concerns around the world—including among some observers in Taiwan—the government’s transparency throughout the crisis, along with its vow to roll back these emergency measures after the pandemic, has built trust here. Very few people in Taiwan are heard complaining. Regardless of that observation, it turns out, contact tracing didn’t even matter in this case.
Here’s the thing: The sailors did not infect a single other soul, despite mingling with the general public for three to four days before being quarantined. Collectively, they spent time over 15 minutes at more than 90 locations across Taiwan. The fact this ultimately led to no new infections, I would argue, proves that masks can be the deciding factor in slowing the spread of the pandemic. These sailors were almost surely wearing masks wherever they went. At that time, most of the country was wearing masks in all public settings, especially where distancing was difficult. To not wear a mask was to invite harsh glares.
Yes, streets were also less crowded as people stayed home. Restaurants and bars were still open in Taiwan, and they were taking temperatures, spraying hands, and enforcing social distancing. To be sure, many other countries took similar distancing measures yet failed to curb the viral onslaught. Maybe they didn’t have the masks, or people just wouldn’t wear them. But masks almost definitely would have helped—a lot.
Whether this deathly failure to see the obvious and follow the real leaders was due to cultural hubris, misinformation or lack of supply matters not. What matters now is that the immediate future for most of the world needs to involve widespread use of masks—the sooner, the better.
(Cover photo via Taiwan Presidential Office, Flickr, CC BY 2.0)
