The Mask Debate: Six Months Later
Hesitancy to accept healthcare advice is a symptom of a broken healthcare system
In late January of this year, my roommate’s air filtration mask came in from Amazon in preparation for a flight we were taking to Philadelphia together. My first reaction was to tease her for her precautions; at the time, COVID-19 was a faraway issue across the Pacific Ocean. If anything, I viewed the epidemic the same way I viewed the Syrian Civil War or gun violence in Chicago. Certainly these were humanitarian issues I wanted to contribute to alleviating, but they stayed shut away from my life thanks to convenient political boundaries. I had lived through Ebola and H1N1 panic with everyone in my social circle unscathed. It would be unusual to assume anything different would come from this virus.
After we returned from our adventures in Philadelphia, I watched a cloud of dread settle over my college town, growing thicker with each news alert. Many of my Asian-American classmates expressed concern over the growing bias against those in masks, and we saw this play out in real time as individuals around the country were subject to harassment and assault just because of a cloth accessory. In the New York Times, medical anthropologist Christos Lynteris attributed the bias against masks to an East-West divide, all the more apparent as Chinese restaurants grew less and less busy thanks to unfounded fear. Even with the conversations surrounding me, I respectfully decided to forgo purchasing an overpriced stockpile and continued to go out with a naked face. I encouraged my friends to do the same. Why would I do this, as an aspiring Public Health student? I did it out of a respect for authority.
Health and Human Services Secretary Alex Azar implied that masks would do more harm than good during a House Appropriations subcommittee meeting in February, stating that “If [a face mask] is not fitted right, you’re going to fumble with it” and “You’re going to be touching your face, which is the No. 1 way you’re going to get disease, is unclean hands touching your face.” A few days after this remark, Surgeon-General Jerome Adams tweeted in all caps “STOP BUYING MASKS” and added that “They are NOT effective in protecting the general public” in an effort to save supply for healthcare workers. Even my favorite podcasters, two PhDs, discussed the drawbacks of masks in one of their February episodes. The message seemed loud and clear to me: the patriotic action was to leave masks to the people trained in using them properly.
I grew up in one of the largest anti-vax counties in Texas, so I prided myself on listening to the authorities on medical matters. My biggest hope was to become a conduit between medical professionals in my community and the skeptics who doubted them. These people weren’t the mean hippie “Karens” that the news depicts when they talk about anti-vaxxers; they were my neighbors and classmates. They loved their community and their children as much as any vaccinating parent, but their experiences with the United States’ infamous healthcare quality for low-income individuals left them skeptical that their kids would be protected in a doctor’s hands. The mask debate had become an extension of their cynicism towards government actions, and I was aspiring to be an example of someone who trusted our leaders to act in the public interest.
Hopefully most readers can sense the utter irony of my attitude in January and February. By March I had read some more literature and seen areas of China and Europe begin to not just recommend but require masks in public spaces. In addition, masks had been helpful solutions in historical epidemics such as China’s pneumonic plague in the 1900s or 1918 influenza. To be quite honest, I felt like a naive teenager who had been duped. From April to July, more and more regions of the United States have made masks mandatory. Previous online articles espousing the disadvantages of masks have a large “out of date” notice plastered below their headline. For many individuals who were already skeptical of public health authority, this instant reversal of opinion, combined with the public expressions of confusion from our political leaders in non-science backgrounds, is practically asking for some form of cynicism.
To me, it is quite disappointing that a lot of the scientific/medical community have mislabeled these peoples’ doubts to be sprouting from bigotry or selfishness rather than misinformation. Instead of responding with explanations of authority’s fallibility, individuals shame anyone on Instagram with a naked face. As someone who works in a restaurant that requires masks, I certainly wonder whether plastering someone’s photo on Twitter does more good than offering them a mask and explaining its benefits. Harvard Professor Julia Marcus made the point in a recent Atlantic article that shaming people who don’t wear condoms didn’t stop AIDS; as the next large public health intervention, are masks really all that different?
Most of my family faithfully follows healthcare advice. However, no one in my family is a doctor or a fancy research scientist; we trust medical providers for accurate information. My classmates may gawk, but this is reality for most Americans. Even with increases over previous decades, over sixty percent of Americans do not have a college degree. This fact is not to discount the intelligence or humanity of the majority of our population. People without college degrees have their own amazing talents, and I would love to see any medical physician try to repair a car or find the perfect shade of blonde to dye a client’s hair. Instead, these individuals’ unique talents and intelligence should be a wake-up call to public health and news outlets whose task is to build rapport with communities that may not be able to interpret scientific literature alone. To have claimed the inefficacy of masks early on in the pandemic without heavy literature to back it up is to have lost credibility with some of those most in need of healthcare information. Any official cannot simply assume their constituents will blindly follow such a stark opinion change without explanation; this implies a lack of respect for one’s intelligence and damages a community’s trust, as we have already seen play out in the past several weeks.
In retrospect, what could we have done better? I go forward with the acknowledgement that hindsight is 20/20. Officials could have started in January and February by explaining to Americans the exact reasons they were discouraging mask-wearing. Some press releases, such as those from the Centers for Disease Control, state very clearly that masks were not recommended at the time because of a lack of evidence for community spread. This makes wearing masks now much more logical; now that there is confirmed community spread, it’s time to wear masks. Some outlets also did not recommend masks because they worried about supply shortages for healthcare workers; for some reason it took a long time for the suggestion of easily homemade face masks for the general public to be accepted. News outlets interpreting these press releases often left out the justification behind the CDC’s decision, leading individuals to believe that masks were ineffective in their entirety. During the infamous 180 rotation in policy decisions, it may have been helpful to explain the scientific literature and supply factors that played into the previous and current recommendations, instead of phone alerts with little explanation and threats of fines for noncompliance.
When I ask a patron to wear a mask at my place at work, I chuckle at how six months ago I was judging masked individuals to be misinformed and panicked. Now, the facts are vice versa. The reality is that COVID-19 is still an extremely new and rapidly evolving disease; there is still so much to learn about it. Many of our current conceptions about its causes, progression, and treatment will likely be overturned in the coming months as well. In the face of misinformation and evolving information, it is important for health communication to grow in its respect and sympathy for individuals who rely on their opinions and insight. If medical professionals trust their mechanics, Uber drivers, and restaurant workers to get them through a day safely, it’s time they earn the trust of the people who serve them as well.
