To Mask or Not to Mask When Masking is Not Mandatory

Source: Adobe stock image by kanvictory, licensed by Ravi Chandra

A federal judge recently overturned CDC mask mandates on national transit. The Department of Justice is poised to appeal. In the meantime, many were shocked by the seemingly callous way some airlines, air hosts, and pilots “celebrated” the change in guidance. In some cases, masked passengers were bullied and berated, neglecting varying vulnerabilities and anxiety levels. Americans have been dinged for reaching a peak of narcissism in the last decade (see The Narcissism Epidemic by Jean Twenge and Keith Campbell), and this might be seen as another data point in that conversation.

But this is the fundamental challenge revealed at this stage of COVID. We are all in different places emotionally. Some are “done” with anything perceived as a restriction. Others are more vulnerable emotionally or physically. For these folks, masking just feels safer. Or they rationally recognize their risk. Certainly, no one wants to be harassed for their choice. Also, it makes it easier if there were clear, individualized, scientific advice for masking or not masking. But guess what – that’s pretty unlikely because of the aforementioned variability emotionally and physically.

And yes, emotional vulnerability is a reason to listen to your discomfort and do what feels safe for you. I was really heartened to see nationally recognized San Francisco public health expert Dr. Monica Gandhi’s last tweet of a long thread that basically provided evidence for ‘one way’ masking as opposed to generalized mask mandates. This pronouncement on mask mandates may be well and good from a top-level public health point point-of-view, but really too broad for the granularity that I’m seeing with individuals of varying sensitivity and vulnerability.

She wrote in her final tweet:

“And finally, let's respect each other's mask choices. I am so glad we have one-way masks available for the whole public that protect so well (as an ID doctor, I see TB patients & wear an N95); good masks used to be only available for some. Respect each other, everyone's choice”

Her entire thread is here.

Bob Wachter, Chair of the Department of Medicine at UCSF, also had a thread on the topic on April 17, 2022. (titled aptly, in part, “It’s a particularly confusing time…”)

He lists a variety of situations where he might be potentially exposed, and briefly details his reasoning around masking or not masking. He sums it up in this tweet:

“When I do something risky, I try to ask myself, “How will I feel if I get Covid?” If the answer is, “I’d kick myself because it wasn’t worth the risk,” then I try not to do it. If it’s, “It would've been worth it,” then I try to forget about C & enjoy myself.(15/25)”

That’s fine, I guess, but the “is it worth getting COVID?” question is really variable depending on who you are. No one can tell you with certainty what your experience with infection will be. I’ll pass on the possibility, thank you, and continue to do my best to minimize risk for myself and those I am in contact with. I’m also generally trying to avoid participating in activities which would send the message that there’s no risk.

The fact is that public health officials do in fact disagree, and our feelings are in fact a really good gauge of what we should do. We should, by this time of COVID, be aiming to be more sensitive to other people’s needs, not more ready to assert our “freedom and independence”. Actually, from a psychological perspective, when I saw people ripping off their masks and cheering mid-flight, I saw not just understandable relief, but also conformity to an almost megalomanic, invulnerable sense of self which is the epitome of “the ugly American.”

And that is the other contagion which we have to protect against, and hopefully, defeat - with compassion.

(c) 2022 Ravi Chandra, M.D., D.F.A.P.A.