Face masks have become iconic if multifaceted objects of the COVID-19 pandemic, a sign of conflicting views among scientific communities, public health failures, community solidarity, global trade and ecological calamity. [1] This object of care suddenly turned into an everyday object, hotly debated and making newspaper headlines. The pandemic also fundamentally changed the material culture of clothing for health care workers. While most already wore some sort of uniform, whether for hygienic reasons or as a visible sign of their status, COVID-19 profoundly transformed the codes governing clothing, beyond the mere question of masks. [2]

In medical and nursing history, the focus of interest has so far generally been on the hard things of material culture such as instruments and architecture, [3] rather than on “ordinary” clothing. [4] While some culturally inspired studies have demonstrated how clothing has materialised gender, class or race, [5] few have addressed how care practices have been conditioned by the materiality of garments. In recent years, some scholars such as Christina Buse and Julia Twigg have called for dress and care studies to be considered in conjunction with each other. [6] In this contribution, I will approach COVID dress from a twofold perspective.

The first aspect I will consider is how clothing can be seen as a boundary object [7]: both the mask and also other COVID-related garments are objects through which boundaries are negotiated in the health care sector, in particular through access to (clothing) resources which were initially very rare, but also between health care workers and the rest of the population. Over the past decades, research in science and technology studies in particular has shown that certain objects can cross boundaries between different disciplines, thereby establishing bridges between otherwise separate fields. This was how Star and Griesener originally coined the concept of boundary objects. [8] Objects can however also reaffirm boundaries: I would therefore like to maintain the term but stressing the duality of material entities, going beyond but also re-establishing boundaries.

Secondly, the paper will address the question of how these new garments were changing the sensory and emotional landscapes of health care workers. While there has been growing interest in these questions over the past twenty years, research is often hindered by the transience of the traces kept. [9] The COVID pandemic, like other moments of crisis, can shine new light on phenomena that are rarely expressed in “normal” times: “quiet practices” (or tacit practices) [10] became “noisy” to a certain extent, as everyday ways of doing that are rarely expressed were now explicitly thematised.

The paper is based on 52 interviews with 12 health care workers in Luxembourg carried out in April 2020 focusing on the first weeks of the pandemic when the topic of Covid wear was particularly visible in the testimonies. During this month, Luxembourg shifted from a strict lockdown to a progressive easing of lockdown measures. The first COVID-19 case in Luxembourg was confirmed in late February 2020 and the first fatality on 13 March. In mid-March, Luxembourg imposed a first lockdown: schools and most non-food shops and restaurants were closed, and people were instructed to stay at home. From the end of April 2020 on, these measures were gradually eased: building sites opened on 20 April, primary schools on 4 May and non-food shops on 11 May. During this first wave, excess mortality in Luxembourg compared to that of previous years was relatively limited. [11]

The 52 interviews are part of a larger corpus of interviews carried out between April 2020 and August 2021 by historians at the Centre for Contemporary and Digital History (C²DH) at the University of Luxembourg among them the author of this article. For the moment, the interviews are stored in the C²DH: it is planned to move them over to the Centre National d’Audiovisuel (CNA). A total of around 330 interviews and 136 hours of testimonials were recorded. The interviewees were selected following the snowball effect. Interviews were open-ended and not specifically related to the topic addressed in this article. Multiple short interviews – referred to as “audiovisual diary entries” – were conducted with around twenty health care workers on a regular basis, first twice a week, then once a week, then once a month. [12] “Health care workers” were defined in a broad sense: as well as nurses and physicians, the sample also included social workers, a funeral director and a cleaner.

Mixing reconstructive and narrative analysis, the transcribed interviews were used to reconstitute how the pandemic affected the social world of the care workers but also to carve out the meanings these persons gave to this experience. [13] As can be seen from the box below, the corpus is problematic on at least two levels: it includes the same number of men (6) as women (6) and almost exclusively workers of Luxembourgish nationality. However, the health care sector in Luxembourg is largely feminised – as in most European countries – and also largely driven by a non-Luxembourgish population, some of whom live in Luxembourg and some of whom cross the border every day to work in the country: 58% of healthcare professionals working in Luxembourg are foreigners; 80% of healthcare professionals are women. [14]

Biographies of interviewees used in this article [15]

Victor Perreira – Luxembourgish male social worker working in a care home for the elderly – interviewed by François Klein – one interview used for this article;*

Mike Conrath – Luxembourgish male nurse working in Schrassig prison – interviewed by Victoria Mouton – six interviews used for this article;

Melina Evangelakakis – Luxembourgish female nurse in a general hospital in Ettelbruck – interviewed by François Klein – three interviews used for this article;

Laurent Lamesch – Luxembourgish male undertaker in Luxembourg City – interviewed by Inna Ganschow – six interviews used for this article;

Maria Benvindo – Luxembourgish female nursing auxiliary – interviewed by Elisabeth Guerard – one interview used for this article;*

Carmen Majerus – Luxembourgish female nursing auxiliary – interviewed by Marco Gabellini – three interviews used for this article;

