Unmasked: Face-work in a Pandemic

The beginning of February 2020 was sunny and cool in Hanoi, prompting thousands to shuffle in packed groups around Hoàn Kiếm Lake in the city’s historic centre. Fear of the new coronavirus from China was rising, so most Vietnamese wore face masks. When I went to Văn Miếu, the Temple of Literature, to speak with Đỗ Thị Tám, a director of the Centre for Scientific and Cultural Activities there, she expressed surprise that I didn’t possess any face covering, handing me a flimsy mask wrapped in thin plastic. I quickly stuffed it into my bag, bestowing it a few weeks later on a friend in Melbourne who was growing desperate for a mask, any mask. At the time it had seemed a trivial incident, like Dr Bernard Rieux in Albert Camus’s novel La Peste (1947) casually kicking aside a dead rat on the landing of his surgery in Oran. For both of us, a casual event would come to portend the arrival of plague.

The past few months have shown that masks may be difficult to think with but impossible not to think about. The vehemence of debates, especially in the United States, over whether to mask or unmask indicates that far more is at stake than simple infection control. For some, the mask functions as a sort of talisman, offering almost magical protection; for others, it looks like a badge of infamy, a veil of shame, a muzzling of freedom. As I write this, places that once banned the ‘veil’ and niqab, such as France and Québec, are insisting that people don masks in public to reduce the spread of SARS-CoV-2. Meanwhile, several shops in the United States are banning customers wearing face masks from entering, despite government recommendations, as protesters against pandemic restrictions proudly cluster outside state capitals without wearing them. President Donald Trump appears to regard masks as an unmanly accoutrement that signals fear and weakness in public. When seen flouting rules stipulating masks at a Michigan factory, Trump admitted: ‘I wore one in the back area, I didn’t want to give the press the pleasure of seeing it’. Stephen Colbert agreed: ‘He’s right, there would be enormous pleasure in seeing less of his face’. Or as Maureen Dowd put it in the New York Times: ‘In denying the mask, he denies reality, science and the fact that the country is in a crouch. Trump has proved that people wearing a mask can present more truth than people not wearing a mask’. Clearly, more is going on here than discussion of the technics of virus transmission.

In these pandemic times, it seems the less we know about something, the more people claim expertise in it. As with so many features of COVID-19, the contribution of masks to reducing disease transmission remains ambiguous and contestable. Among those who believe masks ‘work’, disagreement abounds over what kind of mask, ranging from an N95 respirator to a piece of cloth, would be necessary. There’s no doubt that getting symptomatic individuals to wear surgical face masks—‘source control’—reduces viral spread, and it makes sense surely to advise those caring for the sick to cover their own faces to protect against being sprayed with SARS-CoV-2. But what impact does masking have on the shedding of virus from asymptomatic or presymptomatic carriers? Would it make a difference if we were convinced that the virus is transmitted in aerosols as well as droplets? Does the prevalence of the virus in the community, and local population density, influence the effectiveness of masking? Do people know how to ‘enmask’ properly and safely? And is there any good evidence that donning a mask will protect the wearer in public? In response to many of these questions, the epidemiology is inconclusive or contradictory. Sometimes it’s not science that’s bruited, just anecdote and speculation. Still, we’ve all become experts.

Clinical trials so far have found no evidence that mandating masks for healthy individuals in the community would reduce the transmission of influenza and coronaviruses. But no evidence of effect is not the same as evidence of ineffectiveness, of course. Indeed, absence of evidence in favour of community masking flies in the face, so to speak, of mechanistic plausibility or common sense. Some ‘experts’ have pointed to successful containment of COVID-19 in countries such as South Korea, which demanded mask-wearing in public. But other behavioural changes, such as physical distancing and meticulous hand hygiene, confound the impact of that particular intervention. Who knows what really worked? Then there are places such as Australia and New Zealand that flattened the curve, squashed it down, without resorting to mass community masking. Some authorities have even cautioned that masks might engender a false sense of security, leading frustrated and fatigued individuals to abandon measures that are likely to be efficacious, such as physical distancing and handwashing. Again, there’s no evidence that this has happened, or that it won’t happen anyhow. Among other authorities, there was a fear that widespread community masking might result in a shortage of medical-grade masks for health professionals, but that no longer seems a major problem—not enough to constrain the roll-out of masks if they really work. For more than two months, then, masks have prompted academic sparring, fierce community debate, much shouting and even some shooting. Disputes over scientific evidence are the least of it, almost beside the point. This is not really about science.

