In the spring of 1980, my family moved from a small apartment to our first house. For a six year old boy, the excitement of having a backyard to play in was tempered by knowing that I would be switching schools in the fall. The elderly are often stereotyped as being “set in their ways”, but small children are used to their routines and typically dread change. All human beings derive meaning from the social groups to which they belong and, other than immediate family, school is the center of a six year old’s universe.
September came and the time to start second grade arrived. Wearing new clothes and shoes, I remember nervously walking into my new classroom. We are all the center of our own world and the spotlight effect often overstates the degree to which others even take any notice of us at all. But when a new kid joins a class of children that have known each other as long as they can remember, the spotlight really is on you. I was about the same size as the other boys and similar in most ways, including my clothes. But not my shoes! I wore high quality leather shoes, something similar to Rockports, while most other boys wore either Vans or Converse High Tops. Although hardly a debacle, mild ribbing ensued and is still recalled four decades later!
When we go out in public, most people want to appear at least somewhat presentable to others, especially in case we encounter individuals who we know. Generally, the goal is to appear confident, sophisticated, and polished in all but the least formal settings. What is true for the six year old entering a new school is equally true for the 22 year old starting her first job after college or the 50 year old executive going to a dinner party hosted by his company’s CEO. We compare ourselves to others, especially those who appear to be very similar in background. Most people dread “sticking out like a sore thumb” and will avoid doing things to draw attention to themselves, especially negative attention.
Social proof is a crucial principle to understand because it applies in so many different contexts and often is used to manipulate human behavior. According to Robert Cialdini, author of Influence: The Psychology of Persuasion, social proof states that one means that we use to determine what is correct is to find out what other people think is correct. Especially in ambiguous situations, we tend to look at what other people are doing as a guide for what we should be doing. If the parking lot of a grocery story is strewn with shopping carts left haphazardly, we are more likely to simply leave our cart behind our car rather than return it to the front of the store. The effect is enhanced when we see someone we perceive to be an exemplar doing something in an ambiguous situation. If a group of pedestrians are waiting to cross a busy street at an intersection, they are more likely to jaywalk against a red light if a well-dressed man in a suit starts across the street than if a homeless man takes the lead.
Taking cues from others is one of the fundamental ways in which we navigate the world, but the degree to which people look to those in positions of authority to set the tone can vary across cultures and political systems. A homogenous culture with a high degree of respect for authority is going to be much more sensitive to the tone set by political leaders than a diverse culture with a history of vigorous independent thought and skepticism regarding conventional wisdom. The stronger the sense of individualism in a society, the more resistant people are going to be to any effort by authorities to establish social norms. In particularly independent-minded societies, people may actually be eager to do the opposite of what they are encouraged to do especially if they don’t understand or agree with a policy.
While it may seem logical to observe the actions of others when deciding what you should do, we often forget that the people we are observing are probably in the same boat that we are in. They too are probably confused and looking at what we are doing. This is a phenomenon that Cialdini refers to as pluralistic ignorance. He describes horrifying incidents in New York City of large groups of people observing crimes in progress and doing nothing whatsoever to stop an attack. The media described these incidents as attributable to callousness and apathy but Cialdini believes that it is more likely that the crowd was paralyzed because each individual was looking to others to decide what to do and, in a self-reinforcing feedback loop, no one did anything.
Think back to a day not so long ago, probably in January or early February, when the COVID-19 pandemic was merely a minor news story about some weird illness in China caused by unsanitary practices at an open-air market. Many of these stories were often accompanied by photos of people wearing masks for protection. Some of us might recall seeing similar images during the 2002-03 SARS epidemic which caused several hundred deaths in China and Hong Kong.
If you lived in the United States in January, you might have read an article like that and moved on to other things fairly quickly. What would you think if you saw someone at the grocery store later that day wearing a mask? You might connect it with the story you read, or you might not, but what would quickly come to mind for most people would have been something along the lines of:
- This person has a contagious disease and I need to stay as far away as possible.
- This person is seriously ill with a compromised immune system and I should stay as far away as possible.
- This person is paranoid or eccentric and I should not make eye contact and stay as far away as possible.
In the days before COVID-19 changed the country, there was a certain stigma associated with mask wearing in the United States. It was extremely rare to see anyone wearing a mask and obvious negative connotations existed. Very few people would wear a mask in public, outside a health care setting, unless absolutely necessary. People would either think you are sick or strange. Imagine if you happened to run into one of your neighbors or coworkers!
This cultural norm existed in the United States and most western countries, but the culture of mask wearing in Asia was very different. Mask wearing carried no stigma in East Asian culture for a variety of reasons. Memories of contagious diseases, such as SARS, were more recent in Asia and many people wore masks in public simply due to the higher level of air pollution found in major cities. Wearing a mask even during a normal period of seasonal colds was considered a matter of simple courtesy and people would wear masks with various styles and patterns rather than surgical masks that evoke an institutional setting. Before COVID-19, there was no stigma associated with mask wearing in Asian cultures and there could be a stigma if someone who was sneezing or coughing was seen in public without a mask.
When cases of COVID-19 appeared in the United States, the first reaction of authorities was to discourage mask wearing by the general public. Various reasons were given for this guidance including the risk that people would wear masks incorrectly and actually increase their chances of contracting the virus if they touched their face with contaminated hands when putting on or taking off a mask. Additionally, the CDC and the World Health Organization both cast doubt on whether mask wearing would provide any protection for the person wearing the mask. This advice was in place for months after the virus appeared until the CDC finally changed its recommendation in early April.
