Mask and Ye Shall Receive

Abstract

A physician engages in a social media debate regarding mask-wearing during the COVID-19 pandemic and searches for truth and virtue, primarily charity. While wearing masks is commonplace and vital during the COVID-19 pandemic to those working in healthcare, the lay perspective on wearing masks is more varied and can be skewed by politicization, pseudoscience, and misinterpretation. The practicing Catholic physician serves as an important witness to the truth of science and Christ as the Way, the Truth, and the Life. The question of mask-wearing is transformed from merely being a scientific question to more of a moral and theological question.

I normally shy away from debates on social media, but I could not resist responding to a remark insinuating that masks were ineffective during the COVID-19 pandemic.

My hospital requires that we wear both masks and eye protection (Vanderbilt University Medical Center 2020) when seeing patients, and rightly so. The Centers for Disease Control (CDC 2020) and other major medical associations (Brooks, Butler, and Redfield 2020) urge everyone to wear masks to decrease viral transmission in public. Because I primarily see elderly patients with both cognitive impairment and presbyacusis, communication has been difficult when they cannot see my mouth as I speak. I’d posted about the utility of masks with a transparent center to enable others to see the speaker’s lips, which led to an acquaintance, whom I will refer to as “Pat”, remarking something about “air flow” of the mask-wearer being limited.

I’d seen previous posts from Pat making other disparaging remarks about wearing masks, so I knew what was being implied. I hesitated before responding. I really did not want to get into a prolonged discussion on social media. Too many of these unfold into long diatribes, some of which can devolve into more ad hominem attacks. Fingers get pointed, a firestorm of emojis can ensue. Ultimately, it seems nobody is swayed from the original position, so what was the point?

Still, I took a deep breath and responded with a simple request for clarification as to what was meant. Further commentary was generated, specifically noting an increase in “CO” levels. I presumed this was a reference to carbon dioxide (CO2), rather than carbon monoxide, so I responded with the dimensions of CO2, oxygen, and similar molecules in the air, which are well capable of passing through the size of typical mask pores.

This led us deeper into the masking rabbit hole, leading, but not limited, to:

• reviewing the size of COVID-19 relative to mask filtration capability,

• summarizing coronavirus transmission via droplets,

• hand hygiene if masks are touched,

• appropriate laundering of masks,

• the general public’s poor compliance with wearing masks correctly.

Pat is not in the medical field, so I did my best to find online articles that would be relatively accessible to a layperson and stick to the science. When Pat shared outdated articles and links, I pointed out if a retraction or addendum had been issued. I focused on hard data, like molecular size. I found common ground in agreeing that masks that were visibly soiled were probably not effective and should not be used. My hope was that if nothing else were achieved by our exchange, at least our social circle would be able to witness a civil and scientific exchange of ideas between two rational adults.

The polite correspondence took a detour after another physician friend, tired from frequently dealing with conspiracy theories from clinic patients, used stronger language to denounce the pseudoscience in a link that the acquaintance had posted. When two people are completely unknown to each other, joined only by a tenuous thread of an online discussion, it is easier to be blunt and for misinterpretation to ensue. Inferences were made and names were called. If there were an emoji for virtual doors to be slammed while stalking out in a huff, that would have been used. I issued a gentle reminder to keep things civil and, to my physician friend’s credit, the physician friend issued an apology. As of this writing, Pat has not engaged further.

Over the few days that this online exchange occurred, in between regretting getting involved to begin with, I reflected upon why it was important to me to address this. The primary motivation was to encourage mask-wearing to decrease the spread of COVID. Perhaps what bothered me the most was the gross misinterpretation of the data not necessarily by Pat, but by the authors of the websites criticizing masks, some of which were reportedly written by physicians.

Why do I care about data? Medicine? Science? Truth?

The root of the word science comes from the Latin scientia: “knowledge.” I became a physician to grow in the knowledge of this “fearfully and wonderfully made” (Psalm 139:14) human body. I appreciate science because it is true, so as a doctor, I seek the truth behind a patient’s exam, a lab report, a radiology scan, a disease.

As a Catholic, I also seek the Truth, with a capital “T,” Who Is the Way, the Truth, and the Life (John 14:16). What bothers me the most about the embrace of pseudoscience is just that: “false science.” Phrenology and other such fossils litter the halls of pseudoscience. If it is not true, then it is not a reflection of Truth. Particularly when I see other Christians who seem to dismiss what science shows, I am saddened by such division, much like the divisions we see within the Body of Christ with its fractured multitude of denominations.

In sharing that Truth, “instruct the ignorant” is a corporal work of mercy. The root of the term “doctor” is from the Latin docere: “to teach.” My goal is to educate every patient I treat about the disease in question and how best to treat it. In some cases, this means giving a diagnosis where none existed before: to conquer vincible ignorance. Beyond our patients, others beyond our patients often look to us as medical experts as well.

I can also see the perspective of the average layperson, particularly a devout Catholic, who may receive medical news warily from certain sources because of the egregious disrespect for life demonstrated in other topics. Some medical societies champion causes such as abortion and euthanasia, abhorrent to us as we are guided by our Faith, and knowing the biology of when life begins and ends. Sadly, trust in the medical profession has eroded in recent years due to a number of reasons (Blendon, Benson, and Hero 2014). If Catholics cannot trust physician groups regarding these life-related issues, how easily can that trust be eroded on other medical topics? How does the average lay Catholic sort the wheat from the chaff? Thankfully, we have resources like the Catholic Medical Association and the National Catholic Bioethics Center, but the typical layperson is more likely bombarded by the media and social media posts and may not realize we have access to faithful institutions that are also medical, moral, and theological experts on various topics. As faithful Catholics and physicians, we should witness by our lives what is best and true about our practices.

Beyond Truth, there is also Love. While this is not a friend with whom I am particularly close, I still want to show charity. I kept an open mind in reading the links that were shared, vigilant for anything that was true. I care about this individual and family, whom I also know, so I want them to be healthy and safe. I prayed before I responded, specifically for this person. My hope is that other doubters of masks would see our exchange and perhaps revisit their opinion and the data. I might be one of the only doctors in their social media circle, so perhaps I can hold more sway than another “doctor” with dubious credentials. I care about the state of their health.

Charity also undergirds the exhortation to wear masks: to protect the vulnerable, to mitigate disease spread, and to set an example, particularly as a physician. Given the indiscriminate potency that COVID can wield, even among the young and seemingly healthy, I know that I am not without risk even as a relatively hale, middle-aged adult. Those with whom I interact, both professionally and socially—the severely demented Alzheimer’s disease patient cared for by his aged wife, the immunocompromised cancer survivor with “chemobrain,” the single mother of three young children who bags my groceries—are all people I can protect by doing my part: physical distancing, limiting unnecessary travel, meticulous hand hygiene, and wearing a mask.

While I did not ask to get into a debate about masks, I am grateful to have received some unexpected graces and theological insight from the exchange.

And I still wear my mask.

Biographical Note

Lealani Mae Y. Acosta, MD, is an assistant professor of neurology and a board-certified neurologist specializing in neurodegenerative memory disorders. Her range of publications reflects varied neurological interest, including peer-reviewed research articles in cognitive and behavioral neurology and creative writing. Her publications have appeared in Neurology, IAMA, and JAMA Neurology. Most of her research revolves around cognitive impairment and Alzheimer’s disease, including clinical trials for new drug therapies.