Some reflection is overdue on how in many modern societies the mask has been transformed, at least for some, from a taboo object into a kind of fetish. Early in this pandemic, anthropologist Christos Lynteris described masks as markers of ‘medical modernity’ and signals of ‘mutual assurance’, suggesting that they can function symbolically to integrate and bolster societies facing epidemic disease. Physical distancing and handwashing lack the same symbolic import and fail to communicate solidarity as dramatically. In the late twentieth century, masks were taken up avidly in many, though not all, East Asian communities reacting against infectious diseases and air pollution. Then came the 2003 SARS pandemic, prompting frenzied mask procurement across Asia, with face covering assuming a talismanic value, almost a magical protection against natural perils. Masks gave some wearers a sense of control over an invisible menace and feelings of collective commitment. Sociologist Peter Baehr observed that masks were ‘ubiquitous’ during the SARS crisis in Hong Kong, even though senior health officers recommended against their use. Mask wearing commonly signified social solidarity, not the stigma of disease carriage. Failure to don a mask was represented as endangering collective health, to be treated therefore as ‘ritual violation’. The cultural power of the mask quashed any epidemiological quibbles.

At the same time, face covering has exercised a different purpose in the culture wars occurring in Western Europe, especially in France. A sign of social and religious solidarity among Muslim women, the veil or niqab has elicited scorn from many white Europeans who see such coverings as divisive and alienating—as resistance to assimilation. The niqab was both deplored as silencing Muslim women and feared as a cultural threat. Concealing the face raised suspicion, instilled mistrust. Accordingly, France banned full veiling of the face in 2011, and many other European countries, along with Québec, have followed. But now, after some early reluctance, both France and Canada recommend covering one’s face with cloth in public to prevent the spread of SARS-CoV-2. Some French cities have mandated masking during the pandemic. These days, President Emmanuel Macron is never seen in public without his tightly fitted mask. And yet, if you wear a niqab openly you’ll still get arrested.

Stories about masks are examples of what sociologist Erving Goffman in 1955 called ‘face-work’. He described a repertoire of face-saving practices, several derived from Asian societies, that allows individuals to mobilise themselves as ‘self-regulating participants in social encounters’. As Goffman saw it, face-work ensured that social equilibrium was re-established, thereby reinstating the ritual order. Thus, wearing a mask, and effacing himself, would cause Trump to lose face among his cohort; whereas others will don masks, effacing themselves, in order to save face among theirs. The choice to mask or not becomes a statement of social solidarity, of one kind or another. The turmoil and disruption of modern pandemics seem particularly generative of contrasting, even disjointed, face-work, all of it regardless of any scientific rationale.

As the COVID-19 pandemic evolved and intensified, the salience and valence of masks have varied across societies, providing insight into how face-work is unfolding in diverse communities. When I paused in Singapore on my way home from Hanoi, health officials were discouraging public recourse to masks. Yet in Hong Kong, South Korea and many other parts of Asia, government experts recommended that healthy people wear masks outdoors to prevent the spread of the new coronavirus. (In Hong Kong, this advice happened to contradict the ban on protesters hiding behind masks.) Back in Australia, state and territory chief health officers were discounting the value of community masking—and few people objected, perhaps because other methods had already slowed virus transmission. In the United States, the surgeon-general, concerned that healthcare providers were missing out, in late February tweeted: ‘Seriously people—STOP BUYING MASKS!’ Until late March, the US Centers for Disease Control and Prevention remained unyielding in insisting that healthy people not wear masks. Then it shifted stance and recommended that everyone wear non-medical face coverings in public. Some states and municipalities sought to mandate masks, and most issued recommendations; many avoided the issue altogether. Officials in New York City suggested that residents should shield their faces with a cloth covering, such as a scarf or bandana, if they ventured out. Celebrity physician Siddhartha Mukherjee confidently assured his readers that ‘the mask works two ways: not only to protect you from me, but me from you’. The New York Times became a relentless advocate of masking, perhaps because Trump showed so much disdain. ‘Are face masks the new condoms?’ the newspaper asked rhetorically in its editorial pages. Writers in the Times speculated on how to make mask wearing ‘cool and essential’ in their virus-beleaguered country. They hoped to make face covering the ‘new normal’, especially as Americans were encouraged back to work. In the Czech Republic, Slovakia, Austria and many German cities, masks became mandatory during March and April. The fervently Islamophobic Austrian chancellor Sebastian Kurz told his people that this would require a ‘big adjustment’ as ‘masks are alien to our culture’. 

