Mask Use Depends on the Individual, Situation, and Location-Even Without COVID-19 Transmission: An Observational Study in Shanghai

COVID-19 facial covering during outdoor recreation reflects historical disease prevalence and culture above and beyond governmental measures - A study in 53 countries

The COVID-19 pandemic severely influenced human behavior due to governmental restrictions. In addition to administrative restrictions, other factors, like historical disease prevalence and culture might impact on recent behavior. The parasite stress theory of values and sociality predicts an influence of historical diseases on human culture and may be of important influence on current human behavioral responses towards the pandemic. To address the influence on behavior, we studied mask use in outdoor recreationists (N = 4863) from 53 cultures. Studying outdoor recreationists is advantageous because people have at least some choices over their mask use, and it is less strictly controlled. We hypothesize that pathogen prevalence and cultural values of a society predict mask usage above and beyond the simplistic explanation of the strength of the governmental pandemic-related restrictions. Our results indicate that societal variables, especially individualism, contribute to the mask use during leisure activities, with people from more individualistic societies reporting lesser mask usage. Further, historic pathogen prevalence has a significant influence on mask use, even when controlling for the stringency measures of the government, HDI and population density. Zoonotic disease richness, however, did not receive significance. A mediation model showed that historical pathogen prevalence had an indirect effect on mask use, via the two pathways collectivism-individualism and governmental regulations. The total effect size of pathogen prevalence on mask use was 0.61, and with 0.24 as direct, and 0.37 indirect effects. Our data fit into the parasite stress theory of values and sociality. Our results provide evidence that the governmental decisions and restrictions themselves are influenced by the historical pathogens.

Epidemic modelling suggests that in specific circumstances masks may become more effective when fewer contacts wear them

BACKGROUND

The effectiveness of non-pharmaceutical interventions to control the spread of SARS-CoV-2 depends on many contextual factors, including adherence. Conventional wisdom holds that the effectiveness of protective behaviours, such as wearing masks, increases with the number of people who adopt them. Here we show in a simulation study that this is not always true.

METHODS

We use a parsimonious network model based on the well-established empirical facts that adherence to such interventions wanes over time and that individuals tend to align their adoption strategies with their close social ties (homophily).

RESULTS

When these assumptions are combined, a broad dynamic regime emerges in which the individual-level reduction in infection risk for those adopting protective behaviour increases as adherence to protective behaviour decreases. For instance, at 10 % coverage, we find that adopters face nearly a 30 % lower infection risk than at 60 % coverage. Based on surgical mask effectiveness estimates, the relative risk reduction for masked individuals ranges from 5 % to 15 %, or a factor of three. This small coverage effect occurs when the outbreak is over before the pathogen is able to invade small but closely knit groups of individuals who protect themselves.

CONCLUSIONS

Our results confirm that lower coverage reduces protection at the population level while contradicting the common belief that masking becomes ineffective at the individual level as more people drop their masks.

People in Tight Cultures and Tight Situations Wear Masks More: Evidence From Three Large-Scale Studies in China

Studies have found large differences in masks use during the pandemic. We found evidence that cultural tightness explains mask use differences and this association was more robust in tight situations like subways. In Study 1, we observed 23,551 people's actual mask use in public places around China. People wore masks more in tight situations; however, differences did not extend to outdoor streets and public parks, where norms are looser. We replicated this finding using a data from 15,985 people across China. Finally, in a preregistered study we observed mask use with the removal of COVID-19 restrictions, people still wore masks more in tight situations like subways than in loose situations of parks. These findings suggest that norm tightness has a lasting association with people's health-protective behaviors, especially in tight situations. It provides insight into how different cultures might respond with future pandemics and in what situations people adopt health-protective behaviors.

