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What the Never-Ending Mask Debate Is Really About

— Hint: It's not the science

MedpageToday
A photo of a subway advertisement promoting covid masks with an anti-masking sticker covering it.

Masks work!

No they don't!

Yes they do!

No they don't!

Since joining Twitter a few weeks ago, I've been privy to dozens of such exchanges, each one taut with passion and fury. Ping, pong, ping, pong, back and forth ad infinitum. I call it the Mask Debating Olympics and it's exhausting to watch.

It starts innocently enough: a doctor or science journalist posts a tweet urging people to mask up to ease the strain on ICUs. After a few supportive responses, someone jumps in with data showing that mask mandates have no significant impact on COVID cases. Another tweeter counters with the Boston . Soon enough, a diagram of aerosol dynamics pops up in the thread, followed by an illustration of cartoon people breathing on each other. Eventually someone brings up the 2021 cluster-randomized Bangladesh trial, which found that people in villages that promoted surgical masks had an of catching COVID. "That's hardly significant," someone interjects. Yes it is, no it isn't, yes it is, no it isn't...

Next, the conversation branches out to the alleged social costs of masking, from loss of scholastic achievement to impaired communication. "The kids are way behind!" "They'll catch up." "Tell that to all the kids in speech therapy." "Better in speech therapy than dead." "Hypochondriac!" "Egoist!"

On and on, back and forth, slams and counter-slams, tricky corner shots and dazzling saves, the ping-pong rackets dripping with sweat. Almost 3 years into the pandemic, it feels like we're right back in spring 2020, when people were yelling at each other about sitting on park benches.

Beneath all the data and debating points, the accusations and insults, lies an unspoken difference in what we might call the philosophy of living. The two teams are not arguing about science, but about civilization. One team envisions a society of well-defined limits, of common purpose and behaviors, in the interest of keeping everyone as safe as possible: a society organized around the prevention of disease. The other team leans toward a society that champions personal responsibility and choice, while accepting a background risk of disease as an inescapable feature of sharing a planet with viruses.

With almost 3 years of COVID in our rear-view mirror, both teams understand that we're no longer talking about "just a few more weeks" or "until hospital beds open up." What we decide at this juncture will set the tone for the years -- and possibly decades -- to come. We're voting on what could become a seismic shift in social organization, with an increasing reliance on masks to control disease and buffer communal life. In support of this new paradigm, a proposes mask mandates (as well as social distancing) to help protect people from long COVID. Team A embraces this future, while Team B resists it. The sea of masked faces that team A views as caring and comforting looks like an asocial wasteland to team B. To team A, public health comes first, whatever sacrifices it requires. To Team B, public health should operate on the margins of life, rather than hogging the stage.

The two teams are not really arguing about facts, but about the kind of world they want to live in. They keep talking past each other, unaware of (or ignoring) the subtext flashing under their disputes about mask science. It's like a zoologist and a poet discussing the meaning of a flower: they're speaking different languages, so they can never truly hear each other.

If a new study suggests, say, that community masking reduces transmission by 30%, team A will take it as proof that we should all put our masks on, while team B will argue that the joy of impromptu smiles and unrestricted breathing trumps the extra infection risk from going maskless. Team A will point out that we have a duty toward the immunocompromised, while team B will retort that keeping everyone masked up until we achieve perfect risk equity, which will never happen, betrays the social contract and harms the social fabric. Same data, different responses -- not because the two teams interpret science differently, but because they want different worlds.

The arguments for routine masking are low-hanging fruit: if wearing a mask has the potential to reduce the risk of catching a virus, even marginally, why on earth wouldn't we do it? To those who would happily mask forever, concerns about faces and smiles seem insultingly trivial. The opposing arguments sit higher up on the fruit tree. We do not have validated questionnaires to capture such outcomes as "dehumanization" or "negative ontological impact," a concept discussed in an on masking by Melbourne philosophy researcher Michael Kowalik. We struggle to explain why a society in which avoidance of contagion becomes our highest priority, to the detriment of other forms of human caring and connection, disturbs us so mightily. Daniel Hadas, a U.K. classical literature scholar and one of my favorite COVID commentators, says that mask resistance has become "" for the simple reason that the "human face is one of the in the world, and I do not accept to live without that beauty."

One thing is for sure: we're arguing about something bigger than masks, bigger than science. That's why new mask data will never put an end to the debate. As long as masks persist in society -- which by the looks of it, could be a while -- the two teams will continue to hurl invective at each other on social media and elsewhere, burning up energy in the most frustrating and futile tug-of-war of the pandemic era. It's a battle that science will never solve on its own. Perhaps we need a poet or two in the mix?

is an award-winning health and medical writer based in Toronto. Her COVID essays have been published widely in the U.S., U.K., and Canada.