I Just Can’t Even: Mask Shaming Edition

“I can’t imagine fearing for my children’s lives over something that is supposed to ‘protect them'” ~ One of my white Facebook friends

For those who don’t want to read this whole rambling, the point is this:

Masks should not be mandated. If you want to wear a mask, wear a mask. If you don’t want to wear a mask, don’t wear a mask. Regardless of your personal choice, don’t shame other people who make a different choice. Why? Some people have the ability to wear masks safely, others do not. As that image on the left says: “Everyone you meet is fighting a battle you know nothing about. Be kind. Always.”

The first time I really thought about masks was when I saw a picture of my white friend Lori’s white husband wearing a bandana around the bottom of his face. I immediately thought, “A Black guy would get killed for doing that.” And then I thought I’d write a blog post about it. Instead, an actual Black guy wrote an op-ed, “Why I don’t feel safe wearing a face mask.” Since then, we’ve seen more concern from people of color about mask wearing:

• Wearing a face mask helps protect me against Covid-19, but not against racism
• Black men fear homemade coronavirus masks could exacerbate racial profiling
• ‘It Conjures Up Every Racial Stereotype.’ For Black Men, Homemade Masks May Be a Risk All Their Own
• I’m a black man in America. Entering a shop with a face mask might get me killed
• ‘Which death do they choose?’: Many Black men fear wearing a mask more than the coronavirus

We’ve also seen Black men harassed for wearing masks:

• Black men wearing COVID-19 masks at store reportedly booted out for not removing
• Illinois state Representative Kam Buckner stopped by police after leaving store while wearing mask

And then there’s this gem, “Local group asks you to “tip your mask” to help prevent racial biases.”

It’s really just a matter of time before a Black person is killed for wearing a mask. (Other than Elijah McClain, who was killed last year for wearing a mask.) I am legitimately terrified of what could happen to Jackson if he walked into a store wearing a mask without a white person with him.

Several of my friends had other pressing concerns about being forced to wear masks.

• One, a sexual assault survivor, another a victim of childhood abuse, said covering their mouths causes them crippling anxiety. Apparently, this is a known issue. Also, the reverse can be true: People who have been assaulted by aggressors wearing masks are triggered by seeing people wearing masks.
• People with certain medical conditions, such as asthma (like my aforementioned friends) and COPD, or pretty much any condition that makes breathing difficult, should not wear masks either. Neither should people who can’t remove their own masks.
• Some of my friends with special needs kids are stressing over mask wearing. Parents of kids on the autism spectrum are particularly concerned about wearing masks themselves, because their kids already don’t have a great grasp on visual cues. There are kids with sensory disorders who simply will not wear masks or are afraid of people wearing masks.
• A few of my friends have lamented that their masks are causing rashes. People with skin conditions, including staph infections, yeast infections, allergies to fabrics, and contact dermatitis find it difficult to wear masks.

In addition to all of those personal stories from particular friends, there’s the fact that people who are hard of hearing are cut off entirely when everyone else wears masks. Caregivers to the hard of hearing can’t wear masks and communicate with their charges.

Of course, the mask shamers say things like, “Health care professionals wear them all day.” Well, health care professionals signed up for that. UPS drivers have to lift up to 150 pounds, doesn’t mean everyone should suck it up and move that Maytag. Teachers are able to teach 20+ kids at one time, but a lot of parents recently discovered that we couldn’t even teach one.

And the thing is, the science behind wearing masks is ultimately inconclusive. There are “studies” that support mask wearing and “studies” that don’t. I put “studies” in quotes like that, because a lot of what the media is reporting as “studies” are really computer models, statistical analyses (which may or may not control for relevant factors other than mask wearing), or reviews of other “studies.” Note that there are very few randomized control trials of homemade masks, particularly with respect to the COVID-19 virus. A number of “studies” on both sides of the issue that are really meta-analyses of multiple other “studies” note that those original “studies” were poorly designed, or failed to control for behavior or other factors, like this one, for example:

“[T]he existing evidence is sparse and findings are inconsistent within and across studies. Multicentre RCTs with standardized protocols conducted outside epidemic periods would help to clarify the circumstances under which the use of masks or respirators is most warranted.”

These are just a few “studies” that show that wearing masks do little to prevent COVID and/or other viruses:

• A cluster randomised trial of cloth masks compared with medical masks in healthcare workers

“[T]he results caution against the use of cloth masks. This is an important finding to inform occupational health and safety. Moisture retention, reuse of cloth masks and poor filtration may result in increased risk of infection. “

• Commentary: Masks-for-all for COVID-19 Not Based on Sound Data

“Cloth masks are ineffective as source control and PPE, surgical masks have some role to play in preventing emissions from infected patients, and respirators are the best choice for protecting healthcare and other frontline workers, but not recommended for source control. These recommendations apply to pandemic and non-pandemic situations.”

