Questions for Those Who Support Mask Mandates
In our zeal to combat a virus, we are making decisions that not only affect individuals today but that set precedents for future encroachment on informed consent and patient autonomy.
For those who support government-mandated mask requirements, I have a few thoughts and then three questions:
First, while mask-wearing is arguably a small medical intervention that most believe carries little to no risk to most people, there is nevertheless the possibility of harm to the wearer. Some may discount or dismiss any risk of harm, believing the risk is small or non-existent based on statements made by the CDC or other government officials. However, some doctors and scientists contend that there may in fact be harmful effects (and I am not here referring to the many posts about oxygen saturation, CO2 buildup, etc.). For example, one study published in the British Medical Journal that compared cloth masks with medical masks concluded the following:
“This study is the first RCT of cloth masks, and the results caution against the use of cloth masks. This is an important finding to inform occupational health and safety. Moisture retention, reuse of cloth masks and poor filtration may result in increased risk of infection.”
“The physical properties of a cloth mask, reuse, the frequency and effectiveness of cleaning, and increased moisture retention, may potentially increase the infection risk for HCWs. The virus may survive on the surface of the facemasks, and modeling studies have quantified the contamination levels of masks. Self-contamination through repeated use and improper doffing is possible. For example, a contaminated cloth mask may transfer pathogen from the mask to the bare hands of the wearer. We also showed that filtration was extremely poor (almost 0%) for the cloth masks. Observations during SARS suggested double-masking and other practices increased the risk of infection because of moisture, liquid diffusion and pathogen retention. These effects may be associated with cloth masks.”
In light of the fact that at least some research suggests that cloth masks can result in increased risk of harm to the wearer, here are my questions:
(1) The Code of Medical Ethics (Opinion 2.1.1) makes clear that “[i]nformed consent to medical treatment is fundamental in both ethics and law. Patients have the right to receive information and ask questions about recommended treatments so that they can make well-considered decisions about care.” Recognizing that informed consent is “fundamental in both ethics and law,” do you believe that government-mandated mask requirements encroach upon patient autonomy or otherwise interfere with informed consent and the doctor-patient relationship?
(2) If you do not believe that compulsory mask-wearing violates the patient’s right to informed consent (and in turn the freedom of medical choice), why do you believe that it does not violate this right?
(3) If you do believe that compulsory mask-wearing violates the patient’s right to informed consent but you nevertheless support the mandates, on what basis is it permissible to violate the individual patient’s right to informed consent (or choice in one’s healthcare decisions)?
I ask these questions out of a genuine concern that, in our zeal to combat a virus, we are making decisions as a society that not only can affect individuals today but that set precedents for future encroachment on informed consent and patient autonomy. Even if the majority of people are on board with mandated mask-wearing today, once the government overrides patient choice and the right of individuals to refuse medical interventions, what if authorities sought to impose more invasive (or more restrictive) treatments or interventions in the future? I appreciate any responses and will try to respond as soon as I am able.
UPDATE: Dialogue Related to this Post
Commenter 1:
Your pretend concern and flowery language to push politicized crap is frustrating. This article is from April. This new to humanity virus has health experts updating recommendations as soon as possible while still working towards effective treatment/vaccine. The current recommendations from epidemiologists, health experts, and the CDC are to wear masks and distance from people. I’ve read/listened to experts who study this and if just 80% of the population would wear masks and keep 6 feet distance as much as possible, the rate of infection would drop dramatically (like it has in every other major industrialized nation). Proper cleaning and sanitizing of cloth masks keeps the wearer protected. Wearing the mask keeps everyone else protected. This isn’t a question of personal risk on masks, it’s about protecting the community from further spread as people can be fully contagious for the virus for DAYS before they have symptoms.
Response:
To be clear, this study was from 2015. I referenced it because it’s one of very few (really the only controlled study I could find) that I have seen on the use of cloth masks. You are right that the CDC and some health experts recommend all people (who are able) to wear masks; other experts (including The WHO) do not, and some doctors have cautioned against their use. The same is true of the recommended social distancing. The CDC and some experts recommend 6 feet, but there are others who would recommend less (WHO at 1 meter) or some even more. To my knowledge there are no definitive studies confirming an exact distances, just recommendations based on observations/best thinking from different doctors and epidemiologists. If you are aware of other controlled studies on cloth masks, please send them to me, as I genuinely would love to see them.
And to clarify on the post, my aim here was not to debate the efficacy of masks but simply to ask on what basis the government should be permitted to mandate them, as there are at least some (at least a minority) who would caution against their use because of possible risks to health. And as to pretending that I am concerned or using flowery language for some political purposes, I respectfully disagree with you. My aim in my posts is to try to have a reasoned and civil discussion with people who are willing to dialogue. I will do that imperfectly, but I assure you the only reason I would take time to post is out of genuine concern for my friends and loved ones as well as society as a whole.
