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Abstract: COVID-19 has proven detrimental to the economy and changed the nature of social interactions. Governments at every level have increasingly required the use of face masks in public spaces. Evidence has shown that mandatory mask-wearing policies can effectively control the outbreak of the virus, protecting susceptible populations (i.e., individuals with preexisting conditions, individuals 65 and older). Many communities encourage mask-wearing to reduce the chance of viral transmission. 

While mandatory mask policies appear to effectively reduce transmission of the virus, their long-term psychological effects are not yet known. In this study, we examine the association between the implementation of face mask mandates and detrimental psychological and social consequences as well as other relevant aspects. Also, this study tries to figure out if the mandatory mask policies are advisable, and if so, how it benefits the public. 

I. Introduction

The COVID-19 epidemic has changed the way individuals behave and think. Governments were forced to respond and had a variety of approaches to implement mask mandates. What lessons were learned by comparing these methods, and how might this knowledge change our future policy decisions? Possible negative effects of mask-wearing have come to light, such as dizziness, headaches, and fainting.  Elderly individuals were particularly vulnerable, and this effect increases with time and intensity of activity. To further understand the effects of mask-wearing, it can be useful to understand the scope of the changes brought about by COVID-19.

If the social measures of Coronavirus prevention are suppression of personal contact through city blockades and bans on gatherings, personal measures have centered on mask-wearing and hand washing. Although it is believed that wearing a mask is instrumental in preventing the spread of the virus, making it compulsory is a burden that is difficult for society to bear. Mandatory wearing of masks requires penalties such as fines or denial of services that are time-consuming and difficult to enforce. This use of public power limits the freedom of individual citizens. That is why eastern and western countries introduced mask mandates only after COVID-19 infection rates had progressed for extended periods of time. Local governments in a few countries introduced mandates in May 2020, but it was not until October 2020 that the mask mandates were implemented on a national scale.

Figure 1. States that implemented preventative mask mandates saw significantly lower rates of infection. (Parshley & Zhou, 2020)

Figure 2. Mask mandates moderate the rate of infection.

In some countries, it is compulsory to wear a mask while using public transportation. In the subway, even momentarily removing their masks may get them reported and fined.  Notices are prominently displayed and announcements about wearing masks are broadcast on the train. If you do not wear a mask while riding the bus, the bus driver will refuse to let you board. 

II. Mask Policy and Backlash

When masks became compulsory in European countries like Sweden, citizens' reluctance to wear them created a policy dilemma. In August 2020, protesters against wearing masks demonstrated in major European cities. Unlike Western countries, citizens in Eastern countries were not as resistant to masks, likely due to their past experience with the SARS virus and issues with air quality due to industrial and business activities. While Western governments were concerned with citizen resistance to the perceived loss of autonomy, Eastern governments had to focus on avoiding major economic losses.  In order to enforce these mandates, however, local governments must frequently monitor compliance, and impose fines on business owners and citizens who violate the mask mandate, incurring great costs. Moreover, in Korea, the explosive increase in demand for masks in the early stages of the epidemic resulted in masks becoming more scarce. This, in turn, caused the price of masks to skyrocket. 

During the crisis, governments were often reluctant to discuss mask mandates, and the mere mention of it was likely to cause panic.  They had little choice but to trust citizens to voluntarily comply. However, once it was assumed that the mask shortage had been resolved, the mask mandate policy was open for discussion. As the domestic supply of masks stabilized, governments began to enforce mask mandates.  

Figure 2. Weekly death rates (The Economist, 2020)

The United States consistently lacked federal leadership and clarity on its mask mandate. America’s standard pandemic response plan (which includes “data surveillance, testing, tracing the contacts of people carrying a contagious virus, hospital preparedness, distribution of medical supplies from a federal stockpile and federal guidance to state leaders and the public”) requires federal leadership to effectively activate. Unfortunately, the pandemic came at a time when federal leadership was weak, making it exceedingly difficult to implement this existing template to control the virus.  These left individual states are unsupported in combating the virus. 

