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While COVID-19 is busy finding the unvaccinated and the undervaccinated in order to keep spreading, we are left with COVID-19 infection and its sequelae being one more disease of social and physical marginalisation and of poverty
AFTER masking up to pay for petrol last week, I waited for cyclists to pass, before joining traffic on a busy six-lane road. One of the peloton yelled at me as he sped past: “take your f***ing mask off!”
It shocks me: the vehemence with which people respond to masks, a simple measure to reduce the transmission of COVID-19. We have very clear evidence that masking is effective in reducing transmission. Professor Trish Greenhalgh, Professor of Primary Care at the University of Oxford, speaking on Twitter, delivered one of the best arguments for mask wearing as a strategy for reducing the transmission of COVID-19 I’ve seen. It’s a long thread, but full of gems, including research from the American Journal of Tropical Medicine and Hygiene, JAMA Network Open, a demolition of the “risk compensation” argument against wearing a mask, PLOS Medicine, and her own work in the BMJ and the Journal of Evaluation in Clinical Practice.
My colleagues mask all day at work, whether in the operating theatre, in the consultation room or in meetings. Yet, on the train home, I am often one of very few wearing a mask, let alone a high grade one. There have been 9.5 million (reported) cases of COVID-19 in Australia, yet we’ve had messaging such as the “smiles are back” campaign from the Queensland Premier.
In posting a response to interjectors in federal Parliament recently, Dr Monique Ryan noted that “We all have a duty to look after each other. Here and everywhere”. Yet the Prime Minister received his booster shot while not wearing a mask.
While none of this will be unfamiliar to many readers, many others see COVID-19 as no more of a threat than this winter’s next cold, while they see mask wearing as a deeply offensive infringement on their lives.
So, what is this COVID-19 denial? Where does it come from? I find it completely bewildering. Perhaps part of the answer can be found in the way we talk about the pandemic. The public discourse seems to be “live with it”, “return to normal”, “Freedom Day”, “we can’t live like this forever”. The doctors I read and those I speak with are concerned but are often not sure what to do. I feel as if they are not used to the idea of being activists. The doctors who say COVID-19 is all over seem to be regarded by their colleagues as foolhardy, and yet, frustratingly, they continue to be courted by the mainstream media.
Dr Thomas Finch, a psychiatrist in the US, commented on Twitter on the public statement released by President Biden’s office that the President “will continue to carry out all of his duties fully” while COVID-19-positive, taking antiviral medication and isolating. He tweeted that this represented:
“ … a complex organizing belief system about what it means to be strong and virtuous and that we must adopt a certain attitude toward a pathogen … To survive despite COVID is more virtuous than to avoid COVID. … To work when sick, to ‘live with a disease’. Rather than to rest, or to eliminate a disease.”
On Twitter @FinchTH
This is the first time I have some sort of hold on this thinking. It is an echo of long-touted employment policies that insist one must not “abuse the sick days … and only miss work when … genuinely too ill to perform their job”. You cannot simply need time out to recover, to spend time with family, friends. To “soldier on” is virtuous. To “avoid” COVID-19 is to be a wimp, to not stand and face it.
On Twitter, the vocabulary has a negative tone: to evade, dodge, elude, escape COVID-19. It’s not that you’ve been clever, careful or conscientious. Instead, you’ve been cowardly and sheltered behind that mask.
For his sake, I hope President Biden doesn’t get long COVID. The post-COVID-19 persistence of symptoms is well described. The personal impact of persistent symptoms is high – Professor Chris Goodnow, an immunologist from the Garvan Institute of Medical Research, has written about his own experience of a post-COVID-19 heart complication, which occurs in 2% of infected people. Will the US President be expected to carry out his high level executive functions despite any post-COVID-19 repercussions?
I feel a deep despair now. It is wild that we have walked back such a simple measure as wearing a mask in this way. As I see it now, COVID-19 is expert at exposing the inequities of health care (and here). While COVID-19 is busy finding the unvaccinated and the undervaccinated in order to keep spreading, we are left with COVID-19 infection and its sequelae being one more disease of social and physical marginalisation and of poverty.
It joins an already overlong list.
Dr Lilon Bandler is a Sydney-based GP, medical educator, and Associate Professor with the Leaders in Indigenous Medical Education Network at the University of Melbourne. She is Medical Director of health services at The Wayside Chapel.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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I agree with Ben Clark above. Also a recent Insight article stated: “For the Omicron wave this year – by which time most of the population were vaccinated – the case fatality rate has approached 0.1%. This is comparable to the seasonal influenza case fatality rate seen in “normal” flu years.” So quite reasonably, many fit and healthy people think they do not need to take any special precautions.
It’s tough when you are a mask wearer member of a household and the other member is not. It puts the mask wearer at a distinct disadvantage because their decision to mask up is being undermined by the non mask wearer. Not dissimilar to smoking indoors. It takes away the mask wearers choice to stay safe when there is no mask mandate in place. It puts pressure on relationships. There is not even any middle ground either. Eg, shop assistants should show care and don a mask while serving a mask wearing customer. I feel like its the ewuivalent of blowing smoke in someones face if they are not wearing a mask. This pandemic has caused me to stop eating at restaurants and pubs. If we were reducing transmission numbers by wearing masks, I would have more confidence to eat out.
the public are paying a heavy price for this with enormous waits at Emergency departments, inaccessible GP appointments, long waiting lists for surgery, and morbidity and mortality statistics for all health issues ( not just COVID ). unfortunately most of them don’t yet realise it.
Mask wearing behaviour and messaging also has political and economic dimensions. Politicians who want to attract voters nominally more right wing and independent eschew masks to identify with that culture. Avoiding masks also sends the message that it is safe to be out and about, so benefitting retail and tourism sectors economically. As we know all too well, a major determinant of disease burden is irrational human behaviour, and avoiding masks in the face of pathogens is a case in point.
Unfortunately, at least in part, some of the egregious public health measures during the initial lockdowns have led to the public’s current resistance to what are very sensible measures to slow the spread of covid e.g. mask wearing inside. The list is long.Mask wearing outside, restrictions on outdoor activities, playground closures, school closures, refusing to let people return to their own state or country, curfews, cessation of day surgery etc etc. I could go on.
Disappointingly our representative bodies, including(? especially) the AMA were largely silent.
My wearing a mask is doing a much better job of preventing spread than of protecting myself from catching any airborne virus, therefore I should be seen as doing others a service not being self serving, or a wimp.