Facemasks: would you wear one?

Photo by Anastasiia Chepinska on Unsplash

Individuals across the world have been doing their part to combat COVID-19, including adopting simple measures like regular hand washing and keeping physical distance from others.

However, there is one simple measure which some countries have been slow to adopt — facemasks

As of late April, 80–90% of people in China, India, Philippines, Indonesia, Japan, Vietnam, and Malaysia reported wearing facemasks in public. However, only 13% of Britons reported doing the same — among the lowest of any country surveyed.

Are British people open to wearing facemasks?

It might be that people in Britain are more inclined to follow the World Health Organisation’s advice that healthy people should not wear facemasks.

However, a recent international survey found that 60% of Britons think that having everyone wear facemasks outside would be at least moderately effective in reducing the spread of the virus.

The intuition of most Britons that facemasks could help contain the virus is supported by a recent report from the Royal Society, which recommended widespread use of masks in the UK. That recommendation is underpinned by the current understanding that:

1. People can spread coronavirus by breathing out droplets (even when they do not have symptoms).
2. Facemasks can reduce how much droplets people release by 50–100%.

As well as thinking masks are effective, BIT’s own UK polling has found growing support for requiring the use of masks in public. Among a sample of 3,208 UK adults, support for this measure was at 65% last week — up from 44% in late March, with the largest increase in support over that time coming from people aged 55 and older.

So, if most Britons think facemasks can effectively reduce the spread of coronavirus and support mandating their use, why are so few people actually using them?

One plausible reason is that they do not want to take facemasks away from health care workers who need them more urgently. Many countries are facing this same supply challenge — the United States and Czech Republic reached a pragmatic interim solution by encouraging people to use DIY face coverings, while France sought a longer-term solution by ordering 1 billion facemasks from abroad.

Or is it that different cultural perceptions play an important role? In China, people are long accustomed to wearing face coverings in response to persistent air pollution. In South Korea, many people got used to wearing masks as a preventative health measure during the 2015 MERS epidemic. In Europe however, face-coverings are more often associated with wanting to hide one’s identity.

Facemasks in the UK may be about to take off

In the book Diffusion of Innovations, Everett Rogers provides a vivid example of how these kinds of negative perceptions can discourage people from adopting an established health practice. He tells the story of Nelida, a health professional, who tried to encourage people in a village in Peru to boil their drinking water in order to prevent typhoid and other infectious diseases.

After two years of effort, she only managed to convince 5% of the villagers to adopt the practice. Why? Because the locals already had a custom of boiling water — but only for sick people. They had developed a strong association between drinking boiled water and being unwell, and were reluctant to begin drinking boiled water themselves when they thought they were in good health.

We think this story might help explain why people in the UK use masks much less than we might expect — they may associate masks with being sick, and not think of them as a preventative measure.

Another insight from that book is how innovations often get adopted slowly at first, then surge in popularity as people become familiar with the new product and see others using it. This ‘s-curve’ is visible in all of the UK’s major European neighbours in the below YouGov graph on facemask use over time.

There has been a similar recent increase in the use of face coverings in the US, following the CDC’s recommendation in early April that all Americans should use them.

This kind of direct government guidance, mirrored in the UK’s newly released COVID-19 recovery strategy which advises people to use face coverings in public transport and shops, combined with more local social norm effects which encourage more people to use masks as they see others adopting them, suggests that the UK may be about to see a similar dramatic increase in the use of facemasks. This is good news — recent modelling work suggests that the more people that use them, the more effective they will be at containing the virus.

With public and political interest shifting in favour of facemasks the key behavioural question will be how to ensure people are using them correctly. This question is likely to be the focus of British behavioural scientists and public health officials in the coming weeks. We will examine this question ourselves and share with you our findings in future articles.

By Yihan Xu, Research Advisor, and Dr Mark Egan, Senior Research Advisor, BIT