Why do people wear masks during epidemics?
While they fend off disease, masks also show solidarity at a time when a community is vulnerable to being divided by fear, between the healthy and the sick
The latest coronavirus epidemic has sent people scrambling for face masks like never before. “The world is facing severe disruption in the market for personal protective equipment,” Tedros Adhanom Ghebreyesus, the director-general of the World Health Organisation, warned recently. “Demand is up to 100 times higher than normal and prices are up to 20 times higher.” This, even though face masks are not, on their own, a proven prophylactic against infection from the new coronavirus (hand washing is more important, medical experts seem to agree).
And yet we shouldn’t look upon this buying spree as a sign of irrational epidemic-panic. Consider mask-wearing in its historical and cultural context, and you’ll see that in China, for example, it serves as far more than simply a means of protecting oneself from infection.
Masks are also a marker of medical modernity, as well as a signal of mutual assurance that allows a society to keep functioning during an epidemic.
Invented during plague
Anti-epidemic masks as we know them today were invented in China more than a century ago, during the Chinese state’s first effort to contain an epidemic by biomedical means. When the pneumonic plague struck the northeastern provinces of the Chinese Empire (a region known then as Manchuria) in the autumn of 1910, the Chinese authorities broke with their long-standing opposition to Western medicine: They appointed Wu Lien-the (also known as Wu Liande), a young and brilliant Cambridge-educated Chinese doctor from British Malaya, to oversee efforts to stem the outbreak. The plague was about to meet its match.
Soon after arriving in the field, Wu asserted that this plague wasn’t being spread by rats, as had been assumed, but was airborne. The statement was heresy, and turned out to be correct. Wu proved his point by adapting existing surgeons’ masks — which were made of a cotton wad encased in gauze — into easy-towear protective devices and ordered Chinese doctors, nurses and sanitary staff to use them. He also made sure the masks were worn by patients and their immediate contacts, and he distributed some among the general public.
Wu’s Japanese and European colleagues on the ground were sceptical until the death of an eminent French doctor who wouldn’t cover up even while attending patients. Gauze masks were soon adopted, extensively. Some wearers would first stamp them with a seal from a temple — more than simply medical devices, the masks became talismans.
The plague, which caused pneumonia, killed everyone it infected, sometimes within 24 hours of the onset of symptoms. By the time it abated in April 1911, some 60,000 people had died, but Wu’s masks were thought to have prevented an even greater disaster.
The masks weren’t just an effective prevention device: They also were an excellent PR tool for proclaiming China’s position as a modern, scientific nation. And Wu knew that. He made sure to have his anti-plague operations meticulously photographed, turning his mask into an emblem of China’s trailblazing ahead of Western medicine.
The photos were an international sensation: Between January and March 1911, newspapers across the world featured many shots of Wu’s mask — which looks much like the white paper version we know today. Cheap, easy to both manufacture and wear, and — for the most part — effective, it was a triumph. When the Spanish influenza struck in 1918, face masks were readily adopted.
In the West, the use of masks did not last much past the Second World War. But in China, masks remained markers of medical modernity and continued to be used for publichealth crises.
It was the 2002-3 Sars epidemic that led to the adoption of masks as personal anti-viral protection in China and elsewhere in East Asia: More than 90 per cent of Hong Kong residents wore them during the Sars epidemic. Once again, as in 1911 — but on a 21st-century scale — photographs of mask-clad crowds became iconic of Sars across the globe.
In the West, the image of Asian people with masks is sometimes wielded, deliberately or not, as a signifier of otherness. But in East Asia, the act of wearing a mask is a gesture that communicates solidarity during an epidemic — a time when a community is vulnerable to being divided by fear, between the healthy and the sick. Understanding epidemics not simply as biological events but also as social processes is key to their successful containment.