Face masks will be a part of life even after this pandemic ends

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In June 2020, just six months after the World Health Organization first learned of a viral phenomenon in Wuhan, China, that would become the COVID-19 pandemic, life in the city where the disease was first identified was largely back to normal. The Chinese government attributed the success of a brutal lockdown period to its citizens voluntarily adopting safety precautions. Even when residents of Wuhan were no longer required to wear personal protective equipment (PPE) in public, 35 year-old resident Pan Yuan told Reuters that "people still wear masks."

That same month in the United States, Tim Walters, co-founder of an anti-lockdown protest group "ReOpen Maryland," announced on social media that despite contracting COVID-19, he would continue not wearing a mask and would not be assisting in contact tracing efforts.

These are, of course, just anecdotes—the Chinese government has plenty of incentive to showcase its success in containing the virus, and Walters' actions don't represent American response as a whole. But the contrast illustrates an ongoing conflict over how to react to a global pandemic; a conflict that persists despite overwhelming evidence that masks are effective in slowing the spread of a disease that has killed thousands and injured millions physically and economically. Countries that embrace masks as a cultural norm, however, have been far more resilient to the virus's impact, providing ample incentive for the United States to make mask-wearing a cultural norm.

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Face mask habits don't spontaneously appear in fashion like Ugg boots or a bolo tie; they’re nearly always the product of an environmental or biological catalyst. Japan, one of the countries quickest to embrace face masks as a precaution, has been using them for centuries.

Tomatsu Hirai, a clinical pharmacist in Tokyo and a collector of vintage medical paraphernalia, told The Japan Times that wearing masks to contain "unclean" breath dates back to the Edo Period (1602 - 1868) at the latest, and the custom became more widespread after Japan suffered back-to-back disasters in the 1918 influenza pandemic and the Great Kanto Earthquake of 1923, which triggered massive fires that choked the island nation with smoke and ash for weeks—necessitating daily mask wear. When a second flu pandemic hit Japan in 1934, its population had barely had a chance to break the habit.

After that, wearing a mask in Japan became de rigeuer for the sick, the immuno-compromised, and those simply observing an abundance of caution.

Masks serve an entirely secondary function for young people in countries that have adopted masks as casual wear, too: They act as a social firewall. In the U.S., it's not uncommon to wear headphones in public not only to listen to music, but as a not-so-subtle hint that you aren't interested in conversation. Masks serve a similar purpose, with the added implication that it might actually be dangerous to talk to you, since you may be sick with something nasty.

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While it might seem obvious, the fact remains that masks are only effective with widespread use. It's a community effort achieved by collaboration rather than the efforts of a lone hero, and it's influenced largely by social pressure: Jamie Cho, an immigrant from South Korea living in New York, told the Huffington Post that she always wore a mask when sick during her childhood, but changed that habit when she moved to the United States.

"(My mother) was scared of me seeming more foreign than I already was at the time as a young immigrant," she said, "because of that, I’ve never worn a mask in a Western country prior to COVID."

In 2021, young people are disproportionately responsible for spreading SARS-CoV-2 (the virus that causes COVID-19) in the U.S., and a Centers for Disease Control study found that "social or peer pressure to no wear mask" had a large impact on their personal health decisions. Meanwhile, in Asian countries where mask wearing has been common for decades, studies from both the current pandemic and the 2002 SARS epidemic show that normalized mask wearing had a dramatic effect on stopping the spread.

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It's clear that when the U.S. faces its next pandemic, cultural acceptance of masks can play a significant role in mitigating its impact. As for the likelihood of widespread acceptance, New Zealand, which also dealt with anti-mask protests in the early days of the COVID pandemic, provides an example.

"There haven't been mass protests, but there have been some small ones," Professor David Murdoch, MD, of the University of Otago, Christchurch, told SFGATE. "I think for a start that a kind of collective responsibility is stronger in New Zealand. But it was still a transition."

On March 16, 2020, New Zealand Prime Minister Jacinda Ardern mandated that anyone arriving in New Zealand, including citizens returning from abroad, had to quarantine. She made no apologies for what she claimed were the strictest regulations in the world, and by July, New Zealand was free of cases.

Nobody knows exactly how the world will change following this pandemic, but it's naive to think the ongoing lockdown that's approaching a year in length won't have a long-term impact on social norms and customs.

"I think face masks will continue to be used by the general public in times when they don't feel well," Dr. Panagis Galatsatos, a critical care doctor who works with COVID-19 patients, told CNBC. "And honestly, we’re realizing that no one feels slighted without a handshake."

Others take a harder line: "I do think we need a new culture of masks," said former director of the CDC Dr. Tom Frieden, "at least any time not feeling well."

The good news is that the partisan nature of this issue seems to have dissipated over time. According to a PEW Study. In June, 76% of Democrats and 53% of Republicans said they were usually wearing masks in public, but by August, those percentages had increased to 92% of Democrats and 76% of Republicans, reducing the partisan gap from 23 percentage points to 16 percentage points.

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The CDC study also identified confusing messaging as harmful to mask participation. The agency struggled to clarify its message early in the pandemic, and has recently come into conflict with the advice of foreign world leaders. With time and experience, however, that confusion is likely to have less of an impact on the average person's day-to-day decision-making.

Ultimately, masks are effective and simple, making it difficult to argue that the inconvenience of foggy glasses and mild "maskne" outweigh having to relive the darkest days of 2020. But mask wearing in the future will require mainstream acceptance—and not forgetting the lessons of half a million dead Americans.