The Mask as the Great Divider

Ah, the surgical mask. Today’s great divider.

It’s a three-piece wearable article, one I’ve been used to wearing for hours on end while assisting during surgeries in medical school. It’s also something people from my culture don when they’re sick (have a respiratory illness) so that they don’t spread whatever contagious microorganism they have, out of respect for those they may encounter. It’s also in my culture for people to wear it in public when they’re at risk of more easily getting sick, such as when they’re immunocompromised (e.g. undergoing chemotherapy for cancer, pregnant). Because of my background, I don’t see the surgical mask as ominous.

But today, the battle rages between those wanting to wear a mask (or enforce it) and those refusing to do so. The arguments for wearing a mask, especially in the presence of a pandemic, is simple. The hydrophobic layer of the mask keeps away (or traps) the large air droplets in which the viral particles may be enclosed. Meanwhile, the hydrophilic inner layer absorbs the wearer’s respiratory secretions, preventing them from spreading elsewhere. The protective mechanism of the mask is certainly not perfect, especially accounting for airborne transmission (there are other masks and strategies for that), but for the coronavirus pandemic, the mask certainly offers some degree of protection.

In the early days of the pandemic, perhaps around February this year, numerous national governments have discouraged the use of masks. They said it wasn’t effective. Its use was discouraged even in health care settings. I was baffled; it certainly wasn’t foolproof, but theoretically, based on how surgical masks are designed, using it as some form of barrier could help. A study that was done in 2019 even showed how the exterior surface of the mask could entrap viral particles in droplets and recommended that, because of these findings, the exterior surface of the mask should not be touched and should be changed every 6 hours. It became evident later on that governments were saying this for one (or more) of the following reasons: (1) to stem the panic; (2) to ensure there would be adequate supply; and (3) to supposedly not give people a false sense of security, since most of them wear it wrongly anyway. But see how the first and third reasons are quite contradictory. Also, for what were the masks being initially conserved? And if people were wearing it incorrectly, just as certainly as how people were insufficiently washing their hands, why not educate the public instead?

Then new studies started coming in, showing the extent of effectivity of masks, with or without a face shield, and the impact of social distancing in preventing transmission. (I wasn’t surprised. Prior to this, I was working on an informational webinar for compounding pharmacists, and I had some discussion with my colleagues because back then, the CDC did not recommend wearing masks. But I didn’t think that was logical.) By this point, however, even with scientific evidence available, because of the governments’ ineptitude in providing information to the general public and their implementation of sometimes draconian measures, conspiracy theories were a dime a dozen.

What next confused me was the seeming lack of critical thinking on the part of the conspiracy theorists. Yes, it seems to be true that the governments were using the pandemic to curtail some rights and to crack down more on dissidents. Clearly, there were abuses of power. But that didn’t mean that masks didn’t work. Both could be true. Facts are not mutually exclusive.

And then the science behind wearing masks was attacked. All of a sudden, people were supposedly developing hypoxia while wearing masks. But surgeons wear them for several hours on end during an operation; it was part of the necessary personnel protective equipment and it was to keep the operating field sterile. It was also to keep the patient safe from whatever microbes the surgeon can introduce into the open wounds. Besides, surgical masks are not even an enclosed space. Air can flow through the sides: the reason why it is not foolproof is also why it makes it more comfortable than more fitted respirators.

Finally, and perhaps the most stupid argument of all: why do mask naysayers say that the mask is not protective enough for airborne viruses because the filter is big and allows them to pass through (which is true), and then say there is a buildup of carbon dioxide behind the mas and oxygen can’t get through? Certainly a molecule of oxygen gas is far smaller (and can therefore pass through easily) than free viral particles?

All these has made the surgical mask a political issue, so much so it’s now a my right versus your right issue, or sometimes even a my right against the health of the public.

Aside from being a political issue, masks have also become a religious issue. In Montreal, people are required to wear masks in public spaces, including areas of worship. Otherwise, businesses and churches, who are left to enforce these restrictions are at risk of being penalized (instead of the actual violators). There are (rather silly) interpretations of wearing the mask as hiding before God, as though in shame, or obscuring the divine image in which God made us. But then, one could just as easily counter: what of veiling one’s self before God? How about verses on charity towards one’s neighbor or of obeying authority set on Earth? If masks can, to some extent, protect you from danger, and you say otherwise, do you not bear false witness? And do you not, in failing to take precautions, fail in prudence, and tempt the Lord in vain?

