Face Masks: Learning a Better Way From History

For the past few months, a phrase my Grade 5 history teacher, Mrs. Galbraith, has been stuck my head: “History repeats itself, but only for those that are open minded enough to see it.”

We were learning about the influx of Irish refugees to Canada and the US who were fleeing the Potato Famine in 1845. They risked everything to come across the ocean in leaky boats with little food in the hopes of finding a better life. At the time, Canada was experiencing a Vietnamese refugee crisis and Mrs. Galbraith wanted the class to see the similarities in how the public was reacting to the foreigners (they weren’t happy with the Irish in 1845 either, but eventually accepted them).

Of course, today we have the COVID-19 pandemic which has parallels to the 1918 Spanish Flu. I’m sure if I was still in Mrs. Galbraith’s class we would be reviewing a side-by-side bullet point chart that outlined the similarities and differences. This of course would lead to a lengthy week-long discussion on what we could take from the past experience in order to do better in the current crisis.

Face Masks

What has me thinking back to my Grade 5 history class today is the challenge of Face Masks. For many, it’s so plainly obvious that wearing a mask saves lives and is the right thing to do, not only for themselves, but for loved ones. These people don masks without hesitation. There is portion of the public, however, that view masks as an attempt to muzzle them and as an infringement on their personal freedom.

I must admit, when masks became recommended by health officials, I didn’t even think twice about wearing one. It just made sense to me. As the weeks went by I became frustrated and little angry at people who weren’t wearing masks. The news had pictures of people gathered in crowds, not respecting the 6ft distance and not wearing any face covering. I was happy when the newscasters and “experts” called them out.

Shaming non-compliant people has now become a sport on social media – with dozens of photos/videos uploaded every minute of people refusing to wear masks, party-goers flaunting public health guidelines and brawls over people being refused entry. Despite this, the level of mask wearing has not appreciably increased. I thought this was surprising…until I began to read about past situations that were similar: condom usage during the HIV crisis and seatbelts in the 1960s.

History is repeating itself and will we listen?

Historic Parallels

In a recent article, Luke Shors writes:

“Wearing masks to limit COVID-19 is by no means the first hard-to-sell public health intervention.  At the outset of the HIV/AIDS epidemic, scientists recognized that correct and consistent use of latex condoms was an extremely effective way to reduce transmission.

Yet assuming that people would use condoms simply because condoms prevented HIV/AIDS transmission was naive. When surveys reported that many people didn’t like condoms, the message from some in the media was to “stop whining.” Like with the New York Times editorial, this message may have worked with a certain segment of the population, but proclaiming that anyone who doesn’t like to use condoms is whining missed reaching important groups who would not change their behavior based on social shaming.”

Shors continues with other examples:

  • Bed nets that prevent malaria were rejected because they made sleeping more difficult
  • Improved cookstoves that did not release poisonous carbon monoxide were not widely adopted because they made food taste different
  • Seat belts were rallied against because they were uncomfortable, restrictive and “infringed on the freedom to drive”, yet were proven to save lives

In all these examples, adoption of the intervention (condoms, bed nets, cookstoves and seat belts) was slow, even though it was “obvious” that it saved lives. The science was irrefutable…or so proponents thought.

Dubious Science

Scottie Andrew at CNN wrote about how detractors used dubious science to refute the claim that they were safer:

“Like opponents of masks, carmakers and lobbyists touted opaque claims that wearing a seat belt could cause more harm than good.

They perpetuated the baseless idea of being “thrown clear,” or tossed away from an accident when you’re ejected from a car instead of being strapped inside. Being “thrown clear” of an accident was considered safer than being trapped inside a vehicle.”

For those of us that work in healthcare or who are health literate (which is most of #hcldr), it’s hard to imagine why people would listen to unfounded claims made by politicians and celebrities. But for many, they simply don’t know any better. If you aren’t science-savvy how would you know good science from bad science?

To simply say that someone should know better fails to acknowledge the fact that they may indeed not know better.

