Coronavirus: Why you see masks everywhere in Asia but not in the West

While masks have become ubiquitous in Asia—even outside of epidemics—they’re still stigmatized in America and Europe, where they’re seen as signs of sickness.

When Simon Li, a Chinese expat in France, went back home for Lunar New Year in January, he arrived at the peak of the coronavirus outbreak in China.

The streets were empty, people were staying at home, and anyone who ventured outside wore a mask, following a directive from local police.

Naturally, Li also wore a mask when he left the house.

But when he flew back to Paris after the holiday, he noticed that the only people covering their faces appeared to be of Asian descent.

Weary of judgement from others, he decided to take his mask off before landing.

Li’s experience illustrates the wide cultural rift between the West and Asia when it comes to wearing masks.

While masks have become ubiquitous in Asia—not just for protection during epidemics but also from air pollution—they’re still stigmatized in America and Europe, where they’re seen as signs of sickness.

Cultural differences

Even before the Covid-19 outbreak, masks were ubiquitous in Asian metropolises. It was not unusual to see people wearing them on the streets of Beijing, Hong Kong, and Tokyo, where they’re seen as a sign of personal hygiene and consideration for others.

People might wear them during flu season to prevent themselves from getting sick, or on days with bad air quality to filter out pollution. For some, it’s even a fashion trend.

(Read more: Meet the woman behind China’s most infamous beach accessory: the facekini)

But in the West, wearing masks remains socially awkward. Some experts even argue that they are ineffective.

“Here in France, covering your face when you meet someone is considered rude,” says Li, who has lived in France for eight years. “Facial expressions are really important here.”

Sociological research has shown that masks can be a cultural marker that fosters a sense of shared responsibility, mutual obligation, and civic duty in times of crisis.

In fact, masks as we know them today emerged in northeastern China over a century ago, when the region was battling a plague.

A Cambridge-educated Chinese doctor named Wu Liande discovered that the disease was airborne and improvised a protective device for the face based on existing surgical masks, according to Christos Lynteris, a medical anthropologist.

The new masks were cheap, easy to produce, and proved effective during the plague. They became the predecessor to the earloop masks now used today.

When the SARS epidemic pummeled Asia in 2002 and 2003, masks became a widely accepted form of personal protection. 

In Hong Kong alone, more than 90% of residents reportedly wore them during the epidemic.

The case for and against masks

But do they actually work? Back in Shanxi Province, where Simon Li is from, there were only two reported cases of coronavirus when he was there, but everyone was religiously wearing a mask. 

Health authorities in China believe masks are effective at capturing respiratory droplets, which is how the virus is mainly transmitted. Local police have been mandating people wear masks when outside, and companies that are still operating have been giving workers free masks every day.

(Read more: With the coronavirus raging, China’s delivery drivers have essentially become first responders)

Proponents of masks say they prevent sick people from spreading the virus, while protecting healthy people from airborne respiratory droplets.

They add that since people with Covid-19 can be asymptomatic, wearing a mask ensures that even apparently healthy people with the virus do not unwittingly spread it.

In Hong Kong, health officials have credited masks for the city’s relatively low caseload of just over 200.

However, governments in America and Europe have recommended saving masks for the sick and medical staff.

Some clinical psychologists have compared wearing masks to “superstitious behavior,” while some epidemiologists argue that it actually increases the risk of infection.

“There’s no evidence that wearing masks on healthy people will protect them,” Dr. Eli Perencevich, an infection prevention expert at the University of Iowa, told Forbes. They wear them incorrectly, and they can increase the risk of infection because they’re touching their face more often.”

Supply shortage

As demand for masks increases with the worsening pandemic, factories have been scrambling to ramp up production.

Short supply is another reason why governments in the West have asked people not to hoard masks. In New York, price gouging has become so severe that one box of 10 masks went for as high as $200.

Before the pandemic, China was already the largest supplier of masks, making half of the world’s supply, with a daily output of 20 million units.

Countries like the United States had been highly dependent on Chinese supply, but when the Covid-19 coronavirus started wreaking havoc in China, the country cut off exports to meet domestic demand.

In China, mask factories increased output nearly 12-fold since the outbreak began, according to government figures.

“We doubled our staff and daily output,” says Wang Changshen, chairman of Sanqi, China’s largest mask manufacturer. “We are pumping out three million masks a day.”

(Read more: Chinese hospitals find help from an unexpected source: Taylor Swift’s fan club)

With the pandemic ramping up in other parts of the world, it’s possible that China could begin exporting its supply of masks again, though the debate over the efficacy continues to rage on.

Meanwhile in France, as the situation worsens there, Li says dirty glances toward Asians who wear masks have disappeared. But most people still won’t wear them.

“You definitely feel the pressure when you don’t wear a mask in China,” says Li, “but you also don’t have the freedom to wear one in the West.”