A doctor wears a protective mask as he walks outside Mount Sinai Hospital in Manhattan during the outbreak of the coronavirus disease (COVID-19) in New York, April 1, 2020.

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Will the US ever mimic Asia’s culture of ‘universal masking’?

Across much of Asia, masks are considered an essential weapon in the war against the new coronavirus. Should Americans follow suit?

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A doctor wears a protective mask as he walks outside Mount Sinai Hospital in Manhattan during the outbreak of the coronavirus disease (COVID-19) in New York, April 1, 2020.

Credit:

Brendan Mcdermid/Reuters 

Having fended off the first surge of COVID-19 cases, Asian health officials are now looking over at a virus-ravaged US and asking: Shouldn’t more Americans wear surgical masks?

China’s top virologist, George Gao, is one of them. Educated at both Harvard and Oxford universities, and now heading the Chinese Center for Disease Control and Prevention, he was recently asked to lend advice to other nations.

Related: Is coronavirus reshuffling the global power deck?

“The big mistake in the US and Europe, in my opinion, is that people aren’t wearing masks.”

George Gao, virologist, China

“The big mistake in the US and Europe, in my opinion,” Gao told Science Magazine, “is that people aren’t wearing masks.”

Across much of Asia, masks are considered an essential weapon in the war against the new coronavirus. Nations and territories such as South Korea, Hong Kong and Taiwan promote “universal masking” — the idea that everyone in public should be masked up, even if they feel perfectly fine.

As in the US, officials in parts of Asia were initially caught off guard and faced a shortage of surgical masks. But unlike America, the Taiwanese and South Korean governments quickly intervened to boost the supply of masks — propelled by a conviction that universal masking really helps.

That belief is not widespread in the US, where the surgeon general says putting the masses in masks makes the virus spread faster. As US Surgeon General Dr. Jerome Adams told Fox and Friends, “folks who don’t know how to wear them properly tend to touch their faces a lot and can actually increase the spread of coronavirus.”

At the moment, with American hospitals pleading with the federal government for more high-grade masks, universal masking would be difficult to execute in the US.

But as the virus spreads, should America make it a priority to put everyone in masks — at least those in crowded environments?

Related: How the World Bank Group is helping developing countries respond to COVID-19

There are studies — such as one published by the National Institutes of Health — suggesting masks help prevent an infected person from spreading the coronavirus, especially if it’s a high-grade, N95 mask. A paper published in peer-reviewed journal, The Lancet, suggests universal masking can be effective “if supplies permit.”

Yet, the World Health Organization continues to assert that masks are not needed for anyone who does not show symptoms. (The Centers for Disease Control and Prevention, after having issued similar opinions, is reconsidering the question.)

What many fail to grasp is that masks are more about “preventing the spread of disease rather than preventing getting the disease,” said Linfa Wang, a leading infectious disease expert. He heads a research team jointly run by Duke University and the National University of Singapore.

The point of universal masking, Wang says, is to cover the faces of people who are infected but don’t yet know it.

Many people carrying the new coronavirus are oblivious that they spread viral droplets each time they open their mouths. Yet, if they follow WHO guidelines, they wouldn’t put on a mask until symptoms arise.

“If every citizen can abide by that rule, that’s a good thing. But I know that, in certain societies, it’s hard, right? People are less educated or economically at a different stage. Or less obedient as a society.”

Linfa Wang, infectious disease expert, Duke University and the National University of Singapore

Thus the imperative, Wang says, to slap a mask on everyone.

“If every citizen can abide by that rule, that’s a good thing,” Wang said. “But I know that, in certain societies, it’s hard, right? People are less educated or economically at a different stage. Or less obedient as a society.”

Related: Madrid’s health system under duress as ice rink turns into morgue

“If your prime minister says ‘wear a mask,’ but only two out of 10 sick people follow the advice,” he said, “then the society will be in trouble.”

Masks are far from foolproof and all masks are not created equal. A snug-fitting N95 mask — which is supposed to filter out 95% of incoming particles — is far superior to one made of cotton.

In fact, WHO says cloth masks “are not recommended under any circumstances.”

Whether cotton masks are better than nothing is debated. One study suggests cloth masks — which grow moist from breath — hardly filter out any particles at all and “may result in increased risk of infection.” Yet, the CDC is considering urging Americans to wear cloth masks in public; there are too few N95 masks available even for front-line health care workers.

“The outside of your mask may be enriched with viral particles so, when you’re taking it off — if you’re not careful — you can get an infection.”

Linfa Wang, infectious disease expert, Duke University and the National University of Singapore

Even the best masks require careful handling and an educated public. Echoing the US surgeon general’s fears, Wang said, “The outside of your mask may be enriched with viral particles so, when you’re taking it off — if you’re not careful — you can get an infection.”

Still, he says, an informed public can learn to handle masks properly and benefit from their mass adoption.

Before the United States can consider universal masking, it will first have to satisfy hospitals’ urgent needs for N95 masks — and then import or produce enough masks to outfit the general public (or at least those living in crowded areas).

Related: Combat in the world’s biggest conflict areas not slowing down despite COVID-19

Then, American health care officials would need to absorb the advice coming from their peers in South Korea and China.

But in a crisis, societies are capable of changing habits quickly. Another infectious disease expert, Joseph Tsang, has joined the chorus of Asian specialists urging Americans to consider universal masking. He hopes the US can overcome cultural barriers, such as the intimation that anyone in a surgical mask must be ill.

Tsang points out that even in Hong Kong — where walking the streets unmasked is now taboo — it was also once unusual to see crowds with their faces covered.

Then came a previous coronavirus — SARS (severe acute respiratory syndrome) — that hit in 2003. Before long, the popularity of masks exploded.

“That changed everything for us,” Tsang said. “We’ve learned those painful lessons already … and we all know to be vigilant with wearing masks to stop that painful experience from happening again.”

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