Jun 26 2020

Face Mask War

It’s always disappointing (not surprising, but disappointing) when a purely scientific question unnecessarily becomes a political or social one. Whether or not to wear a face mask during an historic pandemic should be purely a question of risk vs benefit – does it work, and is there any downside? The evidence is clear enough at this point that mask wearing helps reduce the spread of COVID-19. David Gorski recently reviewed the evidence, including a recent meta-analysis, and found:

When it came to masks, an analysis of 29 unadjusted and 10 adjusted studies demonstrated that the use of masks was also associated with a large decrease in transmission, both for N95 masks and for disposable surgical masks or similar reusable 12- to 16-layer cotton masks.

Since that review there have been further studies, such as this one, showing that countries who adopted mask wearing early had fewer cases of illness. The benefit, therefore, seems clear. What’s the downside? Pretty minimal. Sure, it may be a pain and a bit uncomfortable, but this is a minor nuisance at worst. People who are hard of hearing and rely on lip reading probably suffer the biggest downside. There are masks with transparent sections over the mouth to facilitate lip reading, however, for those who need to deal with the hearing impaired.

So wear a mask if you are sick, around other people who are sick, or just in public. In some countries it is considered hygiene etiquette, as it should be.

As a side note, there is some confusion because early on the WHO recommended not to wear a mask in public unless you or others were sick. This was not because the evidence did not support it, however, but because there was a shortage of PPE and people were hording. The idea was to make sure that essential workers had enough masks. This is no longer an issue, and the WHO has revised their recommendations, which are now in line with the CDC – wear a mask, even just to go in public.

And yes – it is still necessary. Depending on where you live it might feel as if the worst of this pandemic is over. The evidence, however, shows that we are just getting started. Look at the graph from the latest worldwide numbers – the curve is still accelerating upwards. It certainly looks like we are not only still in the first wave, but we haven’t crested yet. And of course, once the virus works its way around the world it may come back around for a second or even multiple waves, which is what respiratory pandemics tend to do.

In the US we are seeing a similar trend. There was an initial spike because of NYC, and the northeast in general got hit pretty hard, as well as some other urban centers. Those areas are now on the far side of the first wave, but the rest of the country in total is still increasing in daily cases. Most states are increasing, and some states that opened up perhaps too quickly and not carefully enough are spiking. This is not due to increased testing, because there are more hospitalizations, and the percentage of positive tests is going up.

Even if it feels like the worse is over, the numbers tell a different story. No one wants prolonged economic shut down – that is not sustainable, and will eventually start to have its own toll that can rival the pandemic itself. We needed a shutdown as an emergency measure, but now we need to be shifting into a long term sustainable strategy, and that has to allow as much economic activity as possible. That means we need aggressive hygiene etiquette.

That is the irony of the anti-mask push back. Interestingly, there same thing happened during the 1918 flu pandemic. Mask-wearing was a thing, it was enforced, and some people protested, calling themselves the anti-mask league. The sentiment today is similar:

“Your neighbor thinks he has the power,” a protester wrote in chalk, referring to health officer Chris Farnitano.

“Tyranny is not the answer,” wrote another.

“My body, my choice,” was scribbled in yellow chalk — a battle cry of the abortion rights movement that more recently was adopted by those against another California public health measure — a law strengthening school vaccination requirements

It probably won’t come as a surprise that there is extensive overlap between the anti-mask pushback and anti-vaxxers. The sentiment is the same – portraying public health measures as tyranny, and anti-freedom and a violation of corporal sovereignty. Amanda Hess, writing for the NYT, sums up the culture war over mask wearing:

To its supporters, mask-wearing is a visual expression of civic duty, an affirmation of scientific authority and a show of respect. To its critics, it is a sign of weakness, emasculation and deceit. Most Americans accept the medical benefits of masks, but the ones who do not are, more often than not, Republican and male. Their rhetoric dovetails with racist ideas about Asian cultures, where wearing a mask in public has long been normalized. And it improvises on decades of work on the right to stitch the words “effete” and “liberal” together, painting a whole swath of the political spectrum as a feminine affectation.

It is frightening when a simple and effective public health measure becomes a symbol of political and cultural identity. Not only is it extremely counterproductive, but it is ironic because those protesting masks are asking for the very thing they most do not want. The unavoidable reality is that we need to do something to stem this pandemic. Until we have a vaccine and/or effective treatments, we have non-pharmacological measures that exist along a spectrum from isolation to safe interaction. Isolation is clearly the worse of these two choices. What we are looking for now is a way to open up economic activity safely, and this must include mask-wearing. If you refuse to wear a mask, then either you have to isolate or you will contribute to an increase in the pandemic, which itself will suppress economic activity.

Pushing back simultaneously against the lockdown and mask wearing is mind-bogglingly absurd. It suggests that those who are engaged with such protests have not thought through what they want, even in the slightest, and are just acting out of pure emotion. Or, like some anti-vaxxers, they are in denial of scientific reality. They think the pandemic is a hoax.

Unfortunately, the choices of the uninformed or the profoundly confused affect everyone.  Speed limits are not tyranny, because they affect others on the road, not just you. Smoking bans are not oppression, because your smoke can adversely effect the health of others. Public health mandates, when the science is clear and the benefit outweighs the burden, are not your choice, not if you want to live in society. If you think being told to wear a mask in order to protect other people from your germs is tyranny, then go live in a cabin in the woods.

Or – let’s just all listen to the science and stop making common sense health recommendations into a culture war.




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