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The moment France confirmed its first novel coronavirus case on Jan. 24, Siyu Cao went online and ordered a box of facemasks.

Cao, a Paris-based artist who hails from Beijing, noticed that none of her French friends shared her reaction. But for Cao, donning a surgical mask was a reflexive response.

Cao was a teenager in Beijing during the 2002-2003 outbreak of severe acute respiratory syndrome (SARS) that killed almost 800 people, and recalls the giddy boredom of weeks cooped up at home because school was cancelled, and the fear and worry when people she knew were hospitalized.

“Everyone who has lived through [SARS], they’re prudent, they won’t joke about it,” Cao says. “It has become a habit for people actually—the first thing, the default thing we go to is the mask to protect ourselves.”

Today’s novel coronavirus, 2019-nCoV, belongs to the same family as the virus that caused SARS. On Friday morning, cases of the current coronavirus neared 10,000 worldwide, and the number of deaths passed 200. Most of the cases and all of the deaths occurred in China.

At least 18 other countries have also reported coronavirus cases, and the World Health Organization on Thursday declared an international public health emergency. And as the coronavirus has spread, the habit of wearing facemasks has too—transforming what was once an inexpensive piece of medical paraphernalia into a cultural symbol and a lightning rod for fear.

Do facemasks really protect?

Facemasks became ubiquitous during SARS, and, bolstered by later outbreaks like the avian flu in 2006 and swine flu in 2009, became a go-to preventative health measure for people in China and other parts of Asia.

This history has created a “sociocultural pressure to conform” to wearing a facemask in public, says Ria Sinha, a senior research fellow at the Centre for the Humanities and Medicine at the University of Hong Kong.

“The facemask is a cultural symbol of protection in East Asia—for yourself and others,” Sinha says. “So while there is plenty of evidence that suggests masks do not prevent a person getting an airborne disease such as influenza, it is seen as respectful to others to wear one in public if you are ill.”

Today, in response to the international spread of the current coronavirus, that behavior has spread. People are panic-buying and hoarding facemasks, causing shares in the companies that make them to surge and forcing e-commerce sites to crack down on counterfeits and price gouging.

In the U.S., which has five confirmed cases out of a global 9,800, consumer panic has led to Amazon vendors and major retailers selling out of facemasks, prompting a shortage that could increase the risk of disease by depriving hospitals of facemasks, where infection rates are highest and protection is needed most.

Employees work on the assembly line to make protective masks at a factory operated by Dasheng Health Products Manufacturing Co. in Shanghai, China, on Friday, Jan. 31, 2020. People across the globe are stockpiling facial masks to protect themselves from the new coronavirus, depleting online malls and store shelves from California to Beijing. Photographer: Qilai Shen/Bloomberg via Getty Images — Employees make protective masks at a factory operated by Dasheng Health Products Manufacturing in Shanghai, on Jan. 31, 2020. People across the globe are stockpiling masks as protection against the new coronavirus, depleting online malls and store shelves from California to Beijing.

The worldwide run on masks belies the medical consensus that while facemasks are useful as a “last line of defense,” they are not nearly as effective in preventing the spread of germs as hand washing and avoiding sick people.

Still, facemasks can be useful when worn by sick people, preventing cough and sneeze droplets dispersing into the air, and many governments continue to encourage the use of masks. Singapore is giving free facemasks to every household, and Macau organized fixed-price sales for residents.

In Hong Kong, where the same officials who banned facemasks in October for their use in political protests now sport them at press conferences, looped announcements in subway stations exhort, “Please wear a mask if you have a cough, cold, fever, or sore throat.”

Xenophobic backlash

As France announced more coronavirus cases—six total as of Friday—Cao heard reports that Chinese people and people perceived to be of Chinese descent were being targeted with racist comments and blamed for spreading the coronavirus.

After hearing about an Asian woman wearing a facemask who was “insulted and expelled from a train [in Paris] by the other passengers,” Cao decided to address it in her webcomic.

Cao posted the cartoon on Jan. 28, accompanied by a caption attempting to clear up the “misunderstanding and public panic” in France towards Chinese mask-wearers.

Two days after she posted it, the cartoon had 30,000 likes and 400 comments on Instagram, far above average. On Facebook, it had 11,000 shares, thousands of likes, and hundreds of comments.

Many of the comments detailed similar experiences of discrimination everywhere from Canada and the U.S. to Australia and Germany.

“[S]haming and ridiculing people who choose to wear masks ignores the vast collective trauma of Sars that was shared by millions,” Ian Young, a South China Morning Post blogger, wrote on Wednesday in response to Twitter posts mocking Asian mask wearers in Vancouver.

A girl helping her mother wearing her safety mask near the Louvre Museum in Paris, France, on 26 January 2020. (Photo by Jerome Gilles/NurPhoto via Getty Images) — Chinese people and people perceived to be of Chinese descent have been targeted with racist comments and blamed for spreading the coronavirus. Here, Chinese tourists wearing safety masks near the Louvre Museum in Paris, on Jan. 26, 2020.

In Hong Kong—where around 40% of SARS deaths occurred—queues at local pharmacies snake around the block and some sellers have jacked up prices on masks and heavy-duty N95 respirators.

Unlike in France, the people who stand out on commuter trains in Hong Kong are the very few who are not wearing masks.

A broader significance

Facemasks are incorporated into daily life in China and other Asian countries in ways unrelated to disease prevention: as a fashion accessory, as political protest, as a way to guard against pollution or to hide a pimply or makeup-free face, or even as a social firewall for the chronically shy.

Now, in the face of the novel coronavirus, facemasks are also becoming an expression of community solidarity. Chinese NGOs, individual citizens in China, and Chinese-Americans living abroad are donating masks and raising money to help the facemask shortage in Wuhan and surrounding Hubei province, the center of the outbreak, where hospitals are in especially dire need of supplies.

Cao says the facemasks she ordered have not arrived yet. “I guess all the Chinese people who are in Paris have been on Amazon like me,” she says, laughing.

When her masks do arrive, Cao says she will wear them on the Paris Metro, “especially to protect others as well. I don’t mind. I mean, there will be weird looks, but I think what’s more important is I have to. It’s for their good as well.”