Three years into the pandemic, mask usage varies from country to country

Water pours from a fountain in the central plaza of the small town of Tule in southern Mexico. The national anthem plays from the loudspeakers of city hall. Small groups of people stroll leisurely. Many of them are still wearing masks.

“Here in Oaxaca, there have been many deaths because of COVID [-19],” said Maria Jesus Hernandez, a local cook who’s waiting for a friend. “Many people got scared. So, more than anything else, wearing a mask is a precaution.”

That is something heard over and over again on the streets of Oaxaca: precaution, prevention, protection. Mexico was hit hard in the early days of the pandemic. More than 330,000 people have died. And many are still taking the pandemic seriously.

In towns and along roadsides, a lot of people walk the streets in face masks. Oaxaca is one of five Mexican states where mask mandates are still in effect at schools and on buses.

“Many people had a really hard time with their health during the pandemic,” said Diego Vasquez, a doctor who practices general medicine in Oaxaca. “I think that’s why, despite the vaccine, a certain percentage of the population is still concerned and still using masks.”

This reality is quite different elsewhere around Latin America. Brazil, for instance, was also hit hard by the pandemic, with 700,000 deaths. But, there, masks feel like a thing of the past.

When Brazilians celebrated Carnival in mid-February, masks were nowhere to be seen.

COVID-19 researcher Isaac Schrarstzhaupt said that’s because Brazilians, in general, do not have a culture of prevention.

“Brazilians have a culture of just letting the problem come and then having to fix things later,” he said. “But in Asia, they have a culture of prevention. They want to prevent the problem before it comes.”

Many Asian countries, and in particular, China, battled COVID-19 with strict lockdowns and restrictions. They’re opening up now. But masks have been widespread throughout.

“I think there are cultural differences in Asia as a whole,” said Ben Cowling, a British epidemiologist at the University of Hong Kong. “Mask use in Korea, in Japan, Taiwan, Singapore has been relatively high throughout the pandemic. There were mandates in some parts of Asia, but even in places where there weren’t mandates, mask use was certainly higher than in other parts of the world.”

In part, that’s because many East Asian countries have a longer history of widespread mask usage going back to the 2002 SARS outbreak.

Meanwhile, in the United States, masks and vaccines have become politicized.

“Mask wearing, especially being a very visible thing, becomes a part of identity, so people identify themselves partly by whether they are willing to wear masks or not,” said Donald Milton, a professor at the University of Maryland’s School of Public Health.

Masks are not perfect. But studies in recent years have shown that they helped decrease COVID-19 cases by 10% to 20%  in places where their use was widespread. And that was a godsend for health services battling waves of COVID-19, particularly before the vaccine. But for the most part, mask campaigns are being rolled back as countries try to move on.

UC Santa Cruz medical anthropologist Carlos Martinez studied public health in Mexico throughout the pandemic. He said that this is another reason why he believes many Mexicans are still wearing their masks.

“Mexico does have a form of national health care, but particularly, in the pandemic, it became really difficult for people to access care, as in Mexico City, supplies became very difficult to access for people and I think that really penetrated public consciousness in Mexico,” he said.

In other words, with a problematic health system, masks became an easy way for people to try to protect themselves and their families.

Back in Tule, 16-year-old Norberto Fabian Lopez said that’s why he’s still wearing his.

“Some of my grandparents are pretty sick with other illnesses, and I wouldn’t want to bring COVID-19 home and pass it to them.”

Lopez said he had a hard time getting used to wearing a mask in the beginning.

“It bothered me,” he said. “It felt like I couldn’t breathe well. But some of my friends died of COVID [-19] and I realized I had to take care of myself and my family.”

Like many of those on the streets there, Lopez said that wearing a mask is just a habit now. And it’s something he’s expecting to have to have to do for a long time to come.