To Mask, or Not to Mask … That Is the Question!

Note: This author attempts to wear a mask in public.

In college, I competed in parliamentary debate. This style of debate uses common knowledge, and common sense, rather than statistics, facts, or citations, to persuade a judge (the “prime minister”) and the audience (the “peanut gallery”). I’ve read enough on both sides of the mask argument to feel competent to compete in a “Mask or No Mask” parli round, on either side.

I find parlimentary debate to be helpful in discussions such as the mask/no mask question. For every study that shows homemade masks are helpful, there’s an equal study showing they are not. For every statistic demonstrating homemade masks are helpful, there’s an equal statistic demonstrating they are not. For every expert stating homemade masks are helpful, there’s an equal expert stating they are not.

Maybe we should stop listening to the studies, statistics, and experts, and just think critically for a minute.

I want to frame this debate using the BRAN questions, helpful in analyzing a plethora of health questions. BRAN stands for: Benefits, Risks, Alternatives, and (Doing) Nothing. We’ll look at the mask issue with these comparisons in mind. Also, the term mask in this discussion is limited to homemade, non-surgical masks for laypeople. I do not intend to address healthcare workers wearing medically approved masks, though I do make reference to such situations. And finally, while parliamentary debate does not normally use citations, I have included some for the benefit of this “peanut gallery.”

Bran—The Benefits of Wearing a Mask

Benefit 1: Potential Protection of Others

There is some compelling evidence that wearing a mask can help keep your germs to yourself, thus potentially protecting someone else. I stay potentially because a mask can only partially stop an individual from sharing the virus, and only then if he actually has the virus. The vast majority of people walking around Walmart do not have the virus at all, particularly in most rural counties. Therefore, while a person may wear a mask as a symbol of willingness to protect others, unless he carries the virus, in reality he is not protecting anyone. Let’s also be clear that there is evidence that homemade masks do not protect oneself from contracting the virus through the air, nor do they completely protect others from it. However, since there is some evidence of a few possible carriers of CV-19 known to be asymptomatic, the mask approach has some credibility, and likely does protect some people in some cases.

But let’s take a look at this benefit further.

There is a crass analogy circulating in the "meme world" that wearing a mask to protect someone else is like wearing pants in public to stop a splash of urine if one is incontinent in public. Unfortunately, this is a completely false (and gross!) analogy. Insofar as the two situations are analogous, the comparison actually reveals harms, not benefits. First, if one urinates in one’s pants in public, there will still be a puddle on the floor that someone can step in and get splashed. Likewise, unfitted homemade masks leave plenty of room for germs to escape. Second, if one urinates in one’s pants in public, one is quite likely to touch and rearrange said pants because they become uncomfortable, thus getting germs onto one’s hands and spreading infection to high-contact places, such as the credit card payment pad. Likewise, folks fiddling with unfitted masks debatably touch their mask and face more than they would otherwise, spreading germs. Finally, if one urinates in one’s pants in public and leaves that warm, wet, moist pair of pants on for the rest of the day, that individual will likely get a rash at best, or an infection at worst. The same, logically, applies to breathing through a warm, wet, moist mask in public.

Benefit 2: The Public Good

Many people wear a mask, not because they are concerned about contracting or spreading illness, but rather, because wearing a mask serves the public good. We should all do this because it might help someone. Let’s place the idea of wearing a mask for public good into a syllogism:

People are morally obligated to protect others, even at their own expense.
Wearing a mask protects others.
Therefore, people are morally obligated to wear masks.

The syllogism is valid, but not sound, because it has one faulty premise: people are morally obligated to protect others at their own expense. We can see that this isn’t true, because it doesn’t apply to other situations.

Situation One: Driving. If I never drive, I will never accidentally crash my car and harm someone else. Therefore, I must never drive.

Situation Two: Airplane Emergencies. If a low-pressure system occurs when I am on an airplane, I must help everyone else with their supplemental oxygen before putting on my own, even to my own detriment. (Whoops! That’s exactly what the flight attendants caution against!)

Situation Three: Abortion. If I am pregnant against my own wishes, I cannot seek an abortion, because I must protect others (i.e. the unborn child) at my own expense. (While I agree with this logic, we can see society does not hold it to be true, since most abortion clinics remain open during this pandemic.)

With all of this being said, though, shouldn’t people just wear a mask if it might potentially protect someone else? After all, there are no possible harms to wearing a mask! Or, are there?

bRan—The Risks of Wearing a Mask

Risk 1: Oxygen Deprivation

Do you sleep with a sheet over your face? How about a blanket or quilt? Probably not, in part over the concern of restricted breathing. Many masks are made out of these exact types of materials, held closely against the mouth and nose, for hours at a time. From the hearsay of many people required to wear homemade masks for hours at a time, as well as making a logical inference, it comes as no surprise that many masked people report dizziness, shortness of breath, fatigue, lightheadedness, inability to make clear decisions, and much more. And it’s not just a placebo effect: medical studies and scientists show that an N95 mask can reduce oxygen intake as much a 5%-20%. Even during wildfires, the general populace has been advised that while masks filter out pollution, if a mask makes you feel oxygen-deprived, it is better to breathe some pollution than feel like you cannot breath at all.

