Much attention has been focused on scientific and government advice regarding personal protective gear for health-care professionals. Unfortunately much less advice is available on what might be the three important parts of the garb that we citizens wear in public and at home. Yet the choices we make—or choose not to make—in our masks, shoes, and gloves may be critical for our own protection as well as that of our family members, as well as others.
What personal, anecdotal and scientific information exists about what are proper and prudent and even life-saving, personal choices in masks, disposable gloves, and footwear that will help us fight contagion? When we leave home, to go to grocery stores, pharmacies, and emergency health care facilities, what should we be wearing?
Ethical and Moral Dilemmas:
1. Masks: I wanted to pass my growing personal sentiment that we may have been given very bad advice from our governments over the past two months not to wear masks in public. The government gave all sorts of explanations (many were truly senseless, if not demeaning) for why the asymptomatic general public should not be wearing masks. These explanations, in my opinion, were thinly veiled attempts to ensure that the supply of masks was available for the medical establishment, which is a great concern indeed, but not the only one.
Simply, according to some health scientists, masks are not so much for our own protection as to prevent our own droplets which are formed by everyday speech from infecting other people and objects. Infected but asymptomatic people not wearing masks are very likely a key, if not the primary factor driving the spread of COVID-19. Since anyone in public could be an asymptomatic carrier, a clear inclusive public health approach would be to require everyone in public to wear a mask.
Wearing a mask when I go to receive hospital treatments makes me acutely aware of my breathing. The mask barrier over my nose and mouth truly, helpfully and routinely reinforces my intention not to touch my face. To the extent that I am typical of the at-risk population, wearing masks in public would help patients like me be more mindful about avoiding touching eyes, nose and mouth.
2. Gloves. Despite many warnings about not doing so, I am guilty of habitually and involuntarily touching my eyes, nose, beard and mouth. This is a likely habit of at least a few times an hour. I honestly don’t know why—it’s constant and involuntary. Whether at home or outside, I do so without really thinking, and such inadvertence could be deadly.
Wearing light, transparent, disposable and inexpensive gloves has been remarkably effective in making me conscious of where I put my hands in the first place. Simply wearing them makes me mindful of what I am touching. When touching highly public doors, handles and ATM buttons, I readily apply sanitizer to these gloves, which certainly reduces droplet transmission.
3. Shoes. Where is the dirtiest and most dangerous place where I might be expected to be infected? It is likely not my desk, my cell phone, or the grocery counter. Nor is it the surface of a can of peas, the mail, or the pump at the gas station. Rather, it is more likely to be the floor of the pharmacy, grocery or hospital. That’s where all those droplets of the virus fall and congregate for hours before losing their deadly potency.
My good friend, physician Mendl Malkin, has never heard an Infectious Disease Specialist, Emergency or ICU MD or nurse, express concern about footwear. Nor has he seen it mentioned in print. Nonetheless, my approach is to have a dedicated pair of outdoor shoes that I put on and take off in my decontaminated zone of the front hall at home. I wear them only outside the house and try to wipe them clean periodically.
Radio and television coverage rarely seems to address the knowledge-based sanitary dimensions of choice involving gloves and shoes. Some recent radio programs suggest that wearing masks may possibly be the key to us eventually coming out of hiding and starting to congregate together again once the peak of this epidemic is past us, but while some risk of infection still lingers. I can envision social events (conferences, religious services, and the like) where masks are required by everyone attending. This could (and in the opinion of my University of Toronto scientist friend, Jason Weir, should) be the new norm once social distancing measures ease up, but before a vaccine is made available.
The American physician who heads a prestigious scientific panel told the White House yesterday that the best current scientific research shows that the coronavirus can be spread not just by sneezes or coughs, but also just by talking, or possibly even just breathing. He concludes that he plans to wear as well as recommend others wear a balaclava or bandana or home-made mask in public.
Legal and Values Dimensions:
According to social history books, North America’s 1918 experience with the Spanish flu (50 million deaths worldwide) offers many examples of the application of mandatory government edicts that backfired, potentially inciting undue social conflict and uncertainty that worsened disease transmission and, according to today’s standards, would fall far short of ethical standards. In many cities, including Toronto, San Francisco and Denver, local officials passed mask ordinances requiring individuals to wear layered-gauze masks in public, despite having no clear scientific proof of benefit, and authorizing the police to fine or arrest those who did not comply. These mandatory face mask laws proved to be bad policy. Many people wore the masks incorrectly, and some engaged in subterfuge to avoid wearing them. For others, the masks provided a false sense of security from the pandemic.
There were even several instances where those who issued the mask order—including both San Francisco’s mayor and health commissioner—were seen at public events with the masks dangling across their necks and not properly fastened. Some citizens formed anti-mask leagues and placarded the streets with anti-mask manifestos. There also was pushback to mandatory school closures and social distancing measures in many Canadian cities during the fall of 1918, especially when these regulations were deactivated, only to be reactivated days or weeks later when citizens felt that daily life was returning to some semblance of normality. In the worst instances, mandatory pushback put society at greater risk of infection, and the haphazard application of edicts eroded the public trust.
My personal preferences and practical suggestions to best avoid infection and/or transmission of the infection are clear. Wear appropriate shoes and disposable gloves outside the home. Encourage others to do so. If you have a mask, wear it when in public. If you don’t and can no longer buy one, you can make one and wash it between uses. If you are not skilled at making masks, certainly you might consider starting to wear masks when they do become commercially available again. Here I refer to using the loose fitting medical masks – not the N95 masks which are unnecessary, uncomfortable, and should be reserved for the medical establishment at this time.