By Nadezhda Tsekulova
Nadezhda Tsekulova is a freelance journalist and a communication expert, based in Sofia Bulgaria.
The issue of wearing protective masks has been on the agenda since the beginning of the pandemic: Should we cover our face or not? Under what circumstances? What type of mask should we use? Over the past few months, the focus of the debate has changed several times while also opening the door to conspiracy theories and misinformation.
At the beginning of the pandemic, the world faced a huge shortage of masks. News of increased demand, queues in front of pharmacies, speculative price spikes, the crisis in China and other Asian countries affected by COVID-19 reached Europe and North America in the first days of February.
For Europeans, the news came after reports of the first cases of the new disease in Europe and after the World Health Organization (WHO) published its first interim guide on how to use protective masks. “…wearing a medical mask is one of the prevention measures to limit spread of certain respiratory diseases, including 2019-nCoV, in affected areas” read the document.
WHO recommended that only people at great risk — medical staff, patients and those caring for the sick at home — should wear a mask,
arguing that mask wearing could lead to unnecessary costs, supply problems, and the neglect of other measures, such as hand washing and social distancing.
However, these guidelines needed to be updated after it became clear that the spread of the epidemic wouldn’t be limited to Asia, as some hoped in the beginning. People in Italy, France, Britain, and the United States began to stockpile. This led to shortages and difficulties in supplying masks to doctors, patients, and those taking care of them. Thus, at the end of February, WHO published a new report called “Rational use of personal protective equipment for coronavirus disease 2019 (COVID-19)”. The report criticized the hoarding of masks and other protective equipment and noted that “for asymptomatic individuals, wearing a mask of any type is not recommended.”
Thus, the official guidelines were originally intended to persuade people to wear masks only if necessary. Despite the clarification that this was meant to prevent shortages, the guidelines included many facts known to science at the time: that improper wearing of masks can compromise their effectiveness; that their widespread use may adversely affect compliance with other measures; that fabric masks are not as effective as medical ones and that all of these factors combined can contribute to the spread of the virus, instead of slowing it down.
Still, in March, some countries — Venezuela and Vietnam were among the first in the world — introduced mandatory mask wearing in indoor public places, public transport, supermarkets, and pharmacies. Bulgaria tried to follow suit on March 30, but the order was revoked less than 24 hours after its announcement.
A month later, the European Center for Disease Prevention and Control, ECDC, and its counterpart agency in the United States published official recommendations for the wearing of masks in public places. Both guides recommended reusable masks sewn from cotton fabric and emphasized the supposed benefit of wearing them to prevent the spread of COVID-19, even by asymptomatic patients.
Both documents correctly stated that no studies had yet proven the benefits of face covering, but that there was enough circumstantial evidence for it. At the same time, WHO published its updated recommendations for wearing masks, which explicitly emphasized that “there is currently no evidence that wearing a mask (whether medical or other types) by healthy persons […] can prevent them from infection with respiratory viruses, including COVID-19.”
The discrepancies caused a scientific scandal, but the discussion did not lead to clearer and less ambiguous guidelines.
On the contrary. Months later, there was still no universal message regarding the wearing of masks. Meanwhile, conflicting information coming from WHO and the scientific controversy itself have added to the doubts about whether the institutions know what they are doing, recommending one measure or another in the name of public health, and further fuelled conspiracy theories on the subject.
Misinformation as the big winner
The clash between the divergent messages coming from public figures, experts and organizations resulted in an explosion of conspiracy theories and misleading news related to mask wearing. The usual sources of fake news started exploiting the current social anxiety by offering simple explanations and blaming the usual “culprits”.
The risk of carbon dioxide poisoning, headaches, dizziness, even bacterial pneumonia and legionellosis, a type of infectious disease that causes severe pneumonia, has been cited as an argument against face coverings. Social networks have exaggerated the contradictory messages about the effectiveness of masks convincing many users that the masks can’t actually protect against the disease. A study by the University of Cambridge shows that
people who mostly get their news from social networks are more likely to believe in conspiracy theories
and ignore public health measures. Platforms such as Facebook and YouTube have helped disseminate the myth that the introduction of mandatory protective clothing is actually intended to make it easier to control society. Pseudo-media, spreading disinformation on social networks, used this conspiracy as a way to make a quick profit.
The rumour that compulsory face coverage is a deliberate plan to restrict human rights and freedoms in democratic societies has also been used for political gains. In the United States, for example, the political affiliations of some Americans were directly linked to their willingness to wear a mask and even to their belief in the existence of the virus.