In the United States, as nowhere else, masks have been enlisted in the culture wars. As a recent Politico headline put it: ‘Wearing a mask is for smug liberals. Refusing to is for reckless Republicans’. Donning a face covering, or not, determines the company you keep—you may as well be sporting a Hillary 2016 T-shirt or a MAGA cap. ‘I will not wear a mask’, declared Nino Vitale, a Republican politician in Ohio. ‘That’s the image of God right there, and I want to see it in my brothers and sisters.’ Rogue virologist and antivaxxer Judy Mikovits weighed in, arguing against face covering in the ‘so-called pandemic’: ‘Do you not know how unhealthy it is to keep inhaling your carbon dioxide and restricting proper oxygen flow? Masks will hamper oxygen intake… Do not listen to the government’. In early May, a Family Dollar security guard in Flint, Michigan, was shot dead after telling a customer that her child should be wearing a mask. There was rising animosity between those seeking security and solidarity in masks, using them to help get through the day, to leave the house, and others yearning to tear them off to express their individuality and freedom—and sometimes also to deny the gravity of the pandemic. Bitter conflict prompted comedian Trevor Noah, the host of the Daily Show, to ask:

Why are people so angry? Forget a vaccine, scientists need to start working on a chill pill. Health officials are asking us to cover our faces to protect ourselves, and everyone is acting like they have to get spayed and neutered. And the people who don’t wear masks are ruining it for everyone.

It got so bad that even the Republican governor of North Dakota was heard to muse, ‘it’s ideological or political or something around mask versus no mask’. Struggling to hold back tears, Doug Burgum continued: ‘if somebody wants to wear a mask, there should be no mask shaming’.

For black men in the United States, ‘mask shaming’ has been perhaps the least of their worries. ‘I have a sense of anxiety wearing the mask’, an African American man told the New York Times in the middle of April. In the words of Derrick Richardson, a middle-aged Bay Area medical-industry consultant: ‘It doesn’t matter how many degrees I have, how much money I have. I’m still a black man in America, and the thought of walking down a street with a mask on scares me’. What may be an emblem of social solidarity or a badge of honour in some communities might in other circumstances become a cue for police profiling and harassment. Sure enough, on YouTube one can view several videos of police ordering African Americans and Latinos to remove their surgical masks, kicking them out of Walmarts up and down the country. As Courtney Cogburn, a social-work professor at Columbia University, told Time magazine in April: ‘The issue of the mask is a representation; it’s a symbol of a much bigger and complicated problem’. Many white Americans prefer to regard large, masked black men as threats—hoodlums up to no good—rather than responsible citizens trying to protect others from the virus. ‘I think in the end we are asking a lot from people who are asked to be safe by putting these masks or bandannas on’, said Melanye Price, a politics professor at Prairie View A&M University in Texas. ‘If somebody called the police on them, they could lose their life before the coronavirus could ever get them.’ When the Times editorialised on Memorial Day, late in May 2020, that the most ‘patriotic’ act an American could perform is to fashion a cloth mask, it was appealing to its white, progressive base, desperate for racially regulated social solidarity, not to its vulnerable minority readers.

The enhanced cultural symbolism of the mask indicates that even in these times of social distancing we live in a world of social encounters fraught with meaning. It suggests that our perception of infectious disease is never just about microbiology. It tells us that if we are ever to come to terms with the COVID-19 pandemic, we will need to understand its cultural and symbolic dimensions—along with ethical entailments—at least as well as we understand the virus inciting it.

About the author

Warwick Anderson

A medical doctor and historian, Warwick Anderson is the Janet Dora Hine Professor of Politics, Governance and Ethics in the Department of History and the Charles Perkins Centre at the University of Sydney. His latest book (with Ian R. Mackay) is Intolerant Bodies: A Short History of Autoimmunity (Johns Hopkins, 2014). He has written on the beach as a space of [contamination] (http://somatosphere.net/2020/not-on-the-beach-or-death-in-bondi.html/) in the COVID-19 response, and on how not to have theory in an [epidemic] (http://somatosphere.net/2020/epidemic-philosophy.html/).

More articles by Warwick Anderson

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Comments

“ Clinical trials so far have found no evidence that mandating masks for healthy individuals in the community would reduce the transmission of influenza and coronaviruses.”
So I checked and found this
“ In the community, masks appear to be more effective than hand hygiene alone, and both together are more protective.” From
A RAPID SYSTEMATIC REVIEW OF THE EFFICACY OF FACE MASKS AND RESPIRATORS AGAINST CORONAVIRUSES AND OTHER RESPIRATORY TRANSMISSIBLE VIRUSES FOR THE COMMUNITY, HEALTHCARE WORKERS AND SICK PATIENTS
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7191274/

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