Yves Morby – Luxembourgish male director of CIPA (care home for the elderly) in Berbourg (Luxembourg) – interviewed by Benoît Majerus – three interviews used for this article;

Vera Neuberg – Luxembourgish female nurse working in a mobile blood testing team – interviewed by Marco Gabellini – three interviews used for this article;

Pierre Bofferding – Luxembourgish male general practitioner – interviewed by Vera Fritz – four interviews used for this article;*

Marc Peiffer – Luxembourgish male gynaecologist – interviewed by Manon Pinatel – two interviews used for this article;

Cécile Anciaux – Belgian female nursing assistant at Colpach rehabilitation centre for COVID patients, living in Belgium – interviewed by Estelle Bunout – five interviews used for this article;*

Géraldine Polfer – Luxembourgish female mental health professional working at the psychiatric hospital in Ettelbruck – interviewed by Victoria Mouton – three interviews used for this article.*

In the early weeks of the pandemic in March 2020, protective clothing became a hard-to-get item. In all Western countries, the lack of face masks turned into one of the first “scandals” of the pandemic and was widely publicised. [16] Obtaining these items in the different care systems became a real challenge. In many institutions, “COVIDwear” was stored in specific places and was not freely at the disposal of health care workers. In a home for the elderly, a changing room that was no longer in use was turned into a room specifically dedicated to storing these clothes and was referred to as “Fort Knox” by the director (Yves Morby – 19 May 2020) as only he had access to it. The room was still in use in July 2021, despite everybody agreeing on the fact that there was no longer any risk of shortages. This precaution was undoubtedly due to the experience of the first few weeks of the pandemic when obtaining masks, hand sanitisers, gowns and aprons became difficult as the usual suppliers were no longer able to deliver (Yves Morby – 10 April 2020).

In the preceding decades, the rationalisation of space – a larger space previously used as a storeroom no longer existed in this care home for the elderly – and the “just-in-time” approach that was introduced as part of the “new public management” policies [17] had significantly reduced the amount of protective wear that was kept in storage, making the care home more vulnerable in time of crisis. At the Colpach rehabilitation centre, masks were also rationed in the early weeks and distributed in limited numbers day by day in a sealed envelope with indications of when they should be changed (Cécile Anciaux – 2 April 2020). The state of abundance that had characterised Western societies since the end of World War Two became a state of scarcity again.

In March and April 2020, having access to this rare object and being able to wear it became a distinctive sign, an object that indicated who was a health care worker and who was not. The testimony of Mike Conrath, a nurse who worked in the prison in Luxembourg, illustrates this boundary role:

Three weeks later, masks were accessible for everyone – nurses, guards and prisoners – but the prisoners did not have medical masks; instead they had cloth masks sewn by female prisoners (22 April 2020).

The chronology of mask distribution also reveals hierarchies within the health care sector, hierarchies that reproduced inequalities – between men and women, between Luxembourgish and non-Luxembourgish health care workers – that existed before the crisis. For example, gynaecologists were supplied with masks before midwives (Marc Peiffer – 14 April 2020). Similarly, the staff of care homes, institutions that primarily house elderly people with severe dependence, did not have masks, unlike the general practitioners who visited them (Pierre Bofferding – 11 April 2020). The care assistants in the mobile team, who are at the bottom of the hierarchy of care professions – Anne-Marie Arborio refers to them as the “invisibles” [18] – did not immediately have access to masks, which caused some concern among elderly people who depended on these home care services (Maria Benvindo – 15 April 2020).

For some carers, wearing masks was nothing new. Melina Evangelakakis, who worked as a nurse anaesthetist, when asked when she first heard about COVID-19, says that it was when she saw a leaflet that made wearing a mask compulsory. At the same time, because of her speciality, it was something she was used to and therefore did not constitute “a significant change” (18 April 2020). For others, the change was more radical. Laurent Lamesch, who as an undertaker normally worked in “a shirt, tie and suit” and who was used to only wearing gloves when handling the dead, now had to put on a full protective suit when he went into the nursing home:

As a professional who worked on the margins of care and has no specific training in this field, his ability to correctly put on the “COVIDwear” was explicitly and specifically checked, a procedure that Laurent Lamesch did not formally contest but that he did explain in detail during the interview. Very often the new gear required specific training, as many health care workers had never learned to put on such clothes. Physiotherapists or occupational therapists who had had less medical training than nurses – “who had never seen basic care” as one nurse put it (Cécile Anciaux – 2 April 2020) – needed to be given accelerated training.

While masks were worn by people in specific roles within the field of care, the separation between health care workers and patients was even clearer: in the early days of the pandemic, only the former wore masks. In the first few weeks, some health care workers claimed a certain exclusivity, feeling that this object should be reserved for them, as this nurse explained:

Three weeks later when face masks were already mandatory for some activities among the general population, this narrative remained: non-health care workers were criticised because they wore masks when it was not considered necessary (driving in a car, walking alone in a park, etc.); there was a view that “masks would be more useful in certain clinics where there is a shortage” – especially as these people often failed to wear their masks correctly, thereby creating a “false feeling of security” (Carmen Majerus – 23 April 2021). These positions were perhaps also linked to the fact that the wearing of face masks by the general public was initially quite controversial, with varying recommendations in European countries. [19] Even later – when masks came into more general use – they remained small but powerful markers of social distinction: at the neuro-psychiatric hospital in Ettelbruck, nurses wore surgical masks while patients wore cloth masks (Géraldine Polfer – 25 April 2021).

