To stem the coronavirus outbreak, European nations and even the United States are starting to adopt the wearing of masks in public, a practice long established in Asia.
Credit…Andrea Mantovani for The New York Times
PARIS — Until a few weeks ago, Asian tourists were the only mask-wearers in Paris, eliciting puzzlement or suspicion from French locals, or even hostility as the coronavirus began sweeping across Europe.
Four days into a national lockdown to stem the outbreak, the French government spokeswoman, Sibeth Ndiaye, warned that face masks were so unfamiliar that wearing them was too difficult technically and could even be “counterproductive.” Even on Thursday morning, when asked whether she wore a mask or made her children wear one, she said, “Oh, no, not at all.”
This taboo is falling fast, not only in France but across Western countries, after mounting cries from experts who say the practice is effective in curbing the coronavirus pandemic.
The shift for Western nations is profound and has had to overcome not merely the logistical challenges of securing enough masks, which are significant enough, but also a deep cultural resistance and even stigma associated with mask-wearing, which some Western leaders described flatly as “alien.”
Seemingly, it won’t be for much longer. After discouraging people from wearing face masks, France, like the United States, has begun urging its citizens to wear basic or homemade ones outside. And some parts of Europe are moving faster than the United States by requiring masks instead of simply recommending their use.
This week, Austria moved to become the fourth European nation to require masks in public, after the Czech Republic, Slovakia and Turkey.
On Wednesday, Sceaux, a small city just south of Paris, became the first municipality in France to require masks in public. Violators will face a fine of 38 euros, or $41. The southern city of Nice announced that it would make masks mandatory next week, and the Paris mayor said on Tuesday that two million reusable cloth masks would be distributed there.
In France, a strong belief that the French would culturally reject the practice — and confidence that masks could be imported quickly if needed — has contributed to a desperate shortage. In the past decade, France’s formidable national stockpile of masks shrank from 1.7 billion to 150 million at the outset of the current pandemic.
The debate over the simple face mask has sometimes evolved into a larger discussion over the role of the individual in society, pitting the West’s individualism against Asia’s collectivism.
President Trump appeared to embody that ambivalence when, even as he announced that the Centers for Disease Control and Prevention now endorsed widespread mask-wearing, he said he would not wear one himself.
Frédéric Keck, a French anthropologist specializing in pandemics, said that, in the West, mask-wearing was seen through an individual’s perspective.
“‘There’s a virus outside, so I wear a mask only to protect myself,’” Mr. Keck said, “whereas collective reasoning, in Asian societies, is to say, ‘I wear a mask to protect others.’”
The difference in mind-set is a crucial one given the nature of all but the highest-grade masks: Masks are believed to have some effectiveness at protecting the wearer, especially in crowded spaces, but are most effective at reducing the risks that the virus will be spread through coughing or talking.
The French government initially said that the vast majority of people need not wear face masks because they didn’t guarantee the wearer protection. In Asia, and in a few European nations, the logic has been fundamentally different: If all individuals wear masks, the society will be protected.
On Monday, Austria made masks mandatory in supermarkets and drugstores, and riders of public transportation will also be required to wear them next week. Chancellor Sebastian Kurz said that the change would require a “big adjustment” because “masks are alien to our culture.”
But masks were also alien to Asia until it was struck by the SARS pandemic in 2003.
In Japan, after people got used to masks, they continued to wear them against seasonal allergies or to protect one another from germs. Unlike in other Asian nations, where many wear masks against air pollution, mask-wearing became widespread despite the absence of immediate threats.
Mask-wearing has become such a part of daily life that it now plays a role in maintaining an overall feeling of being “reassured” in Japanese society, said Yukiko Iida, an expert on masks at the Environmental Control Center, an environmental consulting company based in Tokyo.
“When you put on a mask, you’re not inconveniencing others when you cough,” Ms. Iida said. “You’re showing others that you’re abiding by social etiquette, and so people feel reassured.”
The debate over masks has focused on the divide between the West and Asia. But even inside the West, sharp differences have emerged.
On March 18, the Czech Republic became the first nation in Europe to make mask-wearing mandatory, followed by Slovakia on March 25. Though neither was used to it, people across both countries mobilized by sewing masks at home, often giving them away to doctors, nurses and shop assistants or leaving them on their doors or gates to offer to passers-by.
In Slovakia, television anchors and politicians took the lead, wearing masks in studios and outside. During the swearing-in ceremony of a new government, President Zuzana Caputova wore a red one that matched her dress, helping to remove the stigma.
The mass mobilization in both countries reinforced what experts say is a crucial factor in fighting any epidemic: solidarity.
“When we both have a face mask, I protect you, you protect me,” said a Czech actress in a widely shared video that featured the country’s minister of health and urged other nations to make masks mandatory.
Slovakia and the Czech Republic were quicker to embrace face masks, experts said, in part because of their Communist legacy’s emphasis on collectivism.
“People simply learned to be obedient in critical moments,” said Michal Vasecka, a sociologist at the Bratislava Policy Institute.
By contrast, in France, where a sense of individualism is stronger, even government officials were long pessimistic about the adoption of mask-wearing against potential epidemics. In fact, so ingrained was the cultural resistance to masks that, as a security measure, France became in 2011 the first European nation to ban the public covering of the face, including with the Muslim veil.
