Should All Christians Wear Masks? A Plea for Humility and Charity

Should all Christians wear masks? While the question has stirred much debate in recent weeks, it is just one in a long line of…

Should all Christians wear masks? While the question has stirred much debate in recent weeks, it is just one in a long line of controversial and culturally important questions that Christians have faced over the years — questions that often lead to very strong (and often opposing) views. Take parenting decisions: Public school, private school, or homeschool? Should children have smartphones? What about sleepovers? Then consider politics: Should Christians vote for Trump? For Biden? For a third party? Should they even vote at all? And then there are ethical issues: Can Christians use birth control? Can they watch certain movies, listen to certain music, or play sports that interfere with Sunday gatherings? Should they use marijuana?

Questions like these are incredibly important — even life-altering and culture-shaping — but the Bible does not speak directly to these questions. So how should Christians think through these questions in a way that is biblically faithful and that leads to God-glorifying action?

Prayer, Humility, and Charity

As we wrestle with the complexities of our broken world, we must first approach God’s throne with great humility, asking for wisdom to make the best decisions we can (James 1:5–8). We must also pray for grace and patience to selflessly love our brothers and sisters and to believe the best in them even when we disagree (cf 1 Corinthians 13). Finally, we should all remember (and memorize!) this oft-repeated saying from Rupertus Meldenius, a German theologian from the early seventeenth century:

“In Essentials Unity, In Non-Essentials Liberty, In All Things Charity.”

What are essentials? They are those doctrines that are “central and essential to the Christian faith” — doctrines that must be believed in order to rightly be considered a Christian as defined by Scripture. As Albert Mohler discusses in his immensely helpful article on theological triage, “[i]ncluded among these most crucial doctrines would be doctrines such as the Trinity, the full deity and humanity of Jesus Christ, justification by faith, and the authority of Scripture.”

What about non-essentials? Mohler carefully explains that “[t]he set of second-order doctrines is distinguished from the first-order set by the fact that believing Christians may disagree on the second-order issues, though this disagreement will create significant boundaries between believers. When Christians organize themselves into congregations and denominational forms, these boundaries become evident. Second-order issues would include the meaning and mode of baptism [and] the issue of women serving as pastors.” There are also other non-essentials, often called “third-order” or “third tier” issues, which “are doctrines over which Christians may disagree and remain in close fellowship, even within local congregations.”

As believers, we are called “to contend earnestly for the faith which was once for all delivered to the saints” (Jude 3), but we must be careful to understand what is the essence of this faith (i.e., what doctrines are essential) and recognize that there are some things on which Christians will disagree. As Mark Ross explains, “Tensions arising from diversity of belief and practice among Christians are already apparent in the pages of the New Testament and remain with us today. . . . we must extend liberty to each person to hold fast to his own conscience on what Christ has commanded [concerning secondary and tertiary beliefs] (Rom. 14:5).”

So what about masks?

Brett McCracken, a senior editor at the Gospel Coalition, recently published a thoughtful article that encourages believers to wear masks out of love for their neighbors. McCracken rightly asserts that Christians should “think through what our faith would call us to with regard to wearing or not wearing masks.” He also graciously acknowledges that Scripture does not speak directly to the use of masks but instead calls us to be willing to lay down what rights we may have for the sake of others: “When I look at Scripture I don’t see a mandate about masks, of course, but I see an invitation — to do at least four things.” In addition to loving our neighbors, McCracken contends that Scripture invites us to wear masks to respect authorities, to honor our weak brothers and sisters, and ultimately to further the spread of the Gospel. In sum, McCracken’s article is both helpful and challenging, offering practical ways that believers can “count others more significant than [them]selves” (Phil 2:3 ESV). But while McCracken is clear that Scripture does not explicitly mandate masks, it’s possible to take an article like his and use it as evidence to confirm our personal convictions about masks. More specifically, we may conclude that the best (and possibly only) way to love our neighbor is to wear masks, thus implying (if not outright saying) that it is unloving to one’s neighbor to choose not to wear a mask. What might lead some to this conclusion?