Commenter 1:
https://podcasts.apple.com/.../factually.../id1463460577...
Immunologist Erin Bromage says a lot on here about the importance of mask wearing. I haven’t heard reputable doctors say to not wear masks. I have friends who are immunocompromized and wearing a mask, per experts like the one referenced above, can do a lot to keep them safe. Saying the things above is only calling into question things we don’t have the expertise to question on issues that drastically affect our family, friends, and community. I have only seen clear republican conservative propaganda outlets push the anti mask talk and what you’ve posted is a subtle way of saying just that. Considering medical personnel have been wearing PPE grade masks for hours on end with no issues, I seriously doubt there will be that many people with any kind of issue wearing one.
In short, those who are genuinely concerned for the health and safety of others would be encouraging masks (since masks are a minor inconvenience at worst) instead of having “civil discussions” about wearing them at all with a whole bunch of people not qualified to argue mask efficacy.
Response:
Thanks for your response and for sharing this podcast. I will aim to listen to it at some point this week while I’m driving. As to the mask recommendations, one thing I will say is that it sad to me (and I would imagine sad to you as well) that COVID has become politicized the way it has. As for me, I am not parroting any particular network, as I don’t watch cable news but only peruse articles from many different viewpoints and sources. As to reputable scientists and sources, I think a lot of the disagreement between us (and probably most everyone who has looked at this in much detail over the past several months) is which experts/scientists/doctors/etc. to trust. This is why I have continually wanted to look at as many studies and as much actual data as I can. As to healthcare professionals having no issues, perhaps these issues are not severe, but there are many who would say that they have led to headaches and other symptoms (see here for one example). In all this, my post was not intended to say that people should not wear masks if they choose to do so; my question was only whether masks should be mandated when there is the possibility of adverse effects (no matter how slight).
Commenter 2:
Hi. Medical person here. This is a gross misunderstanding of informed consent. I have held off on commenting on your other posts because, hey, you are entitled to your opinion and you seem to be pretty set in your ways. I am not going to change your mind on any of this, and you seem pretty invested, so I have no interest in altering your mindset. You do you.
However, this line of argument is way off. Masks are not a medical intervention, treatment, or anything similar. Masks (face coverings, as some places are calling them now) are a means of prevention and a simple way of showing you are 1) not an idiot, and 2) a compassionate human. (And by not an idiot, I mean you are aware that there is an international communicable disease all over your country, and you know that the primary mode of spread is respiratory, not contact, and that masks can significantly decrease your risk of acquiring or spreading said infection.) You don't need informed consent to wear a condom, do you? No you don't. You pick it off the shelf and put it on without reading the box or insert because you know what it's for: prevention.
Informed consent happens when I am face to face with a patient and I say "I am going to give you this chemotherapy to treat your cancer. This is the name of the drug. This is how it works. Here are the side effects. Here are the risks. Here are the benefits. Here are the alternatives. What are your questions? Have I answered all of your questions adequately? Do you still want to go forward with this treatment? Sign here please." Informed consent means you have the option to say NO I do not want this treatment. This is not what is happening right now with COVID-19 and PPE.
Absolutely no one is undergoing an intervention or treatment here, and no one has to sign a consent form. If you don't want a cloth mask, by all means, go purchase medical grade masks. They are no more comfortable than anything else out there. There are YouTube videos out there that people can watch to learn proper care, donning and doffing, and disposal of medical masks, as well as proper cleaning and storage of cloth masks.
I know you are not advocating against wearing face masks, but the line of thinking would not fly in any medical facility or hospital. You know what it's for, you know what it's preventing, and you can get one for yourself. If you cannot get a mask without medical professionals giving you one or selling it to you, absolutely, there should be education. But not informed consent. That is not intended for things like this.
Response:
I greatly appreciate your willingness to respond and especially to offer your medical expertise. I also appreciate the clarifying distinction from a medical perspective on the difference between an intervention and prevention. My understanding (in the legal sense) was that preventive measures were subsumed under the broader category of medical interventions (at least this is how some attorneys would speak of it). My understanding of informed consent is also undoubtedly colored by broader legal definitions, so I appreciate the clarification there as well. I apologize if we were talking past each other in the use of these terms.