Messaging from the executive branch became a source of contradiction and partisanship. President Trump frequently “contradicted his own public health advisers,” retweeting conspiracy theories such as the idea that masks do more harm than good.  In turn, measures known to prevent the spread of the disease became politicized. 

In comparing the U.S., Sweden, Canada, and Taiwan, certain trends become apparent (as shown in the graph on the right). These countries’ differed significantly in terms of timing, government messaging, enforcement of safety restrictions, and more. For example, the U.S. has historically struggled with sustaining advanced public health laws and programs due to a lack of enforcement and funds. As such, the U.S. was already structurally at a disadvantage to manage COVID-19.  In contrast, countries like Taiwan (which had systems set up to handle a pandemic due to the country’s SARS scare) were better prepared to handle a pandemic in the first place (Wang et al., 2020).  Beyond issues with the systems, the U.S. also had significant leadership issues, with President Trump actively contradicting science and public health experts throughout the pandemic.  

While Canada enforced travel restrictions and safety measures as early as Taiwan, the country’s unclear messaging on mask usage, limited testing, and use of outdated technologies for health communications hindered its containment of COVID-19 (Detsky, & Bogoch, 2020). Similar to the U.S., Canada initially had inconsistent messaging, but it was able to lower infection rates by implementing relatively strict social distancing measures, correcting its initial stance and advocating mask usage, and reinforcing practices recommended by public health experts (Detsky & Bogoch, 2020). 

III. Enforcement of Mask-wearing Policies: Quantitative Observation

Understanding the effectiveness of mask-wearing would also help countries make strategic plans to fully reopen their respective economies. With the alarming emergence and spread of several COVID-19 variants (DeSimone, 2021), it is crucial to establish the level of effectiveness of protective measures, namely mask-wearing, by elucidating whether countries that strictly enforce mask-wearing policies have had a lower number of COVID-19 cases than countries that have had less strict policies. Although data suggests that mask-wearing reduces COVID-19 transmission, there is less data on whether masking policies are effective across different countries, a problem that this study aimed to address. In addition, there is a substantial lack of data on how the degree of mask enforcement affects compliance and therefore COVID-19 transmission rates, an issue that this study aims to elucidate. It is hypothesized that countries and subnational jurisdictions that strictly enforce mask-wearing in public and shared spaces will have lower infection rates. 

A total of 14 locations globally were arbitrarily selected using a random choice generator from Text Finder, then organized into two categories of mask enforcement: strict and lax). Strict locations included: Connecticut, Qatar, Massachusetts, Kansas, New Mexico, Singapore, and China(Figure 3). Lax locations included: Florida, Iran, Sudan, Brazil, United Kingdom, South Carolina, and Sweden(Figure 4). 

Figure 3. Comparison of the cases

Figure 4. Comparison of the cases

Respective mask-wearing policies were collected from the CDC, WHO, and The New York Times, among other credible sources. Strict enforcement was characterized by locations enacting measurable punishments, such as fines for mask guideline violations. Lax enforcement was distinguished as locations that have allowed individuals to make personal decisions about wearing masks, trusting the individual to be responsible about mask-wearing; lax enforcement also included locations with no restrictions at all.  Locations with strict mask enforcement have the lowest COVID-19 infection rates, whereas locations with lax mask enforcement have the highest COVID-19 infection rates. It can be concluded that mask-wearing policies are the most effective in reducing COVID-19 infection rates when strictly enforced by governments. An explanation for this finding may be that stricter enforcement often results in penalties or fines, which leads to higher adoption rates of mask-wearing, which reduces COVID-19 transmission.

IV. Psychological and Social Impact: Anxiety and Stress

The pandemic has affected the psychological and physical health of millions of people. Especially, the mental-health effects could last even longer and a study shows the data of the impact of COVID-19 on mental health and well-being around the world.

(The Economist, 2020)

Figure 5. Age group vs. anxiety and depression

The authors estimated an increase of 53 million cases of depression due to the pandemic (28% above pre-pandemic levels) and 76 million cases of anxiety (26% rise).  