On the other hand, for months, there was no clear political commitment to establish masks as an important and relatively easy-to-apply tool in the fight against the spread of COVID-19. Many world leaders have appeared in public without masks and openly questioned their benefits, such as US President Donald Trump. Others, such as German Chancellor Angela Merkel, have been the subject of false rumors that they don’t wear a mask during public appearances.
Disinformation campaigns against masks have also sparked mass protests against measures to combat the epidemic
in countries traditionally associated with rationality and discipline, such as Germany. A demonstration in the capital, Berlin, was attended by anti-vaxxers and supporters of the far-right party Alternative for Germany. According to official figures, about 20,000 people marched on the streets of Berlin calling for lifting of the anti-epidemic measures. One of their slogans was “Masks turn us into slaves”. Similar protests took place in other German cities, as well as in the United Kingdom, the United States and Canada.
Around the world and in Bulgaria
The COVID-19 pandemic is occurring during a time of technological revolution and an historically unprecedented level of freedom in the flow of information, people, goods, and capital that has enabled the world to see how the land lies.
Unsurprisingly, given the lack of trust in news media and institutions in recent years, Bulgaria has found itself among the countries where disinformation spreads easily, quickly, and widely. A June survey discovered that more than 40 percent of respondents believed that SARS-CoV-2 was an artificial virus, even a type of biological weapon. Almost a quarter of respondents think that the virus doesn’t exist.
The controversial messages for and against mask-wearing around the world influenced the national debate on tackling the COVID-19 epidemic and its consequences. Moreover, Bulgaria is probably the only country in the world that managed within 24 hours to introduce mandatory wearing of masks in all public places, including outdoors, then implement the measure before cancelling it to reintroduce the same regulation 11 days later. This confusing rule-making process was combined with constant public appearances by politicians and experts who
either didn’t wear masks, or wore them incorrectly, or touched, adjusted, and removed them in front of the cameras, in complete contradiction with their own recommendations.
In one case, which became iconic, General Ventsislav Mutafchiiski, head of the coronavirus National Task Force, took off his mask to kiss an icon during a meeting with representatives of the Holy Synod of the Bulgarian Orthodox Church.
Social networks were flooded with photos showing the various “unconventional” way Prime Minister Boyko Borissov wears a mask. In July, during the first face-to-face meeting of European leaders since the beginning of the pandemic, Borissov’s wrongly placed mask also made headlines around the world. The photo of the Associated Press, which captured the gesture of German Chancellor Angela Merkel, pointing to Borisov’s uncovered nose, circulated around the world and even landed on the front page of the Wall Street Journal.
In Bulgaria, a series of contradictory statements made by opposing expert camps further deepened the general confusion as to whether people should wear a mask or not. On one side, there was the coronavirus National Task Force, which resorted to using firm rhetoric to promote the need for strict measures. On the other side stood the short-lived Medical Council, which also advised the government on how to tackle the pandemic. Among its members was the infectious disease specialist Dr Atanas Mangarov, who stood out due to his alternative advice and media appearances. In more than one interview, Dr Mangarov emphasized that during his 38-year-long career he had never worn a mask in an infectious disease hospital.
At the same time, politicians didn’t help clear up the confusion. Not only the Prime Minister, but also a number of other public officials, were caught violating public health measures. Apart from Borissov, it’s not clear whether other civil servants have been fined for breaking the rules. Such penalties are important because they influence the way measures are perceived by other citizens.
After months of uncertainty, the recommendations of international organizations are now relatively in sync. While WHO is one of the world’s leading organizations in the fight against coronavirus, it wasn’t until early June that it finally updated its guidelines and, cautiously, advised that non-medical masks be worn by healthy people wherever social distancing is not possible.
The recommendation for people in vulnerable groups, for the sick, for those caring for the sick, and for medical staff to wear a medical mask remains unchanged.
At the end of June, obligatory mask-wearing in indoor public places was reintroduced in Bulgaria. This was also required of students when they returned to school in September. This move was not a precedent. On the contrary, mandatory mask wearing has become a standard measure across Europe in an effort to adapt to the “new normal”. In Germany, one of the most discussed topics is how schools deal with the rule that children should wear masks. In Paris, masks are again mandatory for everyone over the age of 11, even in some open places where keeping an adequate distance apart is impossible. The situation is the same in Madrid while in Brussels, Rome, and Athens, masks are mandatory in closed public places.
Wearing a protective mask remains one of the “softest” measures in the fight against COVID-19, along with regular hand-washing and social distancing. In May, Angel Kanchev, Bulgaria’s Chief State Health Inspector, predicted that masks will remain in our lives for a long time. At the moment, it seems very likely that this prediction will come true.