Unfortunately, the two parishes that we frequent have a lot of parishioners who either don’t believe that COVID-19 is real or who don’t take it seriously. One argument that is often thrown, to make a point about how it has been exaggerated, is that the death rates are very low even while infectivity and case rates are high. I would answer: one of the facts that made COVID-19 scary initially was that the doctors were uncertain of how to treat it. Usual measures that would normally result in better outcomes for patients, such as corticosteroids (for cytokine storm) and intubation, were not working as expected. The variations in clinical presentation, especially with patients seemingly okay and able to talk but actually desaturating (having lower oxygen levels in the blood), also confounded management. Eventually, as more information about the disease was ascertained, so did treatment plans become better. However, one aspect of the disease that can be frightening is this: why do some people survive it, and why do some people succumb? There is no clear-cut answer.

This then is my response to those needlessly downplaying the pandemic. It’s all fun and games until the disease strikes you or one of your loved ones. When that happens, all of a sudden, I don’t think you will care about the statistics anymore. You or your loved one is certainly not just a statistic. For me, because I personally know of people and colleagues who have died from it, even while serving as frontliners in the hospital, this pandemic is personal. Hearing other people dismiss it as an exaggeration or as untrue is a mockery of the lives lost, of their loved ones’ grief and mourning.

But back to churches. It is because of people’s attitude that we have avoided going to our usual parishes and instead have opted for those wherein people abide by the rules and show more consideration towards others. It is quite sad because we would have loved to participate in a more reverent liturgy. Unfortunately, the selfishness of the people attending makes us hesitant to even step foot in there, as we’re certain that not only are preventive measures not being followed. It is also likely that people, either out of a lack of boundaries or concern, will also neglect social distancing.

I just can’t have any of that, especially because I’m pregnant and in my third trimester. I am full aware of the studies done in pregnant women, which have shown a higher risk of complications in those who have gotten COVID-19 during pregnancy, labor, and delivery. The placentas of those who have contracted the virus have also shown numerous blood clots characteristic of impaired blood flow, such as in hypertensive disorders. Thankfully, the placenta is quite a redundant organ, and so most of the infants born to COVID-positive mothers remain healthy. Nevertheless, it is not a risk I am willing to take.

The COVID-19 crisis is not likely to go away anytime soon, despite the denial of some that it exists, the insistence of others to get back to their normal lives, or the fatigue of most from taking precautions. I do not want to live in fear any more than the average person does; otherwise, why would I be stepping out of the house to go to work in a hospital? And yet, this I do as a calculated risk. I don’t take public transit, masks are worn and social distancing is enforced at the workplace, and excellent hygiene practices of frequent handwashing has become the norm. I also don’t go anywhere I don’t need to be, such as groceries, parties, and weddings. We have a protocol for when I get home from work so that whatever microbes I bring from the hospital, I don’t let thrive in our house. Every so often, we wipe down packages and most commonly touched areas inside the house.

There is then, obviously, a balance between cowering in fright and hiding at home versus stepping into the world to live life carefully, accounting for not just my rights and my health but that of the people around me. This acceptance of a new reality has made it not only easier to adapt to the present but also to prepare for the future, which we look forward to with great joy.

As for the mask naysayers and COVID-19 deniers, well… I simply try to keep a respectful distance from them. They’ve made their choice, and I’ve made mine, and usually, when it’s as divisive a topic as this, people are loathe to change their opinions even when presented with new facts. (I’m a scientist, so I tend to go with the best available evidence and I’m inclined to change my way of thinking based on updated information.)

On a last note: I am simply grateful that no one has yet tried to be smart with me wearing a mask, calling me names (e.g. a sheeple) or mocking me for wearing one. After all, I am a pathologist-in-training. Do you really want me to share all the hospital microorganisms I carry with you? I’m certain you don’t, just as I really wouldn’t want to see you in the morgue.

How about you? Where do you stand on this great divide?