Habitual Mask Wearing as Part of COVID-19 Control in Japan: An Assessment Using the Self-Report Habit Index

Although the Japanese government removed mask-wearing requirements in 2023, relatively high rates of mask wearing have continued in Japan. We aimed to assess psychological reasons and the strength of habitual mask wearing in Japan. An Internet-based cross-sectional survey was conducted with non-random participant recruitment. We explored the frequency of mask usage, investigating psychological reasons for wearing masks. A regression analysis examined the association between psychological reasons and the frequency of mask wearing. The habitual use of masks was assessed in the participant's most frequently visited indoor space and public transport using the self-report habit index. The principal component analysis with varimax rotation revealed distinct habitual characteristics. Among the 2640 participants surveyed from 6 to 9 February 2023, only 4.9% reported not wearing masks at all. Conformity to social norms was the most important reason for masks. Participants exhibited a slightly higher degree of habituation towards mask wearing on public transport compared to indoor spaces. The mask-wearing rate was higher in females than in males, and no significant difference was identified by age group. Daily mask wearing in indoor spaces was characterized by two traits (automaticity and behavioral frequency). A high mask-wearing frequency has been maintained in Japan during the social reopening transition period. Mask wearing has become a part of daily habit, especially on public transport, largely driven by automatic and frequent practice.

Do Italian people still wear masks? Analysis of personality and dispositional correlates of facemask use in post Covid-19 scenario

Face mask wearing is a low-cost preventative measure for the Covid-19 pandemic. In Italy, face masks are no longer mandatory indoors from the 1st of May 2022. Some research focused on factors that influence the choice of using masks, but less is known about mask-wearing when non-mandatory. The present study aims to compare those who were still wearing masks indoors when non-mandatory and those who were not, in personality traits, anxiety, depression, and trust in healthcare professions, in Italy, in 2022. Furthermore, we analyze if resilience, reactance, political orientation, and Covid-19 vaccinations moderate between negative affectivity and the choice of wearing masks. 1151 adults, aged 18-64, were recruited. Using the Qualtrics platform, participants filled in a socio-demographic interview, and self-report questionnaires. Results showed that people who were still wearing a mask indoors had higher levels of psychoticism and negative affectivity, worse mental health, greater trust in healthcare professions, and worries about the pandemic. Moreover, resilience partially moderates the relationship between negative affectivity and the choice of wearing a mask. These findings provide a better understanding of individuals' responses to post-pandemic changes, identifying the personal and contextual aspects that can make people struggle with the process of returning to normality.

The impact of threshold decision mechanisms of collective behavior on disease spread

Humans are a hyper-social species, which greatly impacts the spread of infectious diseases. How do social dynamics impact epidemiology and what are the implications for public health policy? Here, we develop a model of disease transmission that incorporates social dynamics and a behavior that reduces the spread of disease, a voluntary nonpharmaceutical intervention (NPI). We use a "tipping-point" dynamic, previously used in the sociological literature, where individuals adopt a behavior given a sufficient prevalence of the behavior in the population. The thresholds at which individuals adopt the NPI behavior are modulated by the perceived risk of infection, i.e., the disease prevalence and transmission rate, costs to adopt the NPI behavior, and the behavior of others. Social conformity creates a type of "stickiness" whereby individuals are resistant to changing their behavior due to the population's inertia. In this model, we observe a nonmonotonicity in the attack rate as a function of various biological and social parameters such as the transmission rate, efficacy of the NPI, costs of the NPI, weight of social consequences of shirking the social norm, and the degree of heterogeneity in the population. We also observe that the attack rate can be highly sensitive to these parameters due to abrupt shifts in the collective behavior of the population. These results highlight the complex interplay between the dynamics of epidemics and norm-driven collective behaviors.

Assessing the role of collectivism and individualism on COVID-19 beliefs and behaviors in the Southeastern United States

America's unique response to the global COVID-19 pandemic has been both criticized and applauded across political and social spectrums. Compared to other developed nations, U.S. incidence and mortality rates were exceptionally high, due in part to inconsistent policies across local, state, and federal agencies regarding preventive behaviors like mask wearing and social distancing. Furthermore, vaccine hesitancy and conspiracy theories around COVID-19 and vaccine safety have proliferated widely, making herd immunity that much more challenging. What factors of the U.S. culture have contributed to the significant impact of the pandemic? Why have we not responded better to the challenges of COVID-19? Or would many people in the U.S. claim that we have responded perfectly well? To explore these questions, we conducted a qualitative and quantitative study of Florida State University faculty, staff, and students. This study measured their perceptions of the pandemic, their behaviors tied to safety and community, and how these practices were tied to beliefs of individualism and collectivism. We found that collectivist orientations were associated with a greater likelihood of wearing masks consistently, severe interruptions of one's social life caused by the pandemic, greater concern for infecting others, and higher levels of trust in medical professionals for behavioral guidelines surrounding the pandemic. These associations largely persist even after adjusting for political affiliation, which we find is also a strong predictor of COVID-19 beliefs and behaviors.