Risk 2: Carbon Dioxide and Virus Re-inhalation

For all that a mask does to keep your germs to yourself, it also keeps your carbon dioxide in, rather than naturally dissipating into the air. In the same way, if a sick person wears a mask, he breathes out a virus, but it cannot naturally dissipate into the air. A mask, at least to some extent, recycles carbon dioxide and exhaled viral particles back into the breather’s system.

Risk 3: Medical Complications

Many people have been told by their doctor not to wear a mask, for a variety of medical reasons, including but not limited to respiratory complications, such as asthma. Over 8% of Minnesotans have been diagnosed with asthma, which is about average nationwide.  (Incidentally, full childhood vaccination is correlated with higher levels of asthma in comparison to fully unvaccinated children.) Many individuals claim they have trouble breathing through masks. This is not necessary an excuse: they may actually have an undiagnosed medical issue, like asthma.

Risk 4: Cross Contamination and False Sense of Security

Face masks are not a toy; in order to be efficacious, they must be worn and cared for properly. Professionals who wore masks before CV-19 were trained extensively in face mask use, but most laypeople have not been trained. If a mask is touched, even once, it should be thrown away or laundered immediately. Anyone touching his mask can cross-contaminate with his germs anything else he touches. We have all seen people touching their masks or wearing them improperly. It is possible that wearing and caring for a mask incorrectly could actually unintentionally increase viral spread.

In addition, some people with symptoms of a sickness might feel secure in public, so long as they wear a mask. Instead, if masks had not been normalized, they would have stayed home. It is also possible that, due to a hightened feeling of security, people who wear masks may be less responsible with hand-washing and sanitizing than they would be otherwise.

Risk 5: Decreased Safety Due to Vision Impairment

Many individuals who wear glasses find they fog up quickly while wearing an imperfectly fitted mask. I myself have experienced this while trying to shop for essential items, and it is extremely frustrating. Any adjustment to the glasses or mask increases the risk of cross-contamination (see Risk 4 above). In addition, many individuals—glasses or not—have poor peripheral vision while wearing a mask, which increases the risk for an accident or fall, all the while our community goal is to keep hospital space free.

Risk 6: Unknown Harms

We can all agree that wide-spread mask usage is new in our culture. While it is likely that there will be no long-term harm for those who only occasionally wear a mask while shopping, there could be real concerns to individuals whose work requires masking for many hours each day. Plausible studies that have never been done include: possible weakening of the immune system from lack of germ exposure; the psychological impact of not being able to see people’s facial expressions, including smiles; the impact of re-inhalation of oxygen for a developing baby or couples experiencing infertility; and the relational impact of masks blocking interpersonal hormones, like phermones. Many feel it is prudent to watch and wait for more information and research before risking unknown harms.

brAn—The Alternatives to Wearing a Mask

Are there alternative ways meet the goal of public safety, without wearing a mask? Here are some ideas, which should not be construed as medical or legal advice.

Alternative 1: Isolation

Isolation for least for two weeks at a time would let CV-19 run its course. As far as science can tell us, if someone is confined to his home and does not interact with anyone outside of his house for two weeks, he will no longer be contagious (even if he had been), rendering it impossible for him to spread this virus in a singular trip without a mask.

Alternative 2: Private Business Mandates

In a truly free market economy (which unfortunately is not the case in most states right now due to government shut-downs), private businesses should be able to mandate customers or employees to wear masks for the potential protection of others. Likewise, rival businesses can choose to not force customers or employees to wear masks to protect their freedoms (though they would be welcome to wear one if they so choose). No customer or employee is forced to patronize or be employed by any particular company. Thus, if masks truly protect people, those businesses without the mandate will have outbreaks and be forced to close. Alternatively, if people choose the businesses without masks required and they stay well, these businesses can stay open and thrive, and the companies with mandates will slowly lose customers and employees for lack of free choice. (No outbreaks have been traced to Walmart, as far as I know, and the last few times I have been there, fewer than 50% of people were wearing masks. Time will tell how Menards’s and Costco’s ‘masks-for-all’ policies turn out.)

Alternative 3: Social Distancing

Wear a mask, but only when you need to be within 6 feet of another person. The whole reason the government is recommending (or, in some places, mandating) social distancing is that the virus can’t jump from person to person. It moves in droplets which can be passed through the air. Sure, a sneeze or cough can send those droplets farther; even so, it is still recommended masked individuals sneeze or cough into their elbow because the droplets can slip out from behind the mask. So, unmasked individuals can take those same precautions and generally keep people just as safe, if they even have the virus.

