A family member sent me a picture from the grocery store in which two-thirds of the shoppers were wearing some kind of face masks.
There were some homemade masks, along with traditional surgical masks and a few N-95 respirators.
A mask-covered face has quickly become an icon in our culture, but this begs the question, “Should we be wearing them?”
We have seen a lot of confusion about the use of face masks.
At one point, the government was saying they were ineffective for non-health care workers. They should not be worn unless someone is taking care of an infected patient, they are infected or work in health care.
This early advice made no sense to the public who argued, “They must do something or why would hospitals be begging for more and requiring staff to wear them?”
Then the government changed its recommendation, with the Centers for Disease Control and Prevention now recommending that individuals put on “cloth face coverings in public settings where other social distancing measures are difficult to maintain (for example, grocery stores and pharmacies) especially in areas of significant community-based transmission.”
Their guidance continues to emphasize the importance of maintaining six feet of distance whenever possible – even when masks are worn – and notes this guidance is for cloth masks only, not for surgical masks or N-95 respirators that should be reserved for health care workers.
So, did the government lie? What is going on here?
This is a case of poor communication that fueled a misunderstanding. We know that N-95 respirators are effective at protecting the wearer from others and protecting others from the wearer.
Thus, when health care workers are going to potentially be helping a patient with a viral infection of some kind, they put on a respirator protecting themselves from exposure.
When health care workers perform procedures, they will wear surgical or procedure masks in order to make sure they do not expose the patient to their breath.
These masks only provide limited protection in the event the patient is infected with a contagion.
Therefore, wearing a surgical or homemade mask is primarily to protect others and only secondarily to protect one’s self.
On the other hand, the N-95 respirator can work both ways but its primary purpose is to protect the wearer.
Add to this the fact that public health officials have studied the general public’s use of face masks for years. Study after study has revealed that the public does not wear masks correctly.
They will forget to wash their hands, touch the mask to readjust it or remove it improperly. In addition, traditional surgical masks should only be worn for a few hours and not reused.
Some public health officials are concerned that the large-scale use of masks will give the public a false sense of security and discourage aggressive social distancing.
With the above in mind, three moral issues come to the surface.
- Wearing any type of personal protective equipment (PPE) is inappropriate unless you commit to following the guidelines for that item.
Failing to follow the recommended guidelines does three things:
- It does not protect you or others.
- It consumes PPE that could have been worn by a health care worker. Because PPE is currently a scarce resource, the moral duties of beneficence and non-maleficence demand that we either use the equipment properly or allow others to use it.
- The misuse of PPE can actually increase the rate of transmission, especially in the case of reusing masks or wearing them incorrectly.
- Knowing that surgical masks are designed to protect others from the breath of the wearer, it forces us to ask why so many are wearing them in public.
Obviously, they are a good idea if the wearer has been exposed to COVID-19 or another contagion. In like manner, they are useful in settings where social distancing cannot take place.
But let us be clear: Wearing a surgical or homemade mask is not primarily about one’s self. It is about our duty to care for other people.
The individual has to weigh the desire to protect themselves and others by wearing a mask against the shortage of PPE that is affecting health care workers.
If it is determined that homemade masks are effective at slowing or preventing the spread of the virus from an infected person to the uninfected, then wearing one is a moral imperative directed by the obligation to care for others.
- The decision to wear a mask needs to take into account the common good.
If one is at high risk of being infected or is caring for people who are probably infected, then reason dictates we give them a priority in PPE provisions. This is for one of two reasons respectively.
In the first case, society would want to slow the rate of transmission. Therefore, infected or potentially infected people would need priority in getting a mask.
In the other case, healthcare workers are on the front lines fighting infection. As more and more physicians and nurses become infected, there are less and less of them available to take care of the rest of us.
It is not that they are more valuable than the rest of us. It is a pragmatic issue.
If one is worried about becoming seriously ill from the COVID-19 virus, that same person would want to ensure an adequate number of health care workers are uninfected and working in order to save as many lives as possible.
By protecting the health care workers, whether out of a sense of egoism or altruism, one is ultimately protecting the community as a whole and thus themselves.
While the guidelines for wearing masks could change after this article’s publication, the above moral principles will still apply.
In order to be responsible, one needs to ask, “Why am I wearing a mask? Am I ensuring it is being used effectively? And how does this contribute to helping society recover from this pandemic?”