So that you may decrease depression symptoms among people, the World Health Organization(WHO) (2019) and the Centers for Disease Control and Prevention(CDCP) (2020) suggested specific guidelines on the right use of health protection measures with the prospect of decreasing the upset linked with healthcare professions. At similar times, psychotherapists can give psychological support online (Greenberg et al., 2020; Liu et al., 2020). In line with technological progress, professional groups organized specific guidelines and policies in line with customer protection, privacy, screening, evaluation, and development of self-help products (Duan and Zhu, 2020; Zhou et al., 2020). Technological growth in mental health can foresee future trends that incorporate “smart” mobile devices, cloud computing, virtual worlds, virtual reality, and electronic games as well as traditional psychotherapy tools. From this outlook, it is important to aid future generations of psychologists and patients to work together in the potential growth areas, through education and training on the advantages and effectiveness of telepsychology (Maheu et al., 2012).

Negative outlooks and non-compliance when it involves mask-wearing are likely increased, given that the suggestions and mandates have become so polarized. Towards the start of the COVID-19 pandemic, and shortly after the CDC let go of its suggestions for mask-wearing in public, Democrats and Republicans strayed somewhat in their showing of whether or not they always wore a mask in public (38% and 24%, respectively), according to an Axios/Ipsos poll. This percentage went up over time among each group as the magnitude of the pandemic increased. However, mask-wearing likely became a more polarized political issue when the CDC face mask suggestions were thrown out (both in word and action) by major government figures. This, in turn, may have increased an ‘us’ versus ‘them’ behavior between members of each party and may show why, over time, there became an even greater separation in mask wearing among Democrats (65%) and Republicans (35%) a small two months later. 

The effect of mask-wearing on basic psychological necessities (autonomy, relatedness, and competence) is likely an addition to the controversy linked with wearing masks at the time of the COVID-19 pandemic in the United States; however, forthcoming research is necessary to empirically test this theoretical evidence. It is crucial to point out that this commentary talked about some overarching psychological factors that may add to mask-wearing outlooks and behaviors. However, many other factors may also add to the determination to wear a mask and would bring investigation in foreseeable research. Some of these include altruism, self-efficacy, risk assessment, need for control or certainty, self-serving bias, perceptions of fairness, ability to engage in hot vs. cold cognition, short-term vs. long-term orientation, restraint vs. indulgence, trust in science, socioeconomic status, education level, personal experience, and other personality or physiological individual differences. 

V. Discussion

The COVID-19 pandemic, which has presented a dilemma for governments around the world since February 2020, has obfuscated the distinction between short-term and long-term responses. In the early stages of the outbreak, short-term solutions such as lockdowns and capacity restrictions were necessary to stop the spread of the epidemic.

The present discussion focused on the results of wearing a face mask from a personal level. It is imperative to acknowledge that there may be expansive associations and connotations of wearing a face mask not talked about. For example, there may be meso-level outcomes (i.e., medium systems, such as organizational, ethnic, and community), and macro-level impacts as well (i.e., large systems, such as a national economy). To our knowledge, there is presently no research that looks at face mask-wearing and the impact of more meso-and macro-level systems on the present COVID-19 pandemic.

Also, this paper tried to suggest that short-term and institutional responses can coexist as a response to the issue. In addition, the quarantine policy examined in this paper showed a partial response. It is clear that there is no one policy that can comprehensively respond to the global and social problems brought about by the COVID-19 pandemic. Perhaps the government's policy cannot and does not need to fully respond to all the ills that our society faces. The government may be able to alleviate the problem by only partially responding to the public concerns and leaving the rest to the officials and citizens. In addition, the central government can overcome the issue by withholding judgment and by expressing an active choice by local governments and the media. By reviewing the quarantine policy for the COVID-19 crisis, it will be possible to discuss how a partial response to a policy problem can be improved.

This paper focused on social and psychological consequences and policies regarding quarantine and mask-wearing. In the future, it will be necessary to examine how social distancing policies have changed, in consideration of short-term and institutional responses. With more global pandemics expected in the future, it will be meaningful to study the comprehensive policy response to the problem by examining how the mask policy at an individual level and social distancing at a societal level can create an effective response that also addresses peoples’ mental and emotional wellbeing.

References 

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