From a legal perspective, though, my understanding is that informed consent should be given to patients before undergoing any sort of preventive procedure (e.g., a colonoscopy) or other preventive measure (e.g., a vaccine), as there are risks associated with these (no matter how slight). The reason I posed the three questions I did on masks was ultimately to ask whether the government should be able to mandate this preventive measure, as it could have a potentially adverse effect on health (again no matter how slight). As to the condom example, informed consent would not be applicable here, as anyone who uses one does so voluntarily. I would think any type of government mandate concerning the use of condoms would understandably (and rightly!) be met with much resistance from the public. Continuing with this comparison, in the same way that it would not be right for the government to mandate one type of prevention for either pregnancy or STDs (even if the intentions were to further public health), my question is whether or not it is right or permissible for the government to mandate the use of masks. If the government has the authority to mandate the use of masks, it is not a far stretch (at least not legally) to argue that condoms could be required if there were an urgent public health crisis related to STDs (though this should (hopefully) be much harder to enforce).
As to your explanation of informed consent for chemotherapy, this is a helpful illustration. As you say, though, “Informed consent means you have the option to say NO I do not want this treatment.” My question and concern regarding mandating facemasks is that there is not an opportunity to say no because the individual is no longer given a choice. And while I understand what you are saying in that masks are not a treatment medically speaking, anything that has the intent of promoting individual or public health (and that has the potential for adverse consequences, no matter how slight) could be deemed a medical intervention from a legal standpoint. Following this legal reasoning, mandating masks could open up the door for the government to impose other restrictions, regulations, etc.
And you are correct: I am not advocating against the use of face masks in any way; if people choose to wear them for many and varied reasons—to protect themselves or to protect others—they should have every right to do so. And I would never in a million years consider shaming someone for wearing a mask, as sadly happened earlier on and may still happen in some places today (I strongly considered wearing a mask to work and to the store well before Covid was even a concern to most people). My reason for posting was simply to ask on what basis the use of masks should or could be mandated. Your explanation of how informed consent is more narrowly defined from a medical standpoint is helpful. To rephrase the question in a way that’s hopefully clearer, do you believe the government should be able to mandate the use of masks (thus taking away personal choice)? And if so, is there a limit on what governing authorities should and should not be able to mandate for the advancement of public health (vaccines, condoms, etc.)? I appreciate any professional or personal thoughts you have on this (thanks again for your help!).
Commenter 2:
Thank you for your reply! I enjoy these conversations because they cross boundaries and professions and experiences. Yes, I definitely was working out of my profession's understanding of "informed consent" in my reply, so I think the next question would be "who is providing the informed consent?" Because, if you are talking about the legal definition, then I ain't doing it. Modern medicine has enough litigation concerns as it is, so if we are adding mask wearing to the list of things people with no medical knowledge want to sue over, then I'm out.
You misunderstood my statement: mask wearing does not require informed consent because informed consent means you can say no, and this is not a case where you can say no. End of story. This is not a debate. You wear the mask. You should not need a local ordinance to tell you to do the right thing.
I think your line of questioning SHOULD be undertaken. I don't think we came to the same conclusion, but the exercise itself is great. My take on the ordinances is they should NOT be necessary, and local government officials DO NOT WANT TO MAKE THEM. They only become necessary when individual practices become community practices, and these practices lead to crisis. I think if people came to the conclusion that "the actions I take affect more than just me," then we would not be here.
And by crisis I do not mean the rising number of cases. Many cases does not a crisis make, but the result of those many cases are increased odds of high symptom burden and need for critical health care resources that are not in wide supply. Similar to what happened in NY, when you have a problem that overwhelms the system, you in turn have PREVENTABLE deaths, and that is the heart of the issue. If mask wearing (along with hand hygiene AND social distancing AND access to testing, etc.) can help to cut down exposure and spread, then the percentage of people with the disease goes down, and the percentage of people with HIGH SYMPTOM burden goes down. What we are trying to avoid is Italy. I joined several international FB groups at the beginning of the pandemic to watch how data was being shared between nations and hospitals from the get-go, and what we saw was Italy had to make horrible choices because they simply were overwhelmed by the sheer volume of cases.
Now, the whole of the US does not have the same population density of Italy, so the likelihood of Italy happening in rural Kansas is slim to none. However, the likelihood of it happening in most areas of moderate population is actually high because the health system's ability to respond and increase capacity in smaller cities is nil.
The point of the entire system shutting down (and by system I really mean planet) was to prevent the actual horror from happening. We are between a rock and a hard place: either do not shut down and keep everything going and watch hospital beds fill up, or shut down and deal with the consequences for YEARS. The planet chose the latter. Neither option was good. Bodies piling up in morgues happened anyway even with the latter option. Some semblance of controlled chaos happened because of the latter. Would it have been better to keep things open and let the pandemic infect 100% of the population? I don't know. I doubt it.
The problem, then, comes when people do not see the immediate consequences of their actions and start to think "I know better." That is what has led to the need for ordinances and the like. I do not like it any more than the next person. I wish people would utilize caution and intelligence at the same time, because being ordered to wear a mask over your face because you wouldn't unless someone directly ordered you to is pretty immature.
