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Question: Are folks in Nashville (Tennessee) taking COVID seriously? How does the pandemic culture compare with the DC-area?

Answer: Pandemic culture between the DC area and Nashville area is vastly different in my estimation. From what I saw in Nashville, very few people wear masks. Shops don’t require customers to wear them and people just don’t seem to use them. Tourists are abundant, walking in large, unmasked groups, standing in big, undistanced lines, eating outside on crowded decks, having rooftop parties. Given how quickly cases are rising in Tennessee (Figure 1), I found the more “free wheeling” culture rather disheartening. As a reminder to us all, let me take a moment to reflect on why mask wearing is important:

Mask wearing over the nose and mouth keeps respiratory droplets from spreading more widely, thereby decreasing the ability of the virus to spread from the infected person to others. Because the virus can spread during the pre-symptomatic period (see Q&A of 6/9), it is important to wear a mask even if you are not experiencing illness. A growing body of scientific evidence supports face masks as a key intervention for reducing the risk of viral spread and slowing the spread of SARS-CoV-2. For example, a meta-analysis of 172 observational studies published in the Lancet earlier this month found that “Face mask use could result in a large reduction in risk of infection.” For a nice round-up of the additional accumulating evidence, check out this report that NPR published yesterday, “Yes, wearing masks helps. Here’s Why.”

All that said, I get why mask wearing is an issue — we have knowledge, attitude, and behavioral barriers to mask wearing (examples of which are in the bullets below). And if we are going to overcome reticence to mask wearing, we are going to have to tackle these barriers. In good news, many of the issues are similar to other public health challenges — like condom wearing for HIV/STD prevention and seat-belt wearing for injury prevention — and we can use our knowledge and solutions from these challenges to inform our approach to mask wearing.

• Knowledge: Public health communication hasn’t been clear or consistent. Initial CDC and WHO guidance was to only wear a mask if you had symptoms and then changed after a/pre-symptomatic transmission was recognized (for more on this see Q&A of 3/31) — People may not know that asymptomatic transmission is a real threat and therefore think mask wearing is unnecessary unless they feel sick; some scientists have argued that masks can increase face touching and thereby put users at greater risk (note: as more data has come out, this argument has been diminished); leadership on mask wearing has been limited — for example, the President shares guidance to wear masks but does not himself wear a mask.
• Attitudes: Trust in experts has waned; people may fear that if they wear a mask, they will be perceived as sick, weak, or fearful; for some, masks have been turned into a political symbol; for some, they have also been turned into a symbol of emasculation.
• Behaviors: Masks aren’t that comfortable to wear; they are not readily accessible (you typically have to buy them or make them, which takes time, money, and effort); because it’s a new behavior, there need to be ample triggers to remind individuals of the new behavior.

Figure 1. Cases in Tennessee are Rising (data from covidtracking.com)