What’s in a mask?


Masks have surged to the forefront of public attention, propelled by the COVID-19 pandemic. The technical specifications of protective masks, formerly matters of arcane knowledge dimly known to many health professionals, are topics of common conversation. Their manufacturers range from traditional and repurposed factories to volunteers with home sewing machines. Facebook pages hawk masks printed with patterns of flags and of skulls. Governors and the president speak regularly for or against masks. Masks have become powerful symbols of our current health crisis and of our responses to it — as individuals and as a people.
Masks by their very nature act as shields. They shield our identity. They can hide our emotions. Properly designed masks can shield us from the infection of others and protect our health. And properly designed and used, they can limit the risk of us infecting others.
The decision to wear a mask is a personal decision. Employers and governments can advise people to wear a mask, and even require compliance with their advice. Nonetheless, it is the individual who chooses to wear it, when to wear it, and how effectively to do so. Masks are personal statements. A mask improperly worn defeats its purpose. Refusing to wear a mask when required is an act of defiance, as can be wearing a mask against advice. Rather than hiding personal sentiment, the wearing of a mask that is decorated communicates a message. The masks we see in this COVID-19 pandemic are those of caregivers, scientists, family, friends, neighbors, and anonymous others. The masks portray patriotism, rebellion, fatalism, and optimism. They are clinical, tasteful, works of art, and humorous. The use of masks tells us much about ourselves, much about one another, and much about our society. The variety of masks reveals our uniqueness as individuals and our diversity as a nation.
The importance of personal responsibility is a core lesson taught by the COVID-19 pandemic. Health professionals wear personal protective equipment (PPE) to keep themselves safe. Keeping oneself healthy is a personal responsibility for doctors, nurses, and others caring for the ill. It is also more than that. It is a professional responsibility. A health professional who becomes ill cannot care for those who need her. Her personal responsibility by virtue of her work becomes a professional responsibility. Her choice to protect her own health directly affects the health of others.
All of us have a personal responsibility for our health. More than two decades ago, the researchers J. Michael McGinnis and William Foege revealed that 50 percent of human illness in the U.S. can be directly attributed to causes amenable to personal decisions and/or social causes. What we eat, how we work, where and how we live lead to health — both good and ill. Many of the decisions are personal. And all of these decisions have important effects on the health of our community.
The COVID-19 pandemic has dramatically demonstrated the principles of community health. Communities are comprised of individuals. A community’s health, then, is at the very least the sum of its individuals’ health. In the instance of an infectious disease, the health of a community directly affects the risk of illness for individuals. Personal health choices and community public health actions are inextricably related. Personal responsibility for health is not a matter solely under the control of the individual, it is a matter for everyone. And, vice versa.
The wearing of cloth masks in the COVID-19 pandemic is of unclear value. Most cloth masks, especially those that are homemade or improvised, have very limited ability to protect the wearer. If cloth masks are effective at all, they may offer some protection against spreading infection from the wearer to others. For the public, however, the symbolism is powerful. The wearing of a mask proclaims, “I am concerned about illness”; “This illness is a community problem, not just mine”; and, if one knows the science, “I am concerned about your welfare.”
In wearing a mask, we act individually. In wearing a mask, we demonstrate our membership in our community. In wearing a mask, we acknowledge that our personal responsibility extends beyond our own health to the health of others.

Robert Laskowski is a retired health system CEO,  educator, internist and geriatrician. He lives in Oak Bluffs, and is an active member of Healthy Aging M.V.