Should surgical masks be a part of travel etiquette?
It's become the symbol of the coronavirus angst that has gripped the travel industry.
The surgical masks, widely worn throughout China, Japan and Southeast Asia, are a visible cultural marker of concern for an invisible threat.
In a Korean pharmacists they are as readily available as a sticking plaster, but do surgical masks actually help prevent the spread of disease?
Images of people packing out airports, public transport and streets wearing the masks have accompanied reporting of the travel industry's efforts to stop the spread of novel coronavirus (2019-nCoV).
However, anyone who has travelled through China or Japan will know that surgical masks are worn whether there is an outbreak of influenza or not. Here face masks are a common part of travel hygiene.
A surgical mask on the subway might just be a sign that someone was feeling under the weather and, out of consideration for fellow commuters.
Wearing a mask is a sign of respect.
A survey published in the Singapore Medical Journal found that a majority of Japanese respondents felt that the wearing of a face mask was a sign of being "respectful" and taking responsibility for one's health and the community.
It's something that is reinforced in advertisements for surgical masks as a family health staple. Not something that is worn in the event of a public health emergency.
In China the masks are worn on to combat pollution. China's National Meteorological Centre will issue a "yellow" smog warning in urban areas with advice to wear face masks. Although far less effective than dust masks, during the widespread smog of 2014, the ShanghaiDaily reported that city residents spent over $200m on surgical masks.
The mask became a common sight in mainland China following the Spanish influenza outbreak of 1919, adopted as a barrier against airborne diseases.
100 years on, faced with the prospect of another flu-like virus, wearing a surgical mask is a cultural reflex in many parts of Asia.
Following the outbreak of coronavirus demand for masks has risen in Thailand by 80%.
"Sales of disinfectant products and hygiene masks have been rising since last week. First Chinese tourists came to our store to buy these products to bring back with them. They bought in bulk, like two or three boxes per person," Varumporn Krataitohg, an employee of the NanBhesaj drugstore in central Bangkok, told Associated Press.
It's a precaution that many health bodies see as being effective, to an extent.
The WHO has endorsed the face masks as a precautionary measure to avoid contracting coronavirus.
Colleen Kraft, an infectious disease expert for the Emory University Hospital, said that the masks can be effective in combating the two most common ways of contracting a virus in an interview with the Washington Post.
"The mask not only protects you from droplets," said Kraft. "It also protects you from bringing your hand, which may have virus on it, to your mucus membranes such as your nose and your mouth."
However, the masks are only effective under certain circumstances.
If not changed regularly they can become useless, and far less effective when not used with other hygiene precautions.
Dr Jake Dunning, head of emerging infections at Public Health England, told the BBC that : "Although there is a perception that the wearing of face masks may be beneficial, there is in fact very little evidence of widespread benefit from their use outside of these clinical setting."
He said that the masks must be worn correctly and changed frequently in order to benefit from their protection.
"Research also shows that compliance with these recommended behaviours reduces over time when wearing face masks for prolonged periods," he added.
Surgical masks provide some protection but are not meant to be a substitute for the recommended anti-viral hygiene practices.
If you have not recently travelled within China, flu-like symptoms or colds should not be a great concern. However, travel hygiene should be observed in public places.
The Centre for Disease Control issued a separate set of advice for travellers who may have been exposed to the virus.
If you have travelled internationally and feel flu-like symptoms or difficulty breathing the CDC advises travellers to:
- Seek medical care right away. Before you go to a doctor's office or emergency room, call ahead and tell them about your recent travel and your symptoms.
- Avoid contact with others.
- Not travel while sick.
- Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.
- Wash hands often with soap and water for at least 20 seconds. Use an alcohol-based hand sanitiser if soap and water are not available.
The CDC also advised suspected carriers "to wear a surgical mask as soon as they are identified."
The WHO's recommends travellers follow a few basic principles to reduce the risk of spreading the disease:
- Avoid close contact with people suffering acute respiratory infections
- Frequently wash hands, especially after contact with ill people or their environment
- Avoid close contact with sick live farm animals ore wild animals
- People should practice "cough etiquette" (maintain distance, cover coughs and sneezes worth disposable tissues or clothing, and wash hands)
In New Zealand travellers who become sick within a month of their arrival are encouraged to seek medical advice on the free contact Healthline 0800 611 116 or from a doctor.
"It is important to mention recent travel to Wuhan and any known contact with someone with severe acute respiratory illness who has been in Wuhan," says the Ministry's advice.