Alternative 4: Hand-Sanitize Frequently

If you are not wearing a mask, you can still potentially protect others if you are a carrier of the virus by sanitizing anything that you touch or breath on, all the while you keep your distance from others.

Alternative 5: Transparent Face Shield

This kind of protection, often seen in medical facilities, protects others from one’s direct breathing, all the while allowing the wearer to still breathe normally. Any droplets would be forced down, onto the wearer. This would protect against Risks 1, 2, 3, and 5 listed above.

Alternative 6: Hands-Off Cell Phones

Protect your neighbor from viral spread by refusing to use your cell phone in public, which are notoriously dirty!

Alternative 7: Personal Air Filters

Some HEPA and UV filters are effective against viruses. If it sits near your face, likely it will help purify air both coming in and going out. (This is speculative, but then, so is most of the research regarding homemade masks.)

braN—What about Nothing?—Wearing No Mask

If a person does not have a medical concern to prevent wearing a mask, and masks have been proven to potentially protect others from viral transfer, in some cases, why would anyone choose not to wear a mask in public?

I believe the main reason is simple: no mask is nature’s default. No one is born wearing a mask, and in order choose to wear one, one must be convinced by good evidence. The burden of proof rests on those who want to justify wearing a mask, not on those who need no justification to breathe as God created them to. Here are some reasons, both philosophical and practical, I have come across explaining why others might not wear a mask in public.

No Mask Reason 1: They have no mask

Many people do not own a mask, for a variety of reasons. Some already donated their supply of PPE to their local hospital. Some are essential workers, and save their masks for essential work. Some do not have the extra time, money, and resources to make their own mask. (Some do not have spare clothing at home that they could use, or transportation or funds to purchase fabric at a regular store, particularly since thrift stores are closed in my state.)

No Mask Reason 2: Already in the Free and Clear!

In the weeks since CV-19 first came to the U.S. many people have already tested positive for CV-19 and have finished their quarantine. They have no clear scientific reason to mask.

No Mask Reason 3. Sunshine

Some people won’t wear a mask outside, where experts say the virus is unlikely to propagate.

No Mask Reason 4: Source Differences

Some individuals might have read different sources than other people on the need for or efficacy of masks. (We can all admit, especially early on in March, that government recommendations were extremely mixed on this issue.) Or, they might not have access to the same news resources you have. (Many individuals in my county do not have television, and can only access the internet at the Public Library, which is currently closed.)

No Mask Reason 5: A Breath Break

When an individual is noticed without a mask, it could be that he has worn it all day, but just now took it off for a moment, and doesn’t want to put it back on due to cross-contamination.

No Mask Reason 6: Death Wish

An individual might want to get CV-19 because they are suicidal and have a death-wish, in which case for others to mock them is cruel.

No Mask Reason 7: Herd Immunity

Some individuals desire to contract CV-19 to aid in accelerating herd immunity (like Sweden), extremely concerned about no growth whatsoever of CV-19 in their county/area. They might believe that endless extended shut-downs could end in more human lives lost than CV-19.

No Mask Reason 8: Pain

As I experienced during my recent ER visit that required a mask, wearing a mask can be painful, particularly for someone with a sore or infection on their face, neck, or ear.

No Mask Reason 9: Exercise of Conscience

Asking one of these individuals why he is not wearing a mask completely misses the point: These folks consciously do not wear a mask to symbolize the right to worship (if you choose), the right to go back to making a living (if you choose), the right to a free and appropriate public education (if you choose), and the right to once again peacefully assemble (if you choose). Most would welcome others to mask, if they choose, and quarantine, if they choose. This subset of individuals eschew masks in order to stand up for deeply-held principles of liberty, concerned that the political risks of everything a mask symbolize are much greater than the risks of an albeit potentially dangerous virus.

Conclusion

The choice to not wear a mask is not in opposition to “Love your neighbor as yourself.” Instead, it asks, “Who is my neighbor?” which we learn from Jesus’ parable includes those in your midst who have a need. Each of us has different neighbors near to us, with different needs, different risks, and often those needs and risks can be in competition. There isn't a clear cut triage.

There are many creative ways to love our neighbors. Wearing a mask can be one way. But, it isn’t the only way. A masked individual might save a life if he is an asymptomatic carrier. However, unmasked individuals might very well be loving their neighbors in ways masked individuals don’t or can’t.

To mask, or not to mask? Maybe that really isn’t the question. The question, rather, is how do I best care for the health God has given me, all the while sincerely showing love for others?

We cannot know how others answer that question, either by looking into their hearts, or by looking upon their faces. Instead, we must each reflect, deliberate, and love one another with hearts of patience and tolerance for our differences, perhaps more now than ever before.