Physician, Mask Thyself

It may seem redundant to read about the importance of wearing a mask in an article meant for physicians, but one look at social media and you’ll understand why the topic is appropriate for this venue. It pains me as both a physician and a human being to see the number of people, including physicians, posting photos of themselves in large groups without masks. Sadly that is just a small reflection of what you see in US cities, suburbs, and countryside communities on any given weekend. And it leaves me flummoxed.

I am not referring to the people channeling Mel Gibson in “Braveheart” shouting “Freedom!” as though the decision to wear or not wear a mask were political. It is no more political than wearing a helmet to ride a bike or wearing a seatbelt to drive a car. I’m talking about the general population, most of whom spent an uncomfortable amount of time in lockdown, who really want to do the right thing but now desperately want social contact. Unfortunately, given the global respiratory viral pandemic, the choices are 1.) to continue to gradually open businesses and services while maintaining protocols of hand sanitizing, social distancing, and universal public mask wearing, or 2.) to return to lockdown. Social contact isn’t an option.

There are those who will say, “It’s my health and none of your business.” As physicians we are well aware that it is the business of every person on the planet. The decision not to wear a mask in public or not to practice social distancing has a direct effect on the health of everyone with whom you come in contact and everyone they contact and everyone they contact and so on ad infinitum. From a public policy perspective, not wearing a mask in public is akin to drunk driving or smoking in the workplace. A drunk driver risks the lives of everyone else on the road. Second hand smoke is a recognized carcinogen to everyone around the smoker whether they smoke or not. These are personal decisions that affect not only the decision makers but also others around them.

Why does this merit discussion among aesthetic physicians? In recent months, we’ve all made significant changes, at considerable expense, to nearly every aspect of running our offices just to make the environment safe for our patients, staff, and us. Patients must pass stringent viral screening questions and sometimes laboratory tests just to see us in person. The new normal means entering each patient encounter wearing PPE as anti-COVID armor. Office safety is secured. One might assume that anyone taking such care with patients would apply the same principles for the rest of life. But that just isn’t the case.

How are so many of our colleagues interacting with staff, family, friends, their kids’ friends, and trainees without a mask? It is possible to expand your household’s COVID safe “bubble” to include a friend’s household or select outside family members. That presumes that everyone involved agrees to following the code of the bubble: to wear masks and social distance with anyone outside the bubble group.

Some offices do COVID testing of their doctors and staff regularly. Sadly, we know that doesn’t guarantee safety (look at the recent experience of the White House, which tests staffers daily); the rate of false negatives is still high. A positive antibody test isn’t a gold ticket, either; it’s unclear how well it protects against the many COVID haplotypes and for how long any immunity lasts. These tests are all we have, and results are used to allow kids to attend day care and camps and patients to have elective surgery. But the former usually requires some other promise of good COVID safety behavior. And in the latter case, the doctors and nurses treating the patient wear PPE. In fact, every society and government guideline recommends that masks be worn while treating patients—the only question is the level of mask, which depends on the procedure and whether the patient is able to also wear a mask throughout, whether or not the patient had a negative antigen or positive antibody test. So why would you remove your mask with anyone else outside your strict bubble?

For those who have managed to expand their bubbles and post mask-less group photos on social media, please explain it clearly in your caption. For those who are relying on tests and hope, I suggest you rethink. Because COVID hasn’t gone away and isn’t just a big city issue. COVID is everywhere, and if we want to avoid another lockdown, we need to do everything we can to stop viral spread. In a time of viral conspiracy theories and rampant distrust of science, don’t we, as physicians, owe it to ourselves, our families, and our world, to be positive examples of how to best contain this pandemic? Having been through so many years of school and training to reach our goals, we are in an ideal position to explain to others the benefit of short term discomfort for long term gain.