Trauma-Informed Care: A Transcendental Phenomenology of the Experiences of International Faculty during the Delta and Omicron Variant Outbreaks in East China

This transcendental phenomenological study explored psychologically traumatic incidents and risk factors among international faculty members (IFMs) who experienced long-term lockdowns during the Delta and Omicron outbreak periods in East China. Based on empirical voices from 18 IFMs in Shanghai, Hangzhou, and Nanjing, this study used trauma-informed care as its primary theoretical lens to examine potential traumatic incidents and risk factors. Findings showed that participants had neuroses about the omen of lockdowns and felt exhausted and frustrated about persistent polymerase chain reaction (PCR) tests. They also experienced or witnessed burnout and dropout due to leisure constraints. Most notably, participants had concerns about families and friends during the series of lockdowns, entailing extreme stress due to separation, illness, loss, and grief. Overall, this study provides practical implications for counseling practices about social and cultural considerations and systemic barriers that impact clients' well-being.

The 'Myth of Zero-COVID' Nation: A Digital Ethnography of Expats' Survival Amid Shanghai Lockdown during the Omicron Variant Outbreak

This study presents a digital ethnography of expats’ survival amid the Shanghai lockdown during the Omicron variant outbreak. This study drew insights from studies on resilience and secondary coping within the context of global migration to comprehend the diverse emotional challenges faced by expats in a series of lockdowns and persistent nucleic acid amplification tests. Thus, this study asks what the major emotional challenges expats faced and what sources of social support they could draw from citizens in their host country during the Shanghai lockdown. Accordingly, this study collected WeChat group conversations to draw empirical findings, promoted scholarly conversations about fundamental survival necessity, and traced the process for establishing intercultural collective resilience with citizens from their host country. Overall, this study emphasized the significance of host country members who can promote certain coping mechanisms for their visitors in the specific regional and geographical context of China.

Patterns of human social contact and mask wearing in high-risk groups in China

Background

The pandemic of coronavirus disease 2019 (COVID-19) has changed human behavior in areas such as contact patterns and mask-wearing frequency. Exploring human–human contact patterns and mask-wearing habits in high-risk groups is an essential step in fully understanding the transmission of respiratory infection-based diseases. This study had aims to quantify local human–human (H–H) contacts in high-risk groups in representative provinces of China and to explore the occupation-specific assortativity and heterogeneity of social contacts.

Methods

Delivery workers, medical workers, preschoolers, and students from Qinghai, Shanghai, and Zhejiang were recruited to complete an online questionnaire that queried general information, logged contacts, and assessed the willingness to wear a mask in different settings. The “group contact” was defined as contact with a group at least 20 individuals. The numbers of contacts across different characteristics were assessed and age-specific contact matrices were established. A generalized additive mixed model was used to analyze the associations between the number of individual contacts and several characteristics. The factors influencing the frequency of mask wearing were evaluated with a logistic regression model.

Results

A total of 611,287 contacts were reported by 15,635 participants. The frequency of daily individual contacts averaged 3.14 (95% confidence interval: 3.13–3.15) people per day, while that of group contacts was 37.90 (95% CI: 37.20–38.70). Skin-to-skin contact and long-duration contact were more likely to occur at home or among family members. Contact matrices of students were the most assortative (all contacts q-index = 0.899, 95% CI: 0.894–0.904). Participants with larger household sizes reported having more contacts. Higher household income per capita was significantly associated with a greater number of contacts among preschoolers (P_{50,000–99,999} = 0.033) and students (P_{10,000–29,999} = 0.017). In each of the public places, the frequency of mask wearing was highest for delivery workers. For preschoolers and students with more contacts, the proportion of those who reported always wearing masks was lower (P < 0.05) in schools/workplaces and public transportation than preschoolers and students with fewer contacts.