Now, to address the article you posted: if you want to have an intellectually honest conversation about this topic, then you need proper evidence and studies to back your side of the conversation. The evidence, unfortunately, for both sides is slim to none. The best you can hope for is a systematic review or a meta-analysis. The most recent and comprehensive article about masks is here: http://www.ijph.in/article.asp?issn=0019-557X;year=2020;volume=64;issue=6;spage=192;epage=200;aulast=Aggarwal
Things to note: mask wearing alone is not sufficient, most people are not compliant with mask wearing in the first place, and the number of studies is so small that excluding even ONE of them shifts the conclusion of the entire study. The conclusion of this systematic review and meta-analysis is "wash your hands when wearing the mask" and I don't think anyone would disagree with that statement. (Mask wearing+hand hygiene were superior to mask wearing alone which was not significantly better than no intervention.)
So your one article about one study done with a limited number of people that only showed the difference between TYPES of masks, not masks vs. no masks is not adequate to refute the opposition, nor does it even back your side of the argument, which is that masks are potentially more risky than no masks.
I do not like the government stepping in on topics like this any more than you do. I agree with you that "if they can do x then why not y." However, it's a spin on the topic meant to create fear and anxiety. The true argument is "if people would do the right thing in the first place, we wouldn't need any intervention." People are not famous for doing the right thing, though.
As medical and healthcare workers have pointed out on social media, we wear masks all the time, for many hours a day, sometimes up to 20 hours combined. (A surgeon friend of mine was recently in a case where she had to be in the OR for almost 24 hours straight with several short breaks, and that meant being masked up that entire time.) If mask wearing were risky, the data would have been published long ago, because you would have no dearth of cases to sift through. The evidence just isn't there. Informed consent is not needed for interventions that present less than minimal risk, and you are not going to find anyone that is going to do more than stick a printed sheet of information into your mask baggie so you can then throw it away without reading it.
The question I have for you is this: I saw your lengthy post about the shooting of a black man in Georgia. Where are your posts about Breonna Taylor, Elijah McClain, Tamir Rice? Why are you not using your clearly very active brain to fight for justice, to argue for police oversight, to point out how the government ALREADY is getting away with what you are afraid of, harming its citizens without consequence or repercussions? I find that you are extremely selective and biased in what you decide you will or won't analyze under a microscope. Swallowing camels whole and straining at gnats does not a well rounded diet make.
I feel you have the heart and the mind to do good in the world. I fear your experiences have hardened you to the bigger issues that could use your tenderness and intelligence.
Response:
I can’t thank you enough for your thoughtful reply. I, too, enjoy these kind of conversations, and I’m saddened that they seem to be increasingly rare. You’ve definitely helped me sharpen my own thinking and to understand where you and others are coming from. Thank you for taking the time to respond. I’ll try to offer a few brief thoughts in reply.
First, I think you are right that we are at a different place on whether or not people should have the right to say no on masks. I truly believe I understand where you are coming from, though, and I appreciate your taking the time to explain your reasons. I’m also with you 100% on wanting to decrease the overall burden on healthcare systems so that there are no preventable deaths due to lack of care. Early on I was encouraging all my students (and family and friends) to do everything possible to flatten the curve, and I pointed to what happened in Italy (especially the horrible choices you mentioned) as why we as Americans needed to take action IMMEDIATELY to keep it from happening here.
Fast forward to today, though, and my position on the lockdowns, social distancing, and masks has changed. There are many reasons for this switch, but I’ll defer to the article I wrote for much of that if you’re interested in reading it (it’s long and I totally understand not having time—I just appreciate your engaging here). In short, though, I assumed the lockdowns and social distancing would decrease the spread so as not to overwhelm medical systems, but the weight of evidence seems to show that places that locked down were no more effective at reducing spread than those that did not (here’s one thoughtful piece on this: https://wmbriggs.com/post/30833/). Moreover, my understanding is that even New York never ran out of ventilators, etc. and therefore had no preventable deaths from that system being overwhelmed. If you have some information on any COVID deaths that happened due to the system being overwhelmed and not having enough ventilators or beds to treat patients, please send it to me. I’ve genuinely looked and only found evidence to the contrary. And to be clear, I know that hospitals, particularly in New York, seem to have faced a large influx of patients (hence the triage tents, etc.), but I remember this happening back in 2018 as well (see this article from Time: https://time.com/.../hospitals-handling-burden-flu-patients/). To be clear, I’m not saying it’s ideal to set up tents, but as you know, hospitals are only permitted to have a certain number of beds, so they make adjustments to care for patients in these kinds of circumstances. More than anything, though, I changed my position because I did not realize just how damaging both lockdowns and social distancing were, both in terms of short-term effects on health and well-being but also in terms of lost years of life that may not be felt for some time (for a podcast that’s consistent with a lot of my thoughts on lockdowns and social distancing (specifically them doing greater harm than good), here’s an interview with Dr. Scott Atlas (fairly recent from about a week ago)):
https://podcasts.apple.com/.../uncommon.../id1378389941...