• Simple Respiratory Protection—Evaluation of the Filtration Performance of Cloth Masks and Common Fabric Materials Against 20–1000 nm Size Particles

“The penetration values obtained for common fabric materials indicate that only marginal respiratory protection can be expected for submicron particles taking into consideration face seal leakage.”

• Cluster randomised controlled trial to examine medical mask use as source control for people with respiratory illness

“In an intention-to-treat analysis, rates of clinical respiratory illness (relative risk (RR) 0.61, 95% CI 0.18 to 2.13), ILI (RR 0.32, 95% CI 0.03 to 3.13) and laboratory-confirmed viral infections (RR 0.97, 95% CI 0.06 to 15.54) were consistently lower in the mask arm compared with control, although not statistically significant. A post hoc comparison between the mask versus no-mask groups showed a protective effect against clinical respiratory illness, but not against ILI and laboratory-confirmed viral respiratory infections.”

While these are a few “studies” that show that wearing masks may prevent droplets from spreading to others, thus possibly preventing respiratory infections like COVID:

• Respiratory virus shedding in exhaled breath and efficacy of face masks

“Our results indicate that surgical face masks could prevent transmission of human coronaviruses and influenza viruses from symptomatic individuals.”

• Facemasks and similar barriers to prevent respiratory illness such as COVID-19: A rapid systematic review

“There is a ‘very slight protective advantage’ to wearing a medical mask as opposed to wearing nothing at all in a community setting. The risk of acquiring a viral infection is reduced by 6%. When both ill and well wear a medical mask in a household, the risk is reduced by 19%. There is more ‘evidence to support the use of medical masks for short periods of time by particularly vulnerable individuals when in transient high-risk situations.'” (COVID-19 and the Use of Cloth Face Masks)

• Testing the Efficacy of Homemade Masks: Would They Protect in an Influenza Pandemic?

“Results: The median-fit factor of the homemade masks was one-half that of the surgical masks. Both masks significantly reduced the number of microorganisms expelled by volunteers, although the surgical mask was 3 times more effective in blocking transmission than the homemade mask.

Conclusion:Our findings suggest that a homemade mask should only be considered as a last resort to prevent droplet transmission from infected individuals, but it would be better than no protection.”

• Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis

“Face mask use could result in a large reduction in risk of infection (n=2647; aOR 0·15, 95% CI 0·07 to 0·34, RD −14·3%, −15·9 to −10·7; low certainty), with stronger associations with N95 or similar respirators compared with disposable surgical masks or similar (eg, reusable 12–16-layer cotton masks; pinteraction=0·090; posterior probability >95%, low certainty).”

Of course, all of this is predicated on the ideas that COVID spreads through droplets spread over up to six feet and that asymptomatic carriers are unknowingly spreading disease. However, there is evidence that asymptomatic carriers don’t actually infect other people, and that you have to be in “close contact” for a “prolonged period of time” with an infected adult to become infected yourself.

• A Study on Infectivity of Asymptomatic SARS-CoV-2 Carriers
• Unpacking the New WHO Controversy Over Asymptomatic COVID-19 Transmission
• No child known to have passed on coronavirus to adults, global study finds

This also assumes that everyone is wearing their masks correctly, not touching their masks, washing those masks at least daily, sanitizing their hands every time after they touch those masks… and that the masks are made of fabric that might actually filter droplets out.

There are also indications that wearing masks for prolonged periods of time can be harmful to people and the environment.

• Face masks for the public during the covid-19 crisis
• The environmental dangers of employing single-use face masks as part of a COVID-19 exit strategy
• Wearing a Mask Can Harm Your Health

In what is probably my favorite quote in all this mask madness, the New England Journal of Medicine says masks are magic:

“It is also clear that masks serve symbolic roles. Masks are not only tools, they are also talismans that may help increase health care workers’ perceived sense of safety, well-being, and trust in their hospitals. Although such reactions may not be strictly logical, we are all subject to fear and anxiety, especially during times of crisis.”

And the CDC’s statements aren’t necessarily backed up by facts, as noted in “Healthy People Wearing Masks, Should They or Shouldn’t They?”

I’d like to close by pointing out that the WHO still doesn’t recommend mandated mask wearing for the general, healthy public:

“At the present time, the widespread use of masks everywhere is not supported by high-quality scientific evidence, and there are potential benefits and harms to consider.”

If you’ve made it this far, thanks for reading! There are science, statistics, and anecdotal evidence for and against homemade masks. But ultimately, the conclusion is: Stop mask shaming. I mean, we shouldn’t be shaming people in general. But we really shouldn’t be shaming people for wearing or not wearing masks. Some people are able to wear masks safely, some are not. Why do we need to justify our choices by demeaning others?