Changes in awareness on face mask use in Korea.

The present research aims to determine, from the perspective of public health nursing, how Koreans have implemented the mandatory use of face masks during the COVID-19 outbreak by increasing public awareness in the following order: familiarly wearing, frequently wearing, and always wearing a face mask. Other nations may consider applying in their own policies the lessons learned by Korea regarding changes in awareness on face mask use.

INTRODUCTION

Coronavirus disease 2019 (COVID‐19) is a highly contagious disease that is caused by a new strain of coronavirus (SARS‐CoV‐2). It can result not only in death but also in long‐lasting health challenges for those who survive the disease. The first outbreak of COVID‐19 was reported in China at the end of 2019 (Zhu et al., 2020). Mainly because COVID‐19 was a new pandemic, very few people knew how to respond to or deal with the disease until almost the first quarter of 2020. Thus far, many individuals still argue about the wearing of face masks as an emergency response to the COVID‐19 outbreak due to multiple factors, including politics, economic benefits, personal preference, regional temperature, and local culture.

The issue of face mask use as a kind of non‐pharmaceutical intervention may be implemented at a low cost and without abrupt disruption of medical or social practices (Sikakuya et al., 2021). From the perspective of public health nursing, whether people wear face masks or not is crucial to relieving the impacts of COVID‐19. At the same time, the correct use of face masks contributes to an efficient response to the transmission of SARS‐CoV‐2. The wearing of face masks helps increase psychological confidence among masked people and their close contacts during these times of uncertainty.

South Korea (hereinafter Korea), as a neighboring country to China, was hit by the outbreak of COVID‐19 earlier than other countries were. However, the total number of human losses and the amount of confirmed infections in Korea have not been greater than those in other nations. One reason for this is the willingness of many Koreans to wear face masks in public places (Kang et al., 2020). This does not mean that the Korean people are comfortable with the wearing of face masks. In fact, the attitudes of Koreans regarding the use of face masks have changed progressively.

This research aims to examine how public awareness on the wearing of face masks has changed in Korea during the pandemic toward the ultimate goal of disaster management. Awareness refers to the perception of wearing a face mask. Three phases of changes in awareness in Korea are discussed: familiarly wearing a face mask (from a historical perspective), frequently wearing a face mask (around the beginning of 2020), and always wearing a face mask (beginning in winter 2020). Additionally, a lesson on policies regarding the use of face masks is provided for other nations.

THREE PHASES OF CHANGES IN AWARENESS ON WEARING A FACE MASK

The first phase is that of familiarly wearing a face mask. The wearing of face masks has long been a common practice among Koreans, who consider it a natural protection during cold weather, much like the use of winter clothes. In this regard, the local culture did matter during the emergency situation. That is, the Koreans did not attach any stigma or feel any guilt regarding the use of face masks in public places.

The ancient Chinese philosopher Confucius emphasized the importance of etiquette in maintaining the relationships among individuals in a society (Yum, 1988). In substantially following Confucianism, Koreans have also come to embrace this principle. Hence, Koreans suffering from colds or influenza were willing to wear face masks outdoors as a way of showing respect and consideration for other people.

During the spring season, between March and May, yellow dust originating from the dry deserts of Mongolia and northern China are carried to the Korean peninsula by strong winds. The phenomenon typically lasts less than a month. However, because yellow dust causes serious public health concerns in the nation, local governments began to formally issue warning(s) around the beginning of 2014. The yellow dust phenomenon is one of the reasons why the majority of Koreans tend to seasonally or familiarly wear face masks.

The second phase is that of frequently wearing a face mask. During the outbreak of the Middle East respiratory syndrome coronavirus (MERS‐CoV) in 2015, Koreans experienced firsthand the effectiveness of wearing face masks. The number of human losses was 38, whereas the total number of patients quarantined nationwide was 16,993 (Lim et al., 2020). There was an increase in public awareness on the use of face masks, which were worn frequently during the emergency, despite resistance from some people.