As to masks specifically, I supported their use even when Fauci and Adams strongly warned against them, believing them to be “worth a shot” as I had not yet thought through the potential harms (more than just the one study I initially posted—see further thoughts below). I also greatly appreciate your linking to the meta-analysis on masks, and I was able to review it yesterday. After reviewing it, though, I am confused as to how this meta-analysis supports the use of masks based on the following statements from the piece:
“There was no significant decrease in ILI events with mask and hand hygiene compared to controls.”
“We found no significant association between mask use and decrease in events of ILI.”
“[T]he use of medical mask may provide a false sense of security and may lead to neglect of other essential practices such as social distancing and hand hygiene.”
“[U]sing facemask alone may not be an effective strategy in preventing transmission of viral respiratory diseases in community settings. Existing data pooled from the RCTs do not reveal a reduction in the incidence of ILI with the use of facemask alone in community settings.”
And then this concluding statement:
“Available evidence does not confirm a protective effect of face mask usage alone in a community setting against influenza-like illnesses (and potentially, the COVID-19). For maximum benefit, mask use should be combined with other essential non-pharmaceutical interventions like hand hygiene.”
I think you acknowledge these statements when you provide your things to take note of:
“[M]ask wearing alone is not sufficient, most people are not compliant with mask wearing in the first place, and the number of studies is so small that excluding even ONE of them shifts the conclusion of the entire study. The conclusion of this systematic review and meta-analysis is "wash your hands when wearing the mask" and I don't think anyone would disagree with that statement. (Mask wearing+hand hygiene were superior to mask wearing alone which was not significantly better than no intervention.)”
When you say (as the study concludes) that “mask wearing alone [] was not significantly better than no intervention,” that’s honestly one point I have been seeking to make. I wholeheartedly agree with you (and the authors of the meta-analysis) that hand hygiene, etc. should be used to prevent the spread of COVID-19 (and any illness). But one of my many concerns with mandating masks is not only that they have not been shown to be effective (per this analysis) but that they can also provide a false sense of security, resulting in decreased hand washing, etc. (as this analysis also suggests could happen). Please tell me if I am misreading the meta-analysis, but from the quotes above (and your things to take note of), I do not understand how the use of masks has been proven to be helpful. Hand washing—for sure. Staying home when you are sick—I think that’s common sense and common courtesy. But the required use of masks, at least based on the meta-analysis, doesn’t make sense to me.
As to the other concerns I have, I thought about linking to other studies, but this investigative report (two parts) does that better than I could do right now. In hindsight I should have included similar articles that were more comprehensive, but I again posted what I did because it was the only actual study I had seen on cloth masks. These articles are fairly short, but I think they do a good job outlining the concerns that many people would have:
https://alachuachronicle.com/human-factors-expert-masks.../
https://alachuachronicle.com/research-does-not-support-face-mask-orders/
Commenter 2:
The concerns outlined in these two articles, combined with the recognition by the meta-analysis that masks alone have not been shown to be effective, leads me to believe that it is not unreasonable for people to question being ordered to put a mask over their faces. You stated that “I wish people would utilize caution and intelligence at the same time, because being ordered to wear a mask over your face because you wouldn't unless someone directly ordered you to is pretty immature.” I 100% agree that people should use caution and intelligence, but I think it’s entirely possible that someone could intelligently deduce from the meta-analysis you sent (and from other articles, etc.) that (1) masks have not been proven to be effective in stopping the spread of COVID-19, (2) they may lead people to neglect other practices (e.g., hand washing) that are effective, and (3) therefore an order requiring masks could be more harmful than helpful. It’s hard for me to understand how this line of reasoning is immature. This leads to your other point that “if people would do the right thing in the first place, we wouldn't need any intervention.” I can agree with the sentiment here, but it begs the question of what the right thing to do is. If the evidence does not genuinely support that wearing masks is significantly more helpful than harmful (as you rightly said, the “evidence, unfortunately, for both sides is slim to none”), it seems a stretch to say that wearing masks is definitely the right thing to do.
