Face-off over face-masks: Europe’s latest north-south split

DURING THE pandemic, arguments have raged over the wearing of masks. This week in France, they spilled into violence. A bus driver in Bayonne was left brain-dead on Monday after being attacked by passengers. He asked them to wear masks, as French law requires on public transport. Five men refused to comply and assaulted him. A dispute over a measure supposed to protect people’s lives ended in a near-fatal assault.

The refusal to wear masks has been widespread in much of Europe. In February YouGov, a pollster, began collaborating with Imperial College London to monitor behavioural changes in response to covid-19. YouGov tracks the habits of 21,000 people across 29 countries, on a weekly basis. In February, as the pandemic began to spread from China, it found only a tiny proportion of people across Europe were wearing masks. By the end of June, though, mask-wearing had become widely accepted in Spain (86%), Italy (81%), and, despite this week’s attack, France (78%).

In contrast, face-covering habits hardly changed in Norway, Sweden and Denmark. Only 5% of people in those countries said they wore masks in public places. In Britain the rate is higher, but has climbed to just 31%.

Many Americans are also reluctant to don masks. Although 71% say they wear them in public spaces, certain states are witnessing a serious backlash. In Florida residents at a county-commissioners’ workshop likened mandatory masks to “a communist dictatorship” and “the devil’s laws”. In Scottsdale, Arizona, a city councillor co-opted Eric Garner’s dying plea to the police, “I can’t breathe”, to complain about wearing his mask, saying that the cloth restricted proper air flow.

In East Asia, which has had more recent experience in dealing with outbreaks of respiratory disease, masks are nearly ubiquitous, which may be one reason why so many countries in the region appear to have been quick to suppress the spread of the virus.

Much of the international variation in mask adoption stems from differences in government policy. At least 18 European countries have made masks compulsory in certain spaces. But detailed rules vary greatly: Denmark requires them only in airports; Poles must wear them in shops, on public transport or in any public area where they cannot maintain a two-metre distance. Those countries that have succeeded in “flattening the curve” of the virus have tended to have mandatory mask policies alongside lockdowns and phased reopenings. Spain, Italy and France are reporting less than one new case a day per 100,000 people. But in Sweden, which never formally locked down or required masks, the virus is spreading nearly five times faster.

Public-health officials say masks do not entirely protect wearers from contracting covid-19. However, they do help stop its spread. A paper from the Proceedings of the National Academy of Sciences in America reports that masks are the most effective means of preventing transmission between people; with social distancing, quarantining and contact tracing it is the likeliest way of halting the pandemic. Yet a lack of consensus among public-health officials may explain some of the reluctance to wear masks. Both America’s Centres for Disease Prevention and Control (CDC) and the World Health Organisation (WHO) claimed at first that the widespread use of masks (as opposed to their use in hospitals or the homes of the sick, or by those who are ill) would be ineffective in preventing the spread of covid-19. The CDC changed its guidance and began prescribing masks in April. It was June before the WHO started recommending mask-wearing in public spaces. (The Economist called for mask-wearing to be mandatory in crowded spaces in May.)

In the West, some people choose not to wear masks because they are uncomfortable, awkward, or even, in America, too much of a political statement (supporters of President Donald Trump are less likely to wear them than Democrats). With a vaccine still months or even years away, these hardly seem adequate reasons to reject a simple, cheap and at least partially effective way of stemming transmission of the virus.

Editor's note: This article has been amended to clarify WHO's guidance in April. At the time it discouraged the general use of masks in the community, but recommended their use in certain settings, eg, in hospitals.