Following the first confirmed case of COVID‐19 in January 2020, Koreans started frequently wearing masks. Nonetheless, the Korean government did not emphasize the significance of this practice compared with other safety measures, such as disinfection, ventilation, and social distancing (CDCH & CDMH, 2020). The fact that the Centers for Disease Control and Prevention (CDC) did not recommend the use of face masks for Americans left many Koreans somewhat confused, and the warm weather discouraged many individuals from willingly wear face masks during summer.

During the initial period of the COVID‐19 outbreak, many Koreans believed that the economic impact of the pandemic would not last long. However, as the economic damages steadily increased due to quarantine restrictions, limits on business hours, unemployment, and other factors, individuals began reacting. For example, many owners of small businesses frequently asked their customers to wear face masks within their business areas. Some face mask manufacturers were arrested for stockpiling their products in warehouses to force an increase in prices.

The third phase is that of always wearing a face mask. Given that Korea was unable to decrease the speed of coronavirus infection by around the end of 2020, residents were asked to stay home and not go out except to buy essentials and go to work. During the Korean Thanksgiving break (5 days from the last day of September), individuals and families were advised not to visit their hometowns as they have traditionally done.

Since mid‐October 2020, the Korean government has required people to wear face masks in public places, such as mass transportation media, medical facilities, and demonstration sites (Yonhap, 2020). Despite complaints about the related public policy and guidelines, fines were imposed on those who refused to wear face masks and on those who wore their face masks improperly, such as below the nose. Consequently, Koreans now have to always wear face masks instead of only when they felt the need to do so.

Some important factors may further explain why Korea has implemented the mandatory use of face masks (Griffiths, 2020). Based on laboratory experiments, wearing face masks as a source control of infection plays a role in significantly blocking respiratory droplets. Considering that asymptomatic COVID‐19 transmission has recently occurred in Korea, the wearing of face masks makes the public feel safe. Although it is a scientific fact that asymptomatic spread is further rarer than expected (Jeong et al., 2020), such transmission still has a psychological impact. Moreover, without the use of face masks, even fully vaccinated people have been unable to protect themselves from the delta variant.

A LESSON LEARNED

The wearing of face masks would be most effective if 100% of Koreans in the region adopted the practice. Also, few Koreans have realized that wearing two masks instead of one is more effective against COVID‐19 infection (Brooks et al., 2021). Nonetheless, the wearing of face masks has in one way or another contributed significantly to slowing down the transmission of coronavirus infection in Korea. The process of arriving at this third phase of always wearing face masks to protect against COVID‐19 infection has been slow; however, with the nation having to turn to various factors, such as government policies, the pandemic situation, seasonal weather, local culture, and Confucianism, to effect the change in awareness.

The changes in awareness can well explain how Koreans have come to adopt the practice of always wearing face masks during the pandemic emergency. Awareness increases the extent of enthusiasm, energizes self‐mobilization, and animates the national trend (Kite et al., 2018). In fact, awareness changes may or may not happen in time, depending on the regional contingency. Although the coronavirus has spread throughout Korea within a short interval, stakeholders have decisively addressed awareness changes to ensure the survival of the fittest.

Paradoxically, lack of awareness on the use of face masks has led many people in some nations to not always wear them, which has resulted in large numbers of human losses (Kellerer et al., 2021). Although the wearing of face masks may not be a panacea, without it the effects of other measures, such as vaccination, social distancing, and handwashing, might prove to be unsuccessful. Also, the Korean case clearly indicates that changes in awareness on the use of face masks may happen in time if appropriate measures are implemented. To summarize, urgent and systematic efforts to improve awareness on face mask use in other nations will facilitate regional control of coronavirus infections.

The findings of this research may provide appropriate recommendations for nursing practice regardless of national boundaries. Basically, nurses as caregivers for patients need to understand how to correctly wear their face masks. Although the wearing of face masks is mandatory in hospitals, some patients are still unwilling to do so. In this context, nurses may work toward decreasing communication barriers between them and their patients, in particular by referring to the Korean case. Most importantly, nurses need to improve their patients’ awareness on wearing face masks in a timely manner.

CONFLICTS OF INTEREST

The author declares no potential conflicts of interest with respect to this research.

ETHICS STATEMENT

Ethical approval has not been needed for this manuscript.