A 2010 report by the French Senate, the upper house of Parliament, noted that the practice had been met with “cultural reluctance that has proved insurmountable in the short term.” It added, “More than an act of individual or altruistic protection, wearing a mask is seen as stigmatizing.”
Jean-François Mattéi, a former health minister and the current president of France’s National Academy of Medicine, said that because of the cultural reluctance and budgetary problems, maintaining the national stockpile might have been pushed down the list of government priorities.
In 2009, in face of the H1N1 pandemic, France had amassed 1.7 billion masks, but stocks had fallen to 150 million at the outset of the coronavirus pandemic, according to a recent report by the academy.
“This decision was absurd, and we’re seeing the consequences now,” said Philippe Juvin, the head of the emergency department at the Georges Pompidou European Hospital in Paris.
Faced with shortages, which it first denied, the French government discouraged people from wearing masks, saying only the sick should wear them in public and that they were otherwise not useful.
But the recommendations not only failed to convince French people who thronged pharmacies in search of masks, but they also conflicted with images of President Emmanuel Macron wearing a mask when he visited a military field hospital in eastern France on March 25.
Though the French government has yet to make masks mandatory, powerful groups, like the Academy of Medicine, have recommended that they be.
Mr. Mattéi said that wearing masks during epidemics was likely to “become the norm” in Western countries after the end of the pandemic, adding, “I’m convinced that pretty soon everyone in a family will have their two or three reusable face masks.”
Daniel Illouz, a pharmacist in eastern Paris, said that he had been skeptical of the government’s repeated message that widespread mask-wearing was not helpful in fighting the epidemic.
“I don’t see why in all the Asian countries, where they have masks, it would work, but it wouldn’t work for us,” he said.
Reporting was contributed by Aurélien Breeden and Eva Mbengue from Paris; Miroslava Germanova from Bratislava, Slovakia; Hana de Goeji from Prague; Christopher F. Schuetze from Berlin; and Boryana Dzhambazova in Sofia, Bulgaria.
Updated April 11, 2020
When will this end?
This is a difficult question, because a lot depends on how well the virus is contained. A better question might be: “How will we know when to reopen the country?” In an American Enterprise Institute report, Scott Gottlieb, Caitlin Rivers, Mark B. McClellan, Lauren Silvis and Crystal Watson staked out four goal posts for recovery: Hospitals in the state must be able to safely treat all patients requiring hospitalization, without resorting to crisis standards of care; the state needs to be able to at least test everyone who has symptoms; the state is able to conduct monitoring of confirmed cases and contacts; and there must be a sustained reduction in cases for at least 14 days.
How can I help?
Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities. More than 30,000 coronavirus-related GoFundMe fund-raisers have started in the past few weeks. (The sheer number of fund-raisers means more of them are likely to fail to meet their goal, though.)
What should I do if I feel sick?
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
Should I wear a mask?
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
How do I get tested?
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
How does coronavirus spread?
It seems to spread very easily from person to person, especially in homes, hospitals and other confined spaces. The pathogen can be carried on tiny respiratory droplets that fall as they are coughed or sneezed out. It may also be transmitted when we touch a contaminated surface and then touch our face.
Is there a vaccine yet?
No. Clinical trials are underway in the United States, China and Europe. But American officials and pharmaceutical executives have said that a vaccine remains at least 12 to 18 months away.
What makes this outbreak so different?
Unlike the flu, there is no known treatment or vaccine, and little is known about this particular virus so far. It seems to be more lethal than the flu, but the numbers are still uncertain. And it hits the elderly and those with underlying conditions — not just those with respiratory diseases — particularly hard.
What if somebody in my family gets sick?
If the family member doesn’t need hospitalization and can be cared for at home, you should help him or her with basic needs and monitor the symptoms, while also keeping as much distance as possible, according to guidelines issued by the C.D.C. If there’s space, the sick family member should stay in a separate room and use a separate bathroom. If masks are available, both the sick person and the caregiver should wear them when the caregiver enters the room. Make sure not to share any dishes or other household items and to regularly clean surfaces like counters, doorknobs, toilets and tables. Don’t forget to wash your hands frequently.
Should I stock up on groceries?
Plan two weeks of meals if possible. But people should not hoard food or supplies. Despite the empty shelves, the supply chain remains strong. And remember to wipe the handle of the grocery cart with a disinfecting wipe and wash your hands as soon as you get home.
Can I go to the park?
Yes, but make sure you keep six feet of distance between you and people who don’t live in your home. Even if you just hang out in a park, rather than go for a jog or a walk, getting some fresh air, and hopefully sunshine, is a good idea.
Should I pull my money from the markets?
That’s not a good idea. Even if you’re retired, having a balanced portfolio of stocks and bonds so that your money keeps up with inflation, or even grows, makes sense. But retirees may want to think about having enough cash set aside for a year’s worth of living expenses and big payments needed over the next five years.
What should I do with my 401(k)?
Watching your balance go up and down can be scary. You may be wondering if you should decrease your contributions — don’t! If your employer matches any part of your contributions, make sure you’re at least saving as much as you can to get that “free money.”
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