In June 1918, as it became evident that a deadly strain of influenza was spreading through military cantonments in the US, a group of the nation’s premier medical scientists visited Camp Grant to conduct an inspection.
Constructed just the year before, this huge army training center was populated by 57,000 mainly young recruits — “farm boys with straw colored hair and flush cheeks” as described by John Barry in The Great Influenza, his terrifying account of the Spanish Flu.
It was an epidemic waiting to happen.
Though the camp pathologist Joe Capps had noted signs of “a different type of pneumonia” surfacing, the staff at the camp and the team of inspectors had yet to gauge the true extent of the danger.
Still, in response to this and other respiratory diseases, Capps introduced gauze masks to the infirmary.
Aside from some minor tweaks, there was nothing revolutionary about the masks themselves. They had been in use for more than 20 years at that point, making their debut with the discovery of viruses in the 1890s.
This came as germ theory finally displaced the belief that disease was spread by toxic air known as miasma, a view that had held sway in the West for two millennia.
Others had already conducted studies, but what was different about Capps’ experiment into the efficacy of masks was that they were worn by patients.
“So far as we can learn, the use of the face mask for patients had never been practiced. In a hospital where each patient is confined to a separate room, there is no reason for masking the patients. But in hospital wards where, even with cubicles, patients must mingle and expose one another to respiratory infections, the face masks on theoretical grounds promised protection,” wrote Capps in a paper for the Journal of American Medical Studies in August.
The experiments yielded such positive results, particularly in preventing cross-infections, that the masks became standard issue for patients and the staff treating them.
Yet, just weeks after the publication of the paper, influenza had torn through Camp Grant. The first 100 men to be diagnosed were all issued masks and isolated, but within days more than 4,000 men were ill.
By early October, more than 400 men had died. Devastated, the camp commandant shot himself. The masks had failed spectacularly. On a national level, in general population, this was even more evident.
Since the outbreak of the COVID-19 virus in December last year, the “Western” aversion to and the Asian predilection for mask-wearing has been a recurring theme.
Articles in Taiwanese and international media have offered various cultural reasons for these differences, some of them — such as the claim by one medical news outlet that Europeans are happy to get ill because they can take unlimited sick leave — utterly barmy.
However, during the 1918 outbreak in the US, masks, Barry wrote, “would soon be seen everywhere and would become a symbol of the epidemic.”
It did not make a blind bit of difference — infection rates soared and bodies overflowed from morgues into the streets.
“The masks worn by millions were useless,” Barry concludes.
In San Francisco, the Red Cross issued 100,000 masks in late October, and they were credited as having helped the city largely avoid the virulent second wave of the epidemic.
This proved a fatal misjudgement, as the city succumbed to a third recrudescence.
That same month, the ineffectiveness of the masks was further exposed by the death of 33 police officers in Philadelphia who had been sent to dispose of the corpses that were piling up in homes around the city.
Once again, the masks “had no effect on the virus.”
Reflecting on what was one of the first major initiatives to implement widespread mask use, a 2008 paper in the American Journal of Infection Control concluded: “Because influenza is a droplet-borne infection, this policy was based on sound reasoning, and thus favorable consequences were expected. The actual failure of mask use to prevent the spread of disease was disappointing.”
Mask design has improved since the devastating pandemic of 1918, but there remains little in the way of solid evidence that surgical masks are of any value when used in general population.
On the back of the 1968 Hong Kong Flu, which claimed 1 million lives worldwide, research published in the Australian and New Zealand Journal of Surgery suggested that gauze masks had less than 30 percent efficiency at blocking particles of less than 5 micrometers in diameter.
Again, the average surgical mask these days is better than what was available 50 years ago and certainly effective enough to keep out COVID-19 droplets at close range.
There is currently debate over whether the virus remains suspended in the air through droplet nuclei and, if so, for how long.
Recent studies, including opportunistic data collated in Hong Kong during the SARS outbreak of 2002 to 2003, indicate that population-wide use of masks could have some impact on transmission rates of the disease, which is also spread via droplets, as is flu.
Still, the evidence remains flimsy at best, and the fact is, there is also almost zero support within medical and scientific circles for the use of masks in general population as a means of reducing transmission.
The Centers for Disease Control has made it clear that it regards masks as unnecessary for the public; Vice President Chen Chien-jen (陳建仁), an epidemiologist, has reiterated this; and Ho Mei-shang (何美鄉), an epidemiologist with Academia Sinica, “felt puzzled to see the panic buying of face masks when the country is still relatively safe from the virus.”
Ho, who made her name as the public face of science during the SARS outbreak, is surely using conciliatory language here.
She might be “puzzled” as to why her compatriots are completely ignoring professional advice, but she must know that fact-based arguments will do little to change the minds of most Taiwanese who, culturally predisposed to mask usage as they are, have been lining up in droves from the minute the virus reared its floral protuberances.
With the government having shrewdly implemented a rationing program, there is nothing particularly harmful about the public passion for masks, though potential downsides could include the engendering of a false sense of security.
However, more recently, the near-universal praise Taiwan’s government has received for its outstanding response to the virus has caused some citizens (and some media) to attribute the success in part to masks.
Articles and videos have appeared questioning why Europeans do not wear masks; posts on social media have implied that “foreigners” are now reaping what they have sown, and paying the price for foolishness and arrogance.
Some of this is understandable. Reports of racially motivated attacks in the West against Asians have been alarmingly frequent since the onset of the outbreak, and some of them were associated with mask-wearing.
The scorn and abuse for what is seen as a socially responsible practice in much of East Asia is being reciprocated in some quarters.
Still, among the responses on social media to the westward spread of the virus, suggestions that citizens of North America and Europe deserved to be infected were particularly unsavory.
There is no doubt Taiwan’s handling of COVID-19 has been exemplary and deserving of praise. Let us give credit where it is due: A government that followed sound scientific advice rather than Joe Public touting unsubstantiated received wisdom.
James Baron is a freelance writer and journalist based in Taipei.
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