To mask or not to mask, that is the proverbial question. But should it be? More than seven million cases of COVID-19 have been reported nationwide. The president and first lady have tested positive, as well as some White House staffers, members of the White House Press Corps and members of Congress. Former presidential candidate Herman Cain died of COVID-19 in July, having tested positive after attending an indoor Trump rally in Tulsa, Oklahoma, weeks earlier. Yet, as recently as this week’s presidential debate, members of the president’s entourage refused to wear masks, in accordance with the venue’s requirement, rebuffing a Cleveland Clinic physician who sought to provide masks and remind them of the previously announced policy.
Meanwhile, the president again ridiculed Democratic presidential nominee Joe Biden’s extensive mask use. On Oct. 2, hours after the president’s diagnosis was reported, Chief of Staff Mark Meadows briefed reporters unmasked outside the White House, even though he had recent close contact with the president. The following day, dozens of Trump supporters gathered outside Walter Reed National Military Medical Center to express their support, with many in the crowds not wearing masks.
What will it take for these Americans to feel vulnerable to COVID-19? Dr. Anthony Fauci, the renowned immunologist whose five-decade career has included advising every president since Ronald Reagan, recommends mask-wearing to prevent COVID-19 transmission. My personal physician concurs. Does any Washingtonian have a personal physician who recommends otherwise? Notwithstanding this expert recommendation, many disagree, even as we are surrounded by unprecedented and unquestionable illness and death. As of Oct. 4, the District has confirmed 15,547 cases, and 631 residents have died. Recent trends suggest about two District residents develop COVID-19 every hour of the day.
The notion of being required to wear masks to buy groceries, with cashiers behind plexiglass barriers, leery of potential pathogens on cash money, would have been relegated to science fiction eight months ago. Thousands of career-oriented professionals with decades of uninterrupted work history lamenting the loss of a $600-per-week government benefit was unthinkable before. Our lives have been altered in ways we never imagined. So why do large segments of the population refuse to wear masks? Because it’s their constitutional right not to?
In April, University of California legal scholar Erwin Chemerinsky addressed this question in the Los Angeles Times, noting that “the Supreme Court explicitly rejected” the claim that “liberty” under the Constitution includes the right of individuals to make decisions about their own health in instances where those decisions could endanger others. That case set a precedent. By contrast, a ruling by a federal judge in Pennsylvania on Sept. 14 that did not address mask-wearing specifically, found that key components of the governor’s COVID-19 mitigation strategy are “unconstitutional.” While the result of the Pennsylvania Governor’s appeal remains to be seen, one thing is clear. COVID-19 will continue to spread if it remains unchecked.
In public health, we study health behaviors: “actions to maintain, attain, or regain good health and prevent illness.” We also learn that health behaviors are influenced by community norms. For example, smoking has declined exponentially since the 1964 Surgeon General’s Reports on Smoking and Tobacco Use. While Americans still smoke, there is a consciousness in our society about the dangers of smoking that influences our choices. That’s a community norm.
There are similar examples in other health conditions. Community norms are influenced by community leaders. It’s no coincidence that states in which governors modeled COVID-19 prevention on mask-wearing and policy interventions have made significant progress in controlling COVID-19. A study published in the journal Health Affairs on June 16 found that “mandating face mask use in public is associated with a decline in the daily COVID-19 growth rate.”
According to Fauci and other experts, a U.S. vaccine should become available in 2021. It’s difficult to fathom that a vaccine will be a fast-acting magic bullet, however. The logistics of distributing a vaccine to a U.S. population approaching 330 million people are enormous. How many people will refuse it? Then what? It seems to me that I’m going to need my masks at least a little while longer, and I’m going to need to find ways to entertain myself that don’t involve mass gatherings. Fortunately, I like to write.
Guy Weston is a public health consultant that worked in HIV programs for 31 years.