2.1 Face covering as symbols of disease and separation
Tuberculosis (TB) offers an interesting case example where medical masks have been used to prevent spread in health facilities and homes.12 TB is a common, yet highly stigmatised disease. In countries with a high TB burden, medical masks are associated with having Tuberculosis disease, and those who wear one are singled out and ‘marked’ by this publicly visible symbol. 13,14 TB affected communities have suggested universal mask wearing as an intervention to combat this stigmatisation.13 This has led to TB advocacy campaigns calling for Zero Stigma and using social media to influence the symbolism of medical masks (see box 2). The WHO’s initial advice for the use of face coverings by the public similarly recommended their use only for people with symptoms of COVID-19 and those who care for them.8 Such a policy may entrench and propagate similar stigma as seen with TB.13