Confusing the Command with the Conclusion

The desire to love one’s neighbor is good and right; indeed, loving our neighbor is a direct command from our Lord Jesus (Mark 12:28–31)! And as a direct command from our Lord, this command is essential (and central!) to the faith. All believers are called to love our neighbors, and there are no exceptions to this command. But while the command itself is clear and rightly labeled as essential, the specific outworking of this command may vary depending on the situation and may look different from person to person. In the case of masks, because Scripture does not give any direct command, deciding whether to wear one becomes a matter of conscience (cf. Rom. 14). To be sure, believers should always be motivated by love of neighbor and love of God, and any decision to wear or not wear a mask should be made with these commands in mind. Moreover, if believers choose to wear masks, they should wear them to the glory of God; if they choose not to wear them, they should refrain from wearing them to the glory of God:

“23 ‘All things are lawful,’ but not all things are helpful. ‘All things are lawful,’ but not all things build up. 24 Let no one seek his own good, but the good of his neighbor. . . . 31 So, whether you eat or drink, or whatever you do, do all to the glory of God. 32 Give no offense to Jews or to Greeks or to the church of God, 33 just as I try to please everyone in everything I do, not seeking my own advantage, but that of many, that they may be saved.” (1 Cor. 10:23–24, 31–33; see also Col. 3:17).

As believers, we must be seeking the good of our neighbors. Paul reiterates this exhortation in Philippians 2:4 when he implores believers to “look not only to [their] own interests, but also to the interests of others.” This is the reason McCracken concludes that wearing a mask is loving to one’s neighbor:

“For Christians called to love our neighbors as ourselves, wearing a mask in public — particularly indoor spaces where social distance cannot be guaranteed — seems like a relatively easy way to practice neighbor love. Even if it’s annoying to wear one, and even if you aren’t convinced by the science behind it, why not wear one anyway? Given the enduring uncertainty about the way COVID-19 spreads, shouldn’t we err on the side of more protective measures rather than less, for the sake of the neighbor we might — even if it’s a slim chance — unknowingly infect?”

Is McCracken’s conclusion correct?

Examining the Evidence

All believers should agree with McCracken’s call to love our neighbors, and choosing to take action (in this case wearing a mask) to protect our neighbors is rooted in God-honoring self-sacrifice. But concluding that wearing a mask is the best (or only) way to love one’s neighbor rests on several assumptions: (1) that masks have been proven to be effective in slowing the spread of COVID-19, (2) that there is no risk of increased infection or other harm from wearing masks, and (3) that there are no alternative measures that would be equally or more loving.

The Effectiveness of Masks

In support of the conclusion that we should wear masks to love our neighbors, McCracken writes that a “consensus is emerging that wearing masks does slow the virus’s spread and, thus, can save lives.” McCracken cites this June 13th article from Forbes that links to this systematic review and meta-analysis from The Lancet. This review concludes that “[f]ace mask use could result in a large reduction in risk of infection”; however, the author of the review admitted to the Washington Post that “[w]e have low certainty in that.” Part of the reason for the low certainty of this review is that while it analyzed 172 observational studies, it included no randomized controlled trials. While observational studies have great value and are sometimes the only type of study that can explore certain questions, researchers note that “the results of observational studies are, by their nature, open to dispute [because] [t]hey run the risk of containing confounding biases.” The potential for uncontrolled biases or variables to skew the results of observational studies is a primary reason that randomized controlled trials (RCTs) are “still considered the ‘gold standard’ for producing reliable evidence because little is left to chance.”

In contrast to the review of observational studies, this systematic review and meta-analysis concludes that “[e]xisting data pooled from randomized controlled trials do not reveal a reduction in occurrence of ILI (influenza-like illness) with the use of facemask[s] alone in community settings” (emphasis added). This study further concludes that the use of facemasks “may provide a false sense of security” and “may lead to neglect of other essential practices” like hand-washing. But even though this review examined RCTs, other reviews have concluded that masks are effective, while others have argued that they are not and have concluded that “[m]asks-for-all for COVID-19 [are] not based on sound data” (among other critiques). These conflicting reviews show that there is no consensus concerning the use of facemasks to control the spread of COVID-19; significantly, though, most studies do not even address the efficacy of cloth masks but only examine the effectiveness of surgical and N95 masks that are only recommended for use by healthcare workers.