As to your question concerning my post on the Rayshard Brooks shooting, I really appreciate your asking about this. I’m not sure if you saw my post from May 28th regarding the in-custody death of George Floyd, but in that post I shared how what happened to Floyd was in no way justified and shared a post from a fellow officer clearly explaining how the officers in Minneapolis failed to act in a way that is consistent with any type of law enforcement training. Here’s what I said:
“I pray that all my Criminal Justice students will take note of what happened and can one day work to repair the damage done by these officers. Praying for the family of Geroge Floyd and that justice will be carried out swiftly.”
I’d also encourage you to review the entire post that I shared (written by the other officer). It’s been reshared by numerous officers since that time.
Noting that I first posted on George Floyd (and followed that up with a later post related to his death), I disagree that I’m “extremely selective and biased in what [I] decide [I] will or won't analyze under a microscope.” In my use of force class (and in my introduction to criminal justice class), we evaluate numerous police shootings, some of which are justified, some that are not, and some where the officers fail to use necessary force and are killed as a result. To be as clear as I possibly can, I am certainly not someone who desires to absolve police from all responsibility; to the contrary, law enforcement officers should be held accountable for their actions if they act unjustly (just as anyone should).
As to what I choose to post on social media more generally, I normally refrain from posting about officer-involved shootings or other police encounters (or citizen to citizen encounters) because we often see only a small portion of what happened in the event, if there is any real video evidence at all. This is why judgment on what happened in these cases (and in all cases) should ultimately be reserved for a jury where both prosecution and defense can present and debate all the evidence. Nevertheless, I posted about George Floyd because that case was as clear it could possibly be because of the unedited video evidence showing that the officer used too much force (and arguably did so brazenly). I posted about Rayshard Brooks for the same reason: there was clear video evidence that showed the officer’s use of force was objectively reasonable (refer to the post for more details).
As to the three individuals you mentioned, I did not comment on Breonna Taylor because there is no video evidence (at least not that I have seen), so there is not enough information to make any definitive conclusion. As for Elijah McClain, there is some video evidence, but from what I could see McClain was rolled to his side (as he should be), and he may have died more as a result of the ketamine overdose (officers have no control over the dosing). His death is tragic (as is Breonna Taylor’s), but there is not enough evidence (at least not that I can see) to make definitive conclusions. Perhaps I could have posted that we should not jump to conclusions or that we should wait for more evidence, but in my estimation a post of that nature would not have been helpful at that point. As to Tamir Rice, which is an incredibly tragic case, if there is any blame in that situation, it is with the 9/11 dispatcher for failing to relay relevant information. Here’s a link to the 911 call:
https://www.cleveland.com/.../911_caller_was_frightened...
See this link for the alleged failure of the dispatcher:
https://www.cleveland.com/.../tamir_rice_911_call-taker...
It is important to know that, even if the dispatcher provided all relevant information, it is impossible to tell the difference between an air soft gun and a real gun from a distance and often even up close. As I explained in the post on Rayshard Brooks, officers are held to the standard of objective reasonableness— what a reasonable officer in the same or a similar circumstance would do that is consistent with both training and legal precedent. This is similar to the way that you are held to the standard of care within your particular area of medicine, which is also shaped by the community in which you practice (e.g., rural vs. city). You are never expected to be perfect in the care you provide, as that would be entirely unreasonable since you are human, just like everyone else. This is true even if you were performing surgery and a miscalculation or some other error resulted in a person’s death. Such a death would be tragic, but it would not mean that you are liable for malpractice or should be morally culpable unless you intentionally harmed someone or the error was particularly egregious (thus violating the standard of care). In a similar way, because officers are also human, they are governed by the standard of objective reasonableness—what actions would have been objectively reasonable in any given circumstance without the benefit of 20/20 hindsight. If a reasonable officer would have been justified in shooting someone who was reported to have a firearm and then reached in his waistband to retrieve what appeared to be a firearm, then the shooting would be justified (though still tragic). This seems to be what happened in the case of Tamir Rice, but because the video was more spotty (and because I was not really on social media much when that shooting happened), I did not choose to post on it.
I hope these thoughts and clarifications are helpful. I truly appreciate you and am grateful for the conversation. I welcome any responses to anything I’ve said here as we as further dialogue on anything else.
Commenter 2:
I think we have hit an impasse. If you are unwilling to comment on the cases as I mentioned because you do not have enough evidence to do so, but are willing to comment freely and enthusiastically about a topic in my field of expertise that has incomplete and shaky data at best to back your argument, then I think we need to agree to disagree. (I am not discarding your arguments whole-sale, I read your comments and the articles you posted, thank you for taking the time, but I do not think a point-by-point surgical exploration of every piece of data will change your mind.) I use your technique of data overload when I am trying to get a prior auth claim through an insurance company that refuses to pay for a medication that a patient needs/has been on for months. I assume that if I show enough evidence, I will overwhelm the system and they will just say "I don't have time to read all of this, give him what he wants." It's a highly effective method, but unfortunately after reading everything you've posted, I am beginning to realize you actually believe what you believe because you WANT to, not because it's a good thing to believe or because there is clear and definitive evidence that has stimulated the intellectual side of your mind. You have deliberately chosen what you want to believe because you value individualism and "liberty" over personal responsibility and accountability. (I'm sure you've seen the meme "I don't know how to explain to you that you should care about other people" - that's the way I feel right now.)
