In recent weeks, the coronavirus pandemic has surged in the Netherlands, with hundreds of new infections discovered daily. While the Dutch have embraced working from home, and grudgingly adapted to social distancing, there is one powerful tool against the pandemic that they’ve largely avoided: masks.
Due to pressure from the transport union, since June, masks have been compulsory on the country’s trams, trains and buses, but optional in other areas of public life. The National Institute for Public Health (RIVM) argues that “it is not necessary to wear a face mask,” and further claims that “with these measures, the Netherlands is following the recommendations of the WHO”. However, this advice is outdated. On 7 June, the WHO published guidelines stating “that governments should encourage the use of non-medical fabric masks”. How is it possible that masks are compulsory on trains, but discouraged in shops, offices, cinemas, bars, museums, even hospitals?
This mixed message on masks is due, in part, to claims that they are ineffective at controlling the spread of coronavirus. But while evidence might have been scarce back in March, when the pandemic first exploded throughout Europe, there is a growing scientific consensus that masks play an important role in stopping the spread of infection. These include a recent study from researchers at the UMC Utrecht which found that a combination of hand washing, social distancing and masks is sufficient to prevent a future outbreak.And while masks may not be 100% effective at stopping transmission, there is new evidence that they may reduce the severity of coronavirus cases, by limiting how much of the virus we inhale. In other words, a mask doesn’t have to be 100% effective – indeed, even medical-grade masks aren’t – but a harm reduction strategy should embrace the use of non-medical cloth face masks to reduce the chances of serious illness and death.
For all of these reasons, public health bodies such as the Centers for Disease Control in the US and the Scientific Advisory Group for Emergencies in the UK recommend the use of masks in public spaces. Even in the US, where Trump has sent mixed message on masks, and videos of mask refuseniks melting down in grocery stores have gone viral, 95% of Americans now say they wear masks “sometimes or always”. Contrast this with the Netherlands where a whopping 60% say they never do.
So what’s behind the Dutch refusal to wear masks? In a familiar claim, RIVM director Jaap van Dissel argued that masks afford a “false sense of security” which might cause us to lower our guard and stop taking other precautions like social distancing. To address this point, we should first admit that the Dutch public is bad at social distancing. According to the RIVM’s own survey, just 28% of Dutch residents said they always or mostly keep 1.5 meters distance in public spaces. And although the government advises the public to stay home when they have symptoms, the vast majority ignore this advice. An astonishing 89% of people who had symptoms said they went shopping at least once while they had symptoms. 63% said they visited friends or family, while 47% still went to work. There may indeed be a false sense of security in the Netherlands, but is not because of masks. Rather, it seems likely that the Dutch aversion to masks might be precisely because they remind us that we’re in the midst of a deadly pandemic – which most people would rather forget.
Another familiar argument against masks if that they can pose health risks if worn incorrectly. For instance, if we touch an infected surface, and then touch our mask, we could become accidentally infected. But this claim falls apart with even the slightest scrutiny. For example, we know that condoms, when used incorrectly, can lead to the spread of sexually-transmitted disease. However, no public health expert would advise against using condoms to reduce one’s risk of illness. The obvious solution is to not only encourage the use of masks, but also to educate the public on proper wear and hygiene.
There may be something deeper to the Dutch hostility to masks – racism and xenophobia. In April, during a period of dramatic increase in anti-Asian racism in the Netherlands, a member of the government’s Outbreak Management Team dismissed the use of masks as “an Asian superstition”. Indeed, masks are racialized in the Netherlands, signifying otherness. In May, while wearing a mask at my local laundromat, I encountered a white Dutch couple who taunted me with “Are you Chinese? You’re wearing a mask, so you must be Chinese.”
All of this is especially absurd when we consider just how effective most Asian countries have been at controlling the spread of coronavirus – a success due in part to the widespread use of masks. Vietnam, a nation of 95 million, where masks are part of a comprehensive containment policy, has recorded only 5 deaths from the coronavirus (although the number of cases there is rising at the moment). By comparison, the Netherlands, with just 17 million residents, has lost at least 10,000 to the disease.
Finally, while the Dutch government may be immune to the evidence on masks, the public is ready for change. A recent poll found that 55% now favor a policy of mandatory masks for indoor public spaces. The mayors of Amsterdam and Rotterdam have announced plans to require masks in some areas, but what’s needed is clear, consistent national leadership. In a few weeks, the weather will cool, and we’ll all be forced indoors, where aerosol transmission poses the biggest threat. Prime Minister Rutte and the RIVM should listen to the growing body of evidence, and make masks mandatory to prevent widespread illness and untold deaths.
Written by Matt Cornell