Honolulu resident Cyrus Won always has a face mask handy in case he needs to put it on, and keeps a spare one in the glove compartment of his car.

For Won, a retiree, wearing a face mask during a pandemic is a way of showing aloha. It’s no longer about handshakes, hugs or a kiss, but wearing a mask.

“This is Hawaii,” he said. “If you have aloha and show aloha for others, then you wear a mask.”

In a recent letter to the Honolulu Star-Advertiser, Won wrote that masks are worn to protect others and that people who refuse to wear them are posing a risk to others. It is about thinking beyond oneself, he said. Being over the age of 60, he is careful while out and about but has seen others blatantly disregard the rules.

Gov. David Ige, along with Honolulu Mayor Kirk Caldwell, mandated the wearing of nonmedical face masks when visiting essential businesses in April to help stop the spread of the new coronavirus. In Honolulu, masks are required to visit a business as well as to shop and ride the bus, with some exceptions. Masks are not required for outdoor exercise. Hawaiian Airlines requires passengers to wear masks for the duration of a flight.

Scientific studies have shown face masks to be effective in helping to prevent the spread of the coronavirus, according to Dr. Darragh O’Carroll, who was at Caldwell’s news conference to explain how it works, physiologically.

O’Carroll said COVID-19 is an upper respiratory illness, and the virus transmits and multiplies in airways, including the nasal cavity, and travels down to the lungs. When people talk, laugh or cough, these droplets and aerosolized virus particles are expelled from their mouths.

“Even when you’re talking, these droplets can transfer out into the environment to someone you’re talking to,” he said. “One way to combat this is to wear a mask so those droplets and aerosolized particles are not spreading around you.”

Masks make difference

A recent National Academy of Sciences study compared the role of mandated face coverings in three epicenters of the pandemic — Wuhan, China; Italy; and New York City — and found that it made a difference.

The researchers said in their analysis that face masks made a difference for these three epicenters and significantly reduced the number of infections — more than 78,000 in Italy from April 6 to May 9, and over 66,000 in New York City from April 17 to May 9.

“Other mitigations measures, such as social distancing implemented in the United States, are insufficient by themselves,” the researchers said in their abstract. “We conclude that wearing of face masks in public corresponds to the most effective means to prevent interhuman transmission, and this inexpensive practice, in conjunction with simultaneous social distancing, quarantine, and contact tracing, represents the most likely fighting opportunity to stop the COVID-19 pandemic.”

O’Carroll said unlike the SARS epidemic of 2003, the new coronavirus has spread to many people who remain asymptomatic or pre-symptomatic. With SARS, people with symptoms could easily be identified for isolation. With the new coronavirus, the number of people without symptoms — approximately 30%, according to the Centers for Disease Control — presents a challenge.

At the same time, with President Donald Trump refusing to wear a face mask, the decision over whether to wear one has turned into a political football in the U.S., inciting protests in some states and prompting the resignation of a county health official.

Hawaii, despite leaders who embrace the face mask mandate, is not entirely immune to the controversy dividing the nation.

Tina Yamaki, president of Retail Merchants of Hawaii, said there have been confrontations, as well as threats, at local stores.

“It has happened here,” she said. “It’s not the majority. It’s just a handful of people. It’s the handful that makes it worse for the majority.”

Retailers are in an awkward position of enforcing the mask wearing mandate inside their businesses.

The problem, oftentimes, is not that customers enter without a face mask, but that it starts to slip or dangle from one ear at some point inside the store, she said. Some get offended when politely asked to put the mask back on. Many say their masks slipped, and retailers have heard all kinds of excuses.

“It’s not about you,” she said. “It’s about the protection of other people, the kupuna, our children, the workers and other people in the community that may be affected.”

O’Carroll said in order to be effective, the face mask needs to cover both the nose and mouth, below the chin, and fit snugly to the side of the face.

In addition to preventing the spread of droplets, the mask — depending on quality and number of layers and other environmental factors — can also help protect the person wearing it.

“It’s both protection of yourself and protection of others,” said Victoria Fan, assistant professor of health policy at the University of Hawaii. “It confers both benefits.”

Fan said wearing a face mask is “one of the three or four most critical things you can do” to prevent the spread of the virus and that government leaders should repeat these four things — wear a face mask, wash your hands, maintain physical distancing and comply with quarantine measures — over and over again.

Inconsistent message

The CDC sent an inconsistent message by not recommending the wearing of face masks initially, possibly in an effort to save medical- grade masks, N95s, for health care workers facing a shortage. Then the CDC reversed directions and said people should wear a mask.

This created confusion, according to Fan, who said consistent messaging is key, along with supply and accessibility.

“Repetition is one of the most important psychological tools we have to convince people to do things,” she said.

For anyone in a closed or crowded space, wearing a face mask is important, she said, but if others do not wear one and are spreading the virus, the overall circulation of COVID-19 is higher. There has to be a “buy-in” by the public.

“We’re all thinking about a vaccine, but prior to a vaccine, what protection do we have?” she said. “Well, wearing a face mask confers protective effects. If we convince people why we should wear it, then I think we have a better chance.”

People just seem to be letting down their guard and forgetting, said Hawaii Kai resident Charlotte Yee, who adopted mask wearing early, calling it “the new polite.”

While people were wondering where to get a face mask when the mandate came down, the options are now plentiful. Numerous retailers are selling masks in an array of patterns, prints and designs — from Old Navy to Manuheali‘i.

Won, the retiree who said masks are a way of showing aloha, ordered a face mask online with a smiley face on it, which has been a hit, he said.

As soon as Jams World came out with a mask and filter, Tracy Larrua of Kaneohe ordered one, and now has at least a dozen of various styles. She keeps some in her handbag and several in her car.

It is becoming more commonplace to see face masks on dashboards or dangling from the rearview mirrors of cars around the island.

“I have autoimmune issues and take care of my mom as well, so I need to make sure I’m protected,” said Larrua, who has lupus and rheumatoid arthritis. “When I see others wearing a mask, I appreciate it because they’re keeping me and my mom safe.”

Fortunately, she has not had any run-ins, so far, over the mask issue.

“I think definitely it’s something that is so easy to do, and anybody can do it,” said Larrua. “You just have to do it instead of feeling like it’s taking too much time or a hassle. It’s really being thoughtful of somebody else’s life.”

HONOLULU’S FACE MASK ORDER *

>> All customers and visitors of essential businesses shall wear nonmedical grade face coverings over their noses and mouths, as well as all passengers of TheBus and TheHandi-Van.

>> Owners of essential businesses may refuse admission/service to any individual who fails to wear face coverings.

>> Exemptions: banks and financial institutions; children under 5; those with medical conditions or disabilities; first responders if it impedes performance of their duties.

* Effective April 20, 2020