By Joseph Judd*
On my flight back from Auckland to China two weeks ago, the family sitting next to my wife and I were all wearing hazmat suits, goggles, masks and gloves.
We both wore masks too. In fact, everyone including flight attendants on our China Eastern flight wore masks. When we arrived in Shanghai, all the airport staff were in full protective gear.
By contrast, as we walked through Auckland airport none of the customs or security staff wore masks or any other protective gear. Nor were any of the staff on our domestic flight to Auckland.
The widespread use and availability of face masks in China, Korea, Singapore, Hong Kong and Taiwan is only one of the many intensive measures used by these governments in their successful battles against COVID-19, but it has been a critical one, and one that people and leaders in the West seem to overlook or misunderstand.
On February 1, when Singapore had recorded just 13 cases of the coronavirus, the government ordered the Armed Forces to deliver 5.2 million masks to 1.3 million households across the city. In Korea, television broadcasts, subway station announcements and smartphone alerts provide endless reminders to wear face masks.
Taiwan responded immediately by ramping up face mask production, now at 10 million per day. And it’s notable that Hong Kong, the densest city in the world where hundreds of thousands travel to China every day, has almost totally curbed community spread of COVID-19, despite a recent rise in imported cases. Officials in Hong Kong credited universal mask wearing as part of the solution and recommend it in fighting the virus.
In New Zealand the government is only now beginning to focus on providing masks and other protective gear for some of our frontline workers (after outbreaks in hospitals, among the police and airline staff), but still fails to understand the key role widespread mask wearing can play in saving lives.
Fundamental to that is grasping the fact that masks can protect other people from you if you unknowingly have the virus. COVID-19 can spread through asymptomatic transmission: people with the virus don’t show symptoms for 5 to 6 days, and fit, younger people with mild symptoms may not know they are sick or infectious. There is also evidence that masks can help by reducing the amount of virus taken in, since the immune system is more effective if infection starts with a low dose.
Another significant misunderstanding is a cultural one. People in the West often associate face masks in Asia with air pollution, and there’s a negative stigma attached to wearing them. But in places like China, Hong Kong and Taiwan, wearing face masks is a practical, unspoken social contract about being considerate to others when you think you may be sick.
I am not a scientist or medical professional, but seeing the data and studies on what’s worked in China and other parts of Asia, and what’s happening in much of the West, I believe there’s enough evidence available to warrant an urgent review of New Zealand’s current stance on the use of face masks.
The Ministry of Health website says: “For most people in the community, face masks are not recommended. For people with symptoms of an acute respiratory infection, the World Health Organization recommends that there may be benefit in wearing a face mask.”
This is the basic advice of the WHO and the CDC in the US, which has the highest number of COVID-19 cases globally. The CDC is now saying it’s reviewing its advice on masks, and the Ministry of Health said it’s “keeping a close watch” on that.
There are in fact dozens of studies that show masks are very effective in reducing transmission of viruses like COVID-19, along with other measures like social distancing and handwashing.
Face masks were the most consistently effective intervention for reducing the contraction and spread of SARS, according to research in a Cochrane Review. One study following community transmission of SARS in Beijing found that wearing a mask in public was associated with a 70% reduction in the risk of catching the virus. This is why the governments of Hong Kong, Singapore, Korea, Taiwan and China –– who learned from SARS –– made widespread face mask use a central part of their strategies.
A few of Europe’s leaders are catching on. In the Czech Republic, citizens have mobilised in a national effort to make home-made masks following government orders to make face-wear mandatory in public. The Czech Republic and Slovakia are the only two countries in Europe to make mask-wearing mandatory, while Austria and Germany appear to be moving in the same direction. As of Wednesday, the Czech Republic had recorded thirteen COVID deaths, much lower than neighboring Germany and many of its other European counterparts, while Slovakia remained at zero deaths.
The truth is, many governments in the West, along with the WHO, have been hesitant to recommend masks because of concerns of a shortage, public hoarding and healthcare workers missing out. These concerns are valid: healthcare and other frontline workers should absolutely be the top priority for all PPE, including masks, and especially N95 masks.
But the blanket message to the public that “You don’t need them” is misleading and wrongly suggests there’s no urgency in making masks widely available as this crisis unfolds.
A study by Cambridge University showed that even simple homemade masks can be effective. There are many articles that explain how to make them, and lots of information about how to put them on safely.
We pride ourselves on being a nimble, forward-thinking country. Let’s live up to that by urgently catching up with the curve on masks, insisting on their use and making them universally available.
*Joseph Judd is a New Zealander who has been living and working in Taipei and Shanghai for the past seven years. Judd is strategy director at ad agency Bartle Bogle Hegarty in Shanghai.