I am no expert in criminal justice, hence why I said that your voice would be helpful in advocating for those who cannot advocate for themselves (because they are very dead.) I only spoke up on this post because healthcare is my area of concern and I have some minor authority on the matter, not to mention several degrees that have taught me the value of academic integrity. I do not mean to attack or insult you, but I cannot take your argument seriously when you pick and choose what you will focus on so haphazardly and refuse to be consist on when you will use your abilities.
When you err on the side of less caution, then you do not know the true risks of the situation. I hope you learn to use your powers for good one day.
Commenter 3:
The linked article is about HCW wearing cloth masks. A very different setting than the grocery store.
Response:
No doubt a different setting. My aim was simply to show that at least some studies have shown that masks can potentially have adverse effects. Even if that risk is arguably small (and even if the perceived benefits to individuals and society are greater than the perceived risks), my question was whether or not the government should be able to mandate their use, thus taking away personal choice and the ability to decline something that carries risk. If the answer is yes that the government can compel someone to do something that carries risk (again no matter how small), my further question was where (and what basis) to we draw the line (see my reply to Commenter 2 for more on that).
Commenter 4:
If we're going to talk about medical interventions and consent, it's important that we use terms properly and understand what studies are saying (as others have pointed out). The original post here does not.
Response:
If you would be willing, please consider my replies to the other commenters. My questions (rephrased in my response to Commenter 2) remain, and I would love to hear your thoughts.
Commenter 4:
Commenter 2’s reply to you says everything I want to and more. I appreciate what you are trying to do, Josh. But you are needlessly sowing division and confusion where none need exist, encouraging folks to disregard health experts the world over and not wear masks while a pandemic is raging worse than ever because folks aren't wearing masks. It's time to stop debating and start wearing our masks.
The CDC mask recommendations are backed by many studies. Feel free to check them out: https://www.cdc.gov/.../cloth-face-cover-guidance.html...
The CDC cites plenty of emerging studies on why we should wear masks for COVID-19: https://www.cdc.gov/.../cloth-face-cover-guidance.html...
Response:
Sorry for the delay. I just finished reviewing all of the articles at the link you sent. Thanks so much for sharing them. Have you also had a chance to review them? I ask because 13 out of the 20 at the link you sent were not about masks. Of the remaining 7, two of them dealt with types of materials for making cloth masks but did not explore the efficacy of cloth (or other) masks in real life. One of the studies (Leung, N.H.L., Chu, D.K.W., Shiu, E.Y.C. et al) provided promising results from the participants they examined, but this study only covered surgical facemasks, and the conclusions applied to symptomatic spread. Another study (Johnson DF, Druce JD, Birch C, Grayson ML) examined 9 individuals, and while the results there were promising for surgical and N95 masks, cloth masks were also not mentioned (there were some other limitations on this study as well). Another study (Green CF, Davidson CS, Panlilio AL, et al.) examined only commercially available surgical masks worn by simulated contagious patients (nothing on cloth masks).
Only 2 of the 20 studies discussed the efficacy of cloth masks. The first of these two studies (Ma QX, Shan H, Zhang HL, Li GM, Yang RM, Chen JM) examined the use of commercially available masks as well as homemade masks, but the homemade masks evaluated in this study were “made of four‐layer kitchen paper (each layer contains three thin layers) and one layer of polyester cloth.” These are substantially different than many of the cloth masks people are wearing today. The authors provide this caution on these types of masks:
“It is worth noting that the homemade masks shall be of less blocking efficacy if made of fewer layers of kitchen paper. Other types of homemade masks, especially those made of cloth alone, may be unable to block the virus and thus confer no protection against the virus.”
The authors then cite the original study I shared on this post to support their concern. Finally, the authors of this study note that this was not a randomized controlled trial, and they recognize that “[s]ome randomized controlled trials (RCTs) did not support the efficacy of medical masks because medical masks could not reduce infection rates of some viral respiratory diseases.”
As to the second article (Davies A, Thompson KA, Giri K, Kafatos G, Walker J, Bennett A.) that dealt with cloth masks, I will let the authors’ concluding paragraph speak for itself:
“Improvised homemade face masks may be used to help protect those who could potentially, for example, be at occupational risk from close or frequent contact with symptomatic patients. However, these masks would provide the wearers little protection from microorganisms from others persons who are infected with respiratory diseases. As a result, we would not recommend the use of homemade face masks as a method of reducing transmission of infection from aerosols.”