It is important to note that there are two reasons to consider wearing masks in public:
- Wearing a mask might provide protection against contracting the virus for the wearer of the mask.
- Wearing a mask might provide protection for other people if the wearer of the mask is infected.
The motivation for the first case is to protect oneself from illness whereas the motivation in the second case is to protect others. While many people are public spirited and want to do the right thing to protect others, the reality is that nothing motivates more than self-interest. The conventional wisdom, and the opinion still expressed by experts, is that the homemade cloth masks and basic surgical masks commonly in circulation do not necessarily protect the wearer but could very well reduce the amount of virus in the air coming from an infected person.
While homemade and basic surgical masks do not necessarily provide protection, N95 respirator masks clearly do and have been in short supply in the healthcare system throughout the crisis. Due to the shortage of N95 respirators, the CDC currently does not recommend them for the general public, hoping that the limited supplies will be made available exclusively to the medical community. Being on the front lines of the epidemic, it is reasonable for national policy to seek to reserve important equipment for medical professionals.
However, in an attempt to discourage people from attempting to obtain masks early in the crisis, the government went far beyond simply making this case and urging people to not hoard N95 respirators. The government took it a step further and decided to discourage the use of all masks and to implicitly shame people into not wearing masks:
Using unprofessional language bordering on outright ridicule, Surgeon General Jerome M. Adams harnessed the principle of social proof by adding shame to the list of stigmas facing those who appear in public with masks.1 His statement was overly general, not differentiating between the types of masks, and made a blanket statement that masks are “NOT effective”. And the statement was plainly false. N95 masks, when properly used, do reduce the risk of contracting COVID-19. Cloth masks and plain surgical masks do reduce the amount of virus in the air when an infected person wears such a mask, even if such masks do not necessarily protect the wearer from contracting the virus.
As a result of the Surgeon General’s irresponsible statement, let us revise the list of things that might have crossed your mind if you saw someone wearing a mask on February 29:
- This person has a contagious disease and I need to stay as far away as possible.
- This person is seriously ill with a compromised immune system and I should stay as far away as possible.
- This person is paranoid or eccentric and I should not make eye contact and stay as far away as possible.
- This person is selfish. It won’t work and reduces the supply of masks for healthcare workers.
The end does not justify the means in a democratic society, or indeed in any society. Half-truths and outright false statements, even if made in an effort to help some perceived greater cause, are never acceptable. Trust in government and in figures of authority is essential if people are to comply with laws and policies. Instead of cynically manipulative statements leveraging psychological principles like social proof, government officials should level with the American people. The Surgeon General and the CDC could have acknowledged the fact that properly worn N95 respirators offer protection but that it is in all of our interests to ensure that health care workers are protected so that the system we all rely on when we are sick does not collapse. At the same time, they could have stated that wearing homemade or simpler surgical masks could be a responsible choice to protect others if you are an asymptomatic carrier.
Social proof is a powerful psychological force and it is well understood by individuals in business and government. By adding shame to the already long list of barriers to mask wearing, the government delayed the widespread adoption of masks in the United States by well over a month. My own anecdotal observation was that mask wearing was virtually non-existent in late February but widespread by mid-April.
To be sure, not everyone was wearing masks correctly in April and very few of the masks appear to be the N95 masks that are in short supply, but the norms of society have clearly changed. By late April 2020, the situation had flipped entirely. Seeing someone wearing a mask in places like a grocery store became the norm. And if you saw someone without a mask, you might think:
- This person is irresponsible and thoughtless. I want nothing to do with them.
- This person could be infected and spreading the virus. I need to stay far away.
The stigma flipped and social proof was now a force that encouraged mask wearing in public and this was done voluntarily. Probably many people decided to start wearing masks hoping to protect themselves but I suspect that many more simply wanted to be perceived as responsible citizens. More and more articles started appearing indicating that masks work to slow the spread of the virus further reinforcing this change of behavior.
The final cost of the COVID-19 pandemic both in terms of lives lost and economic harm will not be known for some time. Although the pandemic should not be considered a “black swan” event, it qualifies as a very unlikely event that few saw coming. Mistakes are bound to be made in such a situation by governments, businesses, and individuals. At some point, we will be in a position to identify the key mistakes that were made and hopefully learn from them.
As of May 4, 2020, nearly 70,000 Americans have died of COVID-19. The Federal government has appropriated well in excess of $2 trillion to deal with the initial economic turmoil, private businesses have suffered severe harm, and we are probably only at the end of the beginning of the pandemic rather than the beginning of the end.
When the final assessment is made, the stance of the government with respect to masks is very likely to face much deserved criticism. Masks are not a panacea and in an open society like the United States, we were always likely to face a greater toll than in countries that imposed more stringent restrictions. However, there was ample evidence to suggest that mask wearing could help at the beginning of this crisis.
Due to a shortage of personal protective equipment in the medical community, the government rightly wanted to reserve the most effective N95 masks for medical professionals, both for their own sake and to ensure that the medical system would not collapse. However, by making overly broad statements that not only questioned the effectiveness of masks in general but attached a stigma to those who wore them, the government hindered adoption of homemade masks and simple cloth coverings for well over a month. How many more cases of COVID-19 did we suffer as a result? This is impossible to know with precision but we can make inferences based on the countries that adopted masks sooner. Those in government who were responsible for the cynical use of social proof with respect to mask wearing should be held fully accountable.
- Note that the link in the Surgeon General’s tweet now states that cloth face covering should be used. The link did not make that statement on February 29 and recommended that the general public NOT wear masks. See this link for what the page looked like when the Surgeon General tweeted on February 29. [↩]