The bloody mask

 

My honeymoon with Thailand ended yesterday.

We live in a condo in Chiang Mai, Thailand. Signs on every door warn: No Mask, No Entry. Most people comply. Some don\’t. I ignore them unless they try to join me in the elevator. If they do, I wave them away. \”Not without a mask, please.\”

Yesterday, a tall farang (white person) I know well did the same. The man wanting in went berserk. He burst into the elevator punching and kicking. The farang responded in kind. Security came, then the police. Since it turns out that legitimate defense is illegitimate in Thailand, they got both got fined 100 baht each – about $3.

The good news:

1. The farang  was able to afford the fine.
2. Getting punched beats getting shot.
3. Being fit is always a plus.
4. I have an excuse to start learning Muay Thai.

This incident – flabbergasting in a country where 95% of people wear masks – got me thinking. What about wearing a mask drives people insane to the point of shooting others and accusing doctors of crimes against humanity?

It\’s hard to understand, especially for somebody working in healthcare. Even before COVID, OR folks wore it every shift. We, in the ER, wore it for the immunocompromised, the flu-like patients, and whenever we got the sniffles. We double-mask for stinky affairs like fecal disimpactions or trench foot.

Do we enjoy masking? Hell no. We enjoy breathing just like you do, and masks don\’t help.  Wearing them for hours isn\’t fun. Nor is wearing bras, helmets, seatbelts or high heels, but people wear them to protect themselves and fit in society. Masks are more critical: we wear them to avoid killing others by breathing our germs over them.

Masks are uncomfortable. I know. Health care workers choke under so many layers of hot, heavy PPE that they can barely recognize each other. They get bruised from wearing masks for too long, and they get blisters behind their ears. To help with that, savvy businesses invented gadgets to protect them. And I won\’t even mention lipstick, my favorite morale booster, that I had to give up. But we still wear masks, at work and out in public. Why don\’t the others, even though all health care experts recommend them?

To understand, I asked my Facebook friends: Why would you NOT wear a mask? I unleashed a deluge of anger and insults. How dare I even ask?

\”Use your degree to stand firmly and unilaterally in the message that we NEED our citizens to wear masks in public, all citizens, all the time. Otherwise, you look STUPID and irresponsible. Any opinion other than \”everyone should wear a mask\” is STUPID. Get on the right side of history. STRONGLY CONDEMNING people who do not wear masks is the first step. We don\’t have TIME to understand people\’s backward illogical uninformed reasoning.\”

I don\’t know about you, but I don\’t enjoy people calling me stupid. I question their smarts  and common sense. I also feel the urge to do the opposite of what they want, just to piss them off. Does that sound familiar?

Being yelled at may be one reason that people don\’t wear masks. I think a civil conversation may accomplish more.

The inconsistent message is another.  At the beginning, it was: \”Masks don\’t help, and we don\’t have enough of them. Leave them for the healthcare providers.\” Months later, after stumbling through bandannas and thick scarves, by the time the message became: \”Whenever you\’re in public, wear a mask, \” people had lost trust in the messengers.

Even now, there is no unified message. The American government disregards its own health experts\’ guidance on masks and social distancing. Every state and every county has different rules that change every day. People no longer know who to believe.

Unlike many adopters of national mask policies, who value discipline and conformity, Americans hate being told what to do and feel the mask is an assault on their freedom. Unfortunately, that contributed to our high COVID numbers. Thailand – who had the first COVID case outside China –  had a total of 3185 cases, 58 deaths, and no community transmission in weeks. Compare that to the US numbers.  2.9 mil cases, 130K deaths and 58K new cases on July 3rd. Yes, Thailand has 70Mil people, while USA has 328 mil. Still.

Wearing a mask has a lot to do with who we are. The average mask wearer is older, urban, female, high earning, and Democrat. The mask haters are the opposite. They are also less concerned about getting sick. Remember:  You don\’t wear a mask to protect yourself; you wear it to protect the others: The old, the frail, the immunocompromised.