Reasons for No Masks

In the case of bed nets, it was originally thought that charging for the nets would make them more valued and cherished by end-users. This in turn would ensure they took better care of the nets so that would be properly installed and last longer. It turned out to be a significant barrier to their adoption by the people the nets were designed to help – those in the poorest most remote areas.

Put simply, they couldn’t afford the nets so they went without.

The same is happening with masks. We expect everyone to use them, yet they are not readily available to people across all socioeconomic groups. I go to Costco and I see stacks of PPE available for purchase, but when I drop off food at the food bank, there is no PPE that can be taken home.

Now imagine if you are unable to afford masks and you go into a store to buy food for your family, only to be met with stares and comments about “how selfish you are not to wear a mask”. How would you feel?

I have also been reminded recently by friends on Twitter than there are medical reasons why people cannot wear masks. Anyone with severe Asthma, for example, or people who are severely claustrophobic. There are also several pulmonary conditions that may make mask-wearing difficult for extended periods of time.

When I realized this could be the situation for the other person, I stopped feeling angry towards people without masks.

Solutions

So what can we do to improve mask wearing? Here are ideas from various experts and articles (see references):

  • Continue to talk about the science and the facts
  • Educate, educate, educate
  • Use different messaging for different audiences – what a teenager will listen to is different than a 40-year old
  • Make masks more widely available – ie: free at the door to anyone who needs/wants one
  • Make masks in different shapes and sizes to fit different faces and needs
  • Mandate mask wearing (don’t leave it up to individual store/property owners)
  • Reward good behavior not just punish non-compliance

Next HCLDR

Join us on n the next HCLDR, Tuesday August 26th at 8:30pm ET (for your local time click here) when we will be discussing the issue of mask wearing:

  • T1 How do you feel about the issue of wearing masks?
  • T2 How would you approach someone who isn’t wearing a mask? What about someone vocally berating someone who isn’t?
  • T3 Have you seen examples of effective REWARDS for wearing a mask? If not, can you think of one that might work?
  • T4 What suggestions do you have for parents of teenagers to encourage them to wear a mask/take COVID precautions?

References

Shors, Luke. “Condoms, Cookstoves, Seatbelts, and Face Masks”, Think Global Health, 21 July 2020, https://www.thinkglobalhealth.org/article/condoms-cookstoves-seatbelts-and-face-masks, accessed 25 August 2020

Andrew, Scottie. “The debate over masks today is a lot like the decades-long fight to mandate seat belts”, CNN, 5 August 2020, https://www.cnn.com/2020/08/05/us/seat-belts-masks-coronavirus-wellness-trnd/index.html, accessed 25 August 2020

Klass, Perri MD. “To Get People to Wear Masks, Look to Seatbelts, Helmets and Condoms”, The New York Times, 21 July 2020, https://www.nytimes.com/2020/07/21/well/family/masks-condoms-seatbelts-helmets.html, accessed 25 August 2020

Couto, Melissa. “How Wearing A Face Mask Is Like Wearing A Condom”, Huffington Post, 7 July 2020, https://www.huffingtonpost.ca/entry/face-masks-condom-safety_ca_5f04e1d2c5b67a80bbffbe6c, accessed 25 August 2020

Etelson, Erica. “Mask-Shaming Won’t Work. Try These 5 Things Instead”, Yes Magazine, 16 July 2020, https://www.yesmagazine.org/opinion/2020/07/16/wear-face-masks-empathy/, accessed 25 August 2020

Ruiz, Rebecca. “Don’t shame people who don’t wear masks. It won’t work”, Mashable, 19 July 2020, https://mashable.com/article/coronavirus-masks-anger/, accessed 25 August 2020

“Reconstruction of the 1918 Influenza Pandemic Virus”, CDC, https://www.cdc.gov/flu/about/qa/1918flupandemic.htm, accessed 25 August 2020

“The Great Influenza: Lessons To Learn From The Spanish Flu”, NPR, 29 April 2020, https://www.npr.org/2020/04/29/848112072/the-great-influenza-lessons-to-learn-from-the-spanish-flu, accessed 25 August 2020

Image Credit

Photo by L N on Unsplash

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