Coronavirus: impact of cultural difference on face mask usage and crisis response

As I stepped out of the hotel I was staying in, I was confronted by this long queue of people that went right around the block, patiently waiting in line to buy face masks. 95% of them were wearing face masks. Presumably the few who didn't already ran out.

It became quickly apparent that Hong Kong is facing an acute shortage of face masks, with popular pharmacies swarmed by hordes of people, and selling out the moment fresh consignments arrive. The few retailers with stock to sell took the opportunity to dramatically increase prices, with one in Causeway Bay quoting me NZD$40 for a disposable N95 masks (which I guess would normally retail for NZD$2).

I can imagine panic buying has depleted the city-state's supplies of face masks and hand sanitisers.

Malls were eerily quiet, underpasses usually chocka with people deserted, museums and popular attractions like Disneyland and Legoland closed, Even a popular Din Tai Fung dim sum restaurant in Tsim Sha Tsui, where one would normally see long queues of hungry customers, had lots of empty tables at lunchtime on Sunday (2 Feb). Almost everyone serving customers and in public places wear face masks. They tell me many locals choose to stay home and avoid public places.

As at 4 Feb, there are over 20,000 confirmed cases of coronavirus, with 427 deaths. SARS had a mortality rate of 10%. By contrast, the new coronavirus has a mortality rate around 2%. The 2009 swine flu pandemic killed up to 575,000 people, with 11-21% of the GLOBAL population infected, and yet I can't remember as much hysteria over this at the time. I'm not downplaying the seriousness of the situation; it's important to act fast and decisively in the face of crisis - although we should question whether we are overreacting.

I can understand why Hong Kongers would react in this manner, despite 13 confirmed cases and one death as at 4 Feb. Memories of the SARS epidemic which swept Hong Kong in 2003 resulting in 286 deaths, are still fresh amongst Hong Kongers (and other Asians). Proximity to China is another factor. However, culturally, Hong Kongers are also more likely to take extra precautions. Take face mask usage for instance. Notwithstanding the limited protection provided by typical disposable masks, the overwhelming belief is that it's better to be careful "just in case". Most disposable masks are ill-fitting rectangular strips of paper with extensive leaks; there's little difference between wearing a mask and not wearing one. I find it ironic to see smokers with masks strapped on, but pushed under their chin, with a cigarette in their mouth. In Japan, people also wear masks to protect themselves from pollen, as hayfever is highly prevalent there. This face-mask wearing habit is entrenched, which explains why we often see Japanese (and other Asian) tourists in New Zealand wearing face masks, with or without virus pandemics.

In addition to self-protection, there are social etiquette considerations too. There is widespread expectation that you need to protect others from potential contamination, so you should wear a face mask even if you're not sick, again, just-in-case. There are also long-standing cultural considerations that pre-date the coronavirus. For instance, it's quite common for ladies to put on face masks on days when they do not have make-up on, as they may not want to go out without make-up. This concept may be quite foreign to Kiwis, who often do not use much make-up. There's also the sense of mystery with having a face mask on. Celebrities have popularised mask use due to their need to be anonymous in public - and the general population like to emulate celebrities. Fans are often obsessed over the apparel used by celebrities including the type of face mask they don.

It's extremely concerning that there have been recent cases of Asians being racially abused in New Zealand for wearing face masks in public. I fear people unfamiliar with the varied reasons for face mask use, coupled with a lack of understanding of this new coronavirus, will result in more cases of racism as the virus spreads. We have to call out such behaviour when we see them.

New Zealand's response to the coronavirus situation is not uniform. On one hand, we are too relaxed with screening inbound visitors. When I arrived at Auckland Airport yesterday (3 Feb), it was the day the ban on travellers from China took effect. Not once was I screened or asked if I visited Wuhan/Hubei or had my temperature/health checked. Contrast this with the approach taken at Tokyo Narita and Hong Kong, two other airports I visited in the past week, where temperatures are taken at multiple points, and passengers asked about their travel history.

On the other hand, some measures taken may be a little over the top. Despite WHO's advice that suspending travel to China isn't necessary, the New Zealand government has issued a blanket "Do not travel" advisory for China, which practically means you're on your own if you still choose to go. Travel insurance policies typically do not cover visits to countries on this list. On the official Safetravel website, they stated that the "Do not travel" advisory usually applies to areas where there is conflict, warfare or ongoing violent civil unrest - for example, Libya, Afghanistan, Kashmir etc. The blanket ban on travellers from China will impact many international students and visitors, and ultimately the livelihoods of many Kiwis. Now that the virus has gone global, how do we view travellers from Australia (12 cases), USA (11), Singapore (18) or Japan (20)? Whilst I recognise the need for us to be safe rather than sorry, there is a risk that we overreact.

As some of you know, I am also a director of New Zealand face mask business MEO. I wrote this article to highlight some important cultural differences surrounding face mask usage, and also how different countries are reacting to the coronavirus outbreak. The intention here is not to sell face masks. Market demand is far higher than we can supply, and will stay high over the coming months.