At the same time, some health care workers also wore their masks outside the workplace, because they were convinced that they were a threat to their environment:

This fear also explained the preventive measures regarding workwear. Before the pandemic, Vera Neuberg sometimes kept her white coat on when she left work and only changed once she arrived home, but that was no longer possible:

While before COVID, there may have been a certain overlap in clothing between the private and work spheres, the two were very clearly separated during these first weeks of the pandemic. People whose job was intrinsically defined as helping others started considering themselves as potential dangers. For health care professionals working in COVID units, the cumbersome clothing arrangements constituted a radical break with the outside world:

The mask led to a pronounced effect of strangeness between carers and those being cared for, especially in relationships where contact was regular and frequent, such as in home care. Maria Benvindo testified to the fear she initially inspired in her patients: “when we arrived we had a mask [...] it was a bit, um, scary for them but they are used to it now.” (15 April 2020). Some activities shared by health care workers and those being cared for become impossible because of masks. For example, in a ward for mentally disabled people in the neuro-psychiatric hospital in Ettelbruck, it was no longer possible for staff and patients to eat breakfast together because staff were obliged to keep their masks on. (Géraldine Polfer – 15 April 2020). Wearing masks also became a problem when meeting new patients:

The depersonalisation introduced by the mask was perceived as a significant hindrance to quality care that was partly based on (facial) recognition.

This was even more embarrassing for care workers who changed their appearance significantly. For undertaker Laurent Lamesch, the relationship he had with relatives of the deceased was disrupted by the new gear. The black suit and very sober style was his “uniform” as an undertaker, and the protective clothing created a significant barrier with the living, who felt “insecure” when they saw him appear like this (7 April 2020). The gaze of others transformed the undertaker from a benevolent person into someone who was potentially dangerous.

When the first lockdown began to be lifted in late April and early May 2020, the mask lost its distinctive character as the wearing of masks became compulsory for everyone and was thus widespread among the population.

Another reason that “COVIDwear” was such a key marker was because dress is a central element in the sensory experience of care. The pandemic called existing balances into question.

In the first few weeks of the pandemic, the mask turned into a distinctive element. Just as the nurse’s uniform had become a defining element of nursing in the early 20th century, [25] masks emerged as the symbol of the health care professional. Protective clothing was not only seen as a way of achieving “infection control” but also as a way of identifying oneself as a health care worker (“the ones with the masks”) and expressing professional expertise in a non-verbal way (“putting on a mask correctly”). The moral economies that dictated access to these rare objects were widely accepted, even if they strongly reproduced the social and symbolic inequalities that governed the world of remunerated care. At the same time, they were seen as making relationships between patient and practitioner and among health care workers more difficult by sensorially, physically and emotionally changing their working environments.

These new “protections” thoroughly changed the care experience in several ways. As they enclosed the body more intimately, working conditions became more laborious. The impossibility of going to the toilet and/or drinking water, for example, gave rise to new experiences of the body. In addition, verbal and non-verbal communication between co-workers but also with patients turned into a difficult exercise. Ways of caring that were previously taken for granted, such as touching patients, were considered problematic. The sensory landscapes of care (vision, hearing, touch, taste, smell) were fundamentally altered. Working rhythms had to be adopted as putting on the garments took longer. Care clothing had been characterised by a slow destandardisation since the 1970s, [26] but the pandemic reinstated the need for a medical “uniform”.

Clothing regulations once again became very strict. Like the nurse’s uniform in the early 20th century, “COVIDwear” brought with it an inherent notion of “formatting” of the body [27]: the mask, for example, existed as a highly standardised object and was not necessarily adapted and adaptable to bodily diversity, meaning that tinkering was required by health care workers. Although none of the people interviewed questioned the (medical) necessity for masks and other protective clothing, they all stressed the strong disadvantages for their bodies, particularly through the marks that these objects left on the body and the discomfort (breathing, sweating, etc.) that they caused. Several of the health care workers also emphasised that protective clothing led to a strong decline in non-medical care because non-verbal communication became more difficult.

It remains to be seen whether, as with the Black Death of the 14th century or the Spanish flu, which are considered as pivotal moments in the dress codes of care, [28] the COVID-19 pandemic will also be considered as a turning point. One of the remarkable aspects is a certain standardisation, especially the use of masks for health care workers: while there were differentiated temporalities of access to masks which served as a magnifying glass for hierarchical differences, there was also a rapid standardisation that created a certain unity between roles that at first sight appeared very distant, such as the general practitioner in a hospital, the mental health professional in a psychiatric hospital and the employee of a funeral parlour.

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