By Matt Kawahara San Francisco Chronicle
WWR Article Summary (tl;dr) Matt Kawahara takes a look at how "Mask-wearing is increasingly mandated by businesses and jurisdictions, and some believe the rules should be broader."
In February, as awareness of the coronavirus grew, Stanford behavior scientist BJ Fogg took a precaution traveling through Los Angeles International Airport: He wore a mask.
"I was one of like three people in the whole airport that was wearing one, and I felt really odd," Fogg said. "Now, I think it's flipped. The norm, at least there, has probably shifted."
In a few months, masks went from a rare to routine sight in much of the U.S. Health officials now recommend their use in public settings: According to the Centers for Disease Control and Prevention, wearing a cloth face covering may slow spread of the virus that causes COVID-19 by preventing droplets from infected people from being transmitted to others.
Mask-wearing is increasingly mandated by businesses and jurisdictions, and some believe the rules should be broader. Jeremy Howard, a research scientist at the University of San Francisco, co-wrote an open letter signed by more than 100 scientists urging governors to require masks in public. "Pretty much every state also requires that you wear pants in public," Howard said. "A mask is much more important from a hygiene point of view. If you don't wear pants, you're probably not going to kill anybody. But if you're not going to wear a mask, you absolutely might kill people."
The idea is that people who have the virus and don't know it or are asymptomatic are less likely to emit droplets and infect someone if they're wearing a mask. While, at least in the Bay Area, it seems most people wear masks when going into grocery stores, banks, post offices and for curbside pickup, it's clear not everyone is on board.
Objections to mask rules range from high-profile confrontations at stores and protests to walking through the grocery aisles without a mask or with one dangling around the neck. Reasons for resistance can be just as varied.
"I can only guess at what those are," Fogg said. "But some might be to show defiance, to make a political statement, to somehow express or feel like they are free and can do whatever they want."
A HuffPost/YouGov survey released last week found that 8% of Americans self-reported feeling judged negatively for wearing a face mask in public, while 23% felt they were judged positively and 54% felt they were not judged at all. In the poll, 8% said they see wearing a mask as a sign of weakness.
"Which is really weird," said Howard, the USF researcher. "Like, there's so many total badasses that wear masks -- whether they be ninjas, military in the desert, welders, whatever."
A recent study conducted by researchers in Berkeley and Britain found men surveyed were more likely than women to identify wearing a mask as "shameful, not cool, a sign of weakness, and a stigma." The survey, of 2,459 people mostly ages 25 to 54, also found that overall men were less inclined to wear masks than women.
Elena Conis, a historian of U.S. public health and medicine at UC Berkeley, said that people who oppose health guidelines such as vaccinations or quarantines "usually have a handful of reasons."
"Either they don't believe the risk is particularly high for them," Conis said, "or they believe the risk of (the disease) is a risk they want to take. Or they feel so strongly about their individual or personal liberty that it kind of trumps any public health messaging."
As an example, Conis pointed to the forming of an Anti-Mask League in San Francisco during the Spanish flu of 1918. The league protested the city's order that masks be worn in public, drawing 2,000 people to one meeting, even as the disease would ultimately kill more than 3,000 residents.
"It takes infringement of personal liberty to protect the public's health in pandemic times," Conis said. "And in a country founded on principles of individual liberty, that can sometimes be a hard sell."
The coronavirus is believed to spread mainly through droplets produced by an infected person coughing, sneezing or talking. Warner Greene, a senior investigator at the Gladstone Institutes, said the virus is unusual in that people can transmit it for a long period of time without showing symptoms.
A cloth mask can intercept respiratory as well as smaller aerosol droplets, which can carry the virus and travel farther than the 6 feet recommended for social distancing, Greene said.
"Frankly, this is not part of the culture in the United States, this is strange and not something we naturally do," Greene said of masking. "But for this virus it makes incredible sense. And it only works if everybody is doing the same thing, protecting everyone else."
George Rutherford, an infectious disease expert at UCSF, said masks have proven "remarkably effective" at reducing transmission of other viruses causing respiratory illness if worn correctly over the nose and mouth.
"It's the equivalent of not blowing smoke in someone's face," Rutherford said. "If people are going to be out and about, I think we need to be conservative about masks. It's a trade-off."
San Francisco tightened its mask rules Thursday with a new order requiring face coverings in most outdoor settings, including when exercising within 30 feet of another person or walking past someone on the sidewalk, with few exceptions. Throughout the Bay Area, signs at businesses and parks remind people to maintain distance and about county mask rules. But that doesn't always ensure compliance.
At Cole Hardware's half-dozen stores, President Rick Karp said a vast majority of customers have been cooperative, but there have been a few verbal altercations -- and one instance of an employee being pushed -- with people "hassling us and not wanting to wear a mask."
"They tend to be people that, I guess, feel it's a violation of their personal rights," Karp said. "It makes my staff, who already feel on edge and nervous about working, feel even worse."
At three Andy's Local Markets in Marin County, General Manager Brooksley Dixon said that employees have needed to remind a few maskless shoppers of the requirement.
"Sometimes they get mad," Dixon said. "Sometimes they're like, 'Oh, I left it in the car.'"
With some shelter-in-place measures easing, officials caution against letting mask habits slip. State Sen. Scott Wiener, D-San Francisco, said face coverings are "100% essential" to "not just reopening our economy, but keeping it open."
"This is not a forever thing. This is until we have a vaccine or a very effective treatment," Wiener said. "It is a simple, easy way for all of us to help collapse infection rates."
Wiener said he believes that "masks should be required in public, period," and can be mandated as a public health measure by officials.
"It requires all of us to embrace something new," Wiener said. "But if we all do it, it becomes more normal."
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