Masks can be uncomfortable and hot and interfere with breathing, especially when working out. And while CO2 accumulation is a myth – otherwise no surgery would ever happen since everybody in the OR would pass out – masks do increase the breathing effort of those who already have trouble breathing and may cause hyperventilation in those prone to anxiety. To that, I say: Not all masks are created equal. You don\’t need an N95 to walk the dog. Use the mask you can breathe in. A mask is better than no mask.

Sadly, the mask has been weaponized into a political symbol that deepened our national divide. Despite the pictures of refrigerated trucks full of dead bodies, some still believe COVID is a Democratic hoax propagated by the media, unless it\’s a Chinese ploy to destroy America. The president thinks that only people who dislike him wear masks, therefore not wearing a mask is a pledge of allegiance.

Some think masks are ineffective. Then why bother wearing them? It took time for the medical community to learn about COVID and its transmission. And we\’re still learning. But experiments,  studies, and guidance indicate that masks, social distancing, and hand hygiene curb the virus spread.

As per BMJ, \”in the face of a pandemic, the search for perfect evidence may be the enemy of good policy. As with parachutes for jumping out of airplanes, it is time to act without waiting for randomized controlled trial evidence. Masks are simple, cheap, and potentially effective. They could have a substantial impact on transmission with a relatively small impact on social and economic life.\”

A few quotes from my friends:

\”How would a non-mask wearer feel if they came into an operating room to have their knee replaced, and the surgical team WASN\’T wearing the super-duper space suit attire used to prevent the devastating complication of an infected prosthesis? What if no one had a mask on?\”

\”In years gone by, we weren\’t bombarded with all these ideas, recommendations, etc. I am spent with the effort it takes to go out. Do I want to go out and expend the effort of a mask, having hand sanitizer and the 6 ft rule to purchase a plant, a loaf of bread…?\”

\”One problem is the random enforcement of mask-wearing and social distancing rules. Protestors and rioters were allowed to violate every rule without the threat of fine or jail.\”

\”Some don\’t wear masks because of communication problems. They can\’t hear well. It makes people feel unseen and unheard. We all want to be seen and heard. The mask feels like a gag.\”

\”The conspiracy nuts that think the government is trying to control us and take over. What dystopian society will allow citizens to walk about their day with their identity hidden behind a mask?\”

\”It\’s difficult for a deaf person who needs to read lips to understand what people say… American sign language includes body language and facial expressions….\”

\”Masks are to PPE like frosted flakes are to a balanced breakfast. Alone, they\’re about as useful as that proverbial screen door on a submarine (or, to farmers like me, tits on a bull). Masks are an added safety measure like the Nader pin in a car. It won\’t protect you when you hit a tractor-trailer but can help keep the door from opening during a rollover and ejecting the passengers.\”

Bottom line: Masks work. Recent studies show that masks, social distancing, and hand hygiene help curb the spread. I hope that a unified message, education, and a vaccine will stop the spread. But remember that your right to not wear a mask doesn\’t preclude your responsibility to not infect others. If you don\’t wear a mask, stay home. Everybody\’s health depends on all of us.

That brings us back to the beginning. The man who assaulted the tall farang could have used a mask, take the stairs, or wait for another elevator. He chose to fight instead. Why?  It\’s not all about the mask. It\’s about the anger. He got so angry that he was denied access to \”his\” elevator that he failed to see the other \’s right to not be exposed.

Sadly, these miserable days that holds true for all of us. We\’re so angry that we refuse to see the others\’ point of view. Blinded by our anger, we make bad choices. Recognizing how our anger poisons us is the first step to managing  it and be able to communicate and work together.

Rada Jones is an ER doc in Upstate NY. She lives with her husband and his deaf black cat Paxil. She authored three ER thrillers, Overdose, Mercy and Poison, and “Stay Away From My ER,” a collection of medical essays.