Brother, I know you and I have disagreed on masks for the past several weeks, but I hope it is clear that I am seeking to dialogue in good faith. When you said that the CDC had linked to many studies that would show the efficacy of mask use by the general public, I desired to humbly review them to see if I had missed something. But after reviewing these 20 studies, I’m just not seeing the evidence for how universal masking (at least with cloth masks) is effective at slowing the spread of COVID-19. More than that, none of these studies acknowledge the possible risk of masks, which was one of the concerns that initially prompted my post. As to other kinds of masks, if the CDC and others were recommending that individuals all wear N95 and/or surgical masks (and somehow made it possible for this to happen), this would seem to be more reasonable than the use of cloth face coverings. But unless enough masks can be provided for every individual to regularly change these masks every time they become soiled (which would be completely impractical in the real world), such a recommendation could do more harm than good (per the links I sent in my reply to Commenter 2). To be clear, I am not saying that you or anyone else should not wear a mask, as I believe it’s absolutely your right to do so. But the more studies I read (not just the ones that you and Commenter 2 linked to but others as well), it’s very clear that there is no “settled science” on this issue, and I think we should all be careful of making their use law (both literally and figuratively).
In sum, masks may be effective; they may not. The evidence is scant that they actually reduce the spread, and as I’ve shared before there are some studies that indicate that it could increase the risk of infection (not to mention the other harms discussed in the article I provided in my reply to Commenter 2). In light of this at best inconclusive evidence, I think it would be wise for us to continue to act charitably toward others with whom we disagree and to be very careful that we do not imply that wearing masks is the only possible way to love our neighbor during this time. There are other ways we could arguably slow the spread more (e.g., only venturing out if it was absolutely necessary (like a once-a-week grocery store run)). But this then begs an even further question: is the best way to love our neighbor to slow the spread as much as we can? Here’s what I mean:
The initial goal of flattening the curve/slowing the spread was to prevent hospitals from being overwhelmed so that people do not end up dying from otherwise preventable deaths (which to the best of my understanding did not even happen in New York, as they never ran out of ventilators, etc.). As long as we ensure that hospitals are not overrun, would it not be best and most loving for the elderly and for the immunocompromised for healthy individuals to contract the virus as quickly as possible, thus giving some chance at herd immunity sooner rather than later? (some believe the threshold for herd immunity is lower than first thought). Reaching some form of herd immunity is the best way (the only way?) that the weakest among us will be able to reintegrate into society and feel safe doing so. Even if masks were truly effective at slowing the spread, is this not prolonging how isolated some will continue to be? For example, I drove by a long-term care facility about a week ago. Underneath the sign in big block letters were the words “NO VISITORS.” I cannot imagine what it would be like to not see my friends or family for going on 4 months now, and as long as we are prolonging a chance at herd immunity, it may be many more months before these (frankly inhumane) restrictions are lifted. I have heard stories of some who feel their families have abandoned them; others believe they must have done something wrong or hurtful that has kept their families away. How many elderly image bearers will die in the coming days without the chance to hug their loved ones and tell them goodbye? How many have already passed away with no one by their side?
I wholeheartedly believe that you desire to protect others, brother. In that respect I believe we (and everyone else) on this thread want the same thing. I hope and sincerely pray you can see that many who choose not to wear a mask may not do so simply for their own sake but rather out of love for others. I also think it is good and right that we continue to look at the evidence as best we can to make the best decisions we can for those we love and for the good of humanity as a whole, and I am continually open to new evidence that would show how I can better love my neighbor. Toward that end, I welcome any other information you could send. I love you, brother. I pray you understand that the reason I continue to address this issue is out of love for you and others.
Commenter 4:
Thank you for engaging those studies. The key point for me in mask wearing is this: COVID-19 is mostly transmitted on droplets spread through breathing, and most face masks on an infected person catch most of those droplets. Studies on face masks reducing droplet transmission in general are well established. So if most everyone wore effective face masks, infection rates would likely plummet, as they have in East Asian countries and now in the European Union.
I agree with you that isolation is not great. Which is why face masks and other interventions are needed as an alternative to isolation.
As for herd immunity, I would love it if we could achieve that for this disease. The confirmed death rate has fallen considerably already, meaning treatment is improving. Nonetheless, this is a new disease, and we are uncertain about many things, including the long-term health effects for the infected and if and how to achieve herd immunity. Until those matters are more certain, reducing transmission is a safer course of action.
I understand your heart here, and I appreciate you.