While there is significant disagreement among researchers as to the effectiveness of medical masks (surgical and N95), even more disagreement exists concerning the effectiveness of cloth masks. It is true that the CDC recommends that the general public wear cloth facemasks to slow the spread of COVID-19, but very few studies have actually examined the effectiveness of cloth masks. For example, the CDC cites 20 studies on its webpage that recommends cloth face coverings; however, 13 out of these 20 studies do not discuss masks (they instead discuss asymptomatic transmission and modes of transmission). Of the remaining 7 that do discuss masks, two of them deal with types of materials for making cloth masks but do not explore the efficacy of cloth (or other) masks in real life. One of the studies provided promising results, but this study only covered surgical facemasks, and the conclusions applied to symptomatic spread. Another study examined 9 individuals, and while the results there were promising for surgical and N95 masks, cloth masks were not mentioned (there were some other limitations on this study as well). Still another study 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 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 the cloth masks many are currently wearing:

“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.” (emphasis added)

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 that evaluated homemade cloth masks, here is what the authors wrote in their concluding paragraph:

“An improvised face mask should be viewed as the last possible alternative if a supply of commercial face masks is not available, irrespective of the disease against which it may be required for protection. 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.” (emphasis added)

But even if there is only minimal evidence that cloth masks reduce the spread of COVID-19, isn’t wearing them still worth it in an effort to love and protect our neighbors? This leads to the second assumption: that there is no risk of increased infection or other harm from wearing masks.

The Possibility of Harm

While the studies referenced by the CDC provide little if any evidence that cloth masks are effective against COVID-19, many researchers have expressed concern about the potential risks of wearing masks. For example, a 2015 study published in the British Medical Journal cautioned against the use of cloth masks:

“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.” (emphasis added)

The authors of this study then elaborate on their conclusions:

“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 addition to increased risk of infection, others have raised concerns about increased levels of CO2. As this analysis explains, “Numerous articles that discuss the possible hazards of CO2 under masks have been subjected to fact-checkers who declare them to be inaccurate. However, mask proponents and fact-checkers have only looked at worst-case scenarios (i.e., levels required to cause unconsciousness) when dismissing concerns about CO2.”

The authors of this analysis then make the following comparison:

“Consider the difference between alcohol toxicity and impairment. According to the NIH, alcohol toxicity occurs around 0.45% blood alcohol concentration (BAC), but impairment starts as low as 0.05%. Florida law (316.193) sets a legal limit of 0.08% BAC, but a driver may or may not be impaired at that level. Police have suspects perform field sobriety tests to determine ‘the extent that the person’s normal faculties are impaired,’ regardless of the BAC. CO2 can also cause impairment well below the level of toxicity.”

While it is unlikely that most people would suffer serious harm from wearing a mask, especially for a short period of time, even a low level of impairment from elevated CO2 can increase the risk of accidents. Others have raised concerns about the possibility of hypercapnia, a condition where CO2 levels in the blood become elevated. Hypercapnia can lead to a host of health problems and can suppress the immune system, a significant concern for anyone infected with COVID-19. However, Reuters fact-checked many claims that masks can lead to hypercapnia, labeling the claim as “partly false.” Reuters explains:

“While breathing in excessive amounts of CO2 for large amounts of time can be dangerous, it is unlikely that the general public would suffer from these complications by wearing a mask. Most people would wear face coverings on short stints outside their home as a complementary measure to social isolation.”

In reaching this conclusion, Reuters spoke with a representative from the CDC who said that “[t]he CO2 will slowly build up in the mask over time. However, the level of CO2 likely to build up in the mask is mostly tolerable to people exposed to it. You might get a headache but you most likely [would] not suffer the symptoms observed at much higher levels of CO2. The mask can become uncomfortable for a variety of reasons including a sensitivity to CO2 and the person will be motivated to remove the mask. It is unlikely that wearing a mask will cause hypercapnia.”

While Reuters may be right that masks are