Conclusions

Contact screening efforts should be concentrated in the home, school, and workplace after an outbreak of an epidemic, as more than 75% of all contacts, on average, will be found in such places. Efforts should be made to improve the mask-wearing rate and age-specific health promotion measures aimed at reducing transmission for the younger demographic. Age-stratified and occupation-specific social contact research in high-risk groups could help inform policy-making decisions during the post-relaxation period of the COVID-19 pandemic.

Graphical Abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s40249-022-00988-8.

Factors associated with mask use in New York City neighborhood parks during the COVID-19 pandemic: A field audit study

BACKGROUND

Mask use is a cost-effective measure to decrease COVID-19 transmission. Mask mandates intend to increase mask compliance but are often ambiguous when it comes to public outdoor spaces.

METHODS

We used a field audit study to examine mask use in New York City neighborhood parks during COVID-19. 1453 park visitors were observed in 13 parks during July-August 2020 using a modified and validated park use audit tool (System for Observing Play and Recreation in Communities) that included items on general and proper mask use (i.e., mask covering both nose and mouth). Generalized estimating equation regression was used to determine the association between proper mask use and demographic (sex and age) and behavioral (physical and social activity) variables, while adjusting for community-level covariates.

RESULTS

Overall, 39.0% of park visitors used masks (24.4% properly, 14.6% improperly). Females (p = 0.023), adults (p = 0.025), and seniors (p = 0.006) showed higher rates of proper mask use compared to males and younger visitors. Physical and social activity were not significantly associated with proper mask use.

CONCLUSION

There is a need for improved messaging regarding the proper use of masks among males and younger people. This is particularly important for future surges of new COVID-19 variants or other public health crises similar to COVID-19. Future research should focus on developing and evaluating targeted public health messages regarding mask use.

Surgeons' non-transparent facemasks challenge the physician-patient relationship in the orthopedic outpatient clinic of a tertiary university hospital during the COVID-19 pandemic: a prospective cohort study of 285 patients

Background and purpose - Facemasks play a role in preventing the respiratory spread of SARS-CoV-2, but their impact on the physician-patient relationship in the orthopedic outpatient clinic is unclear. We investigated whether the type of surgeons' facemask impacts patients' perception of the physician-patient relationship, influences their understanding of what the surgeon said, or affects their perceived empathy. Patients and methods - All patients with an appointment in the orthopedic outpatient clinic of a tertiary university hospital during the 2-week study period were included. During consultations, all surgeons wore a non-transparent (first study week) or transparent facemask (second study week). Results of 285 of 407 eligible patients were available for analysis. The doctor-patient relationship was evaluated using the standardized Patient Reactions Assessment (PRA) and a 10-point Likert-scale questionnaire ranging from 0 (strongly disagree) to 10 (strongly agree). Results - A non-transparent facemask led to more restrictions in the physician-patient communication and a worse understanding of what the surgeon said. Patients' understanding improved with a transparent facemask with greatest improvements reported by patients aged 65 years and older (non-transparent: 6 [IQR 5-10] vs. transparent: 10 [IQR 9-10], p < 0.001) and by patients with a self-reported hearing impairment (non-transparent: 7 [IQR 3-7] vs. transparent: 9 [IQR 9-10], p < 0.001). The median PRA score was higher when surgeons wore a transparent facemask (p= 0.003). Interpretation - Surgeons' non-transparent facemasks pose a new communication barrier that can negatively affect the physician-patient relationship. While emotional factors like affectivity and empathy seem to be less affected overall, the physician-patient communication and patients' understanding of what the surgeon said seem to be negatively affected.

Historical rice farming explains faster mask use during early days of China's COVID-19 outbreak

In the early days of the coronavirus outbreak, we observed mask use in public among 1,330 people across China. People in regions with a history of farming rice wore masks more often than people in wheat regions. Cultural differences persisted after taking into account objective risk factors such as local COVID cases. The differences fit with the emerging theory that rice farming's labor and irrigation demands made societies more interdependent, with tighter social norms. Cultural differences were strongest in the ambiguous, early days of the pandemic, then shrank as masks became nearly universal (94%). Separate survey and internet search data replicated this pattern. Although strong cultural differences lasted only a few days, research suggests that acting just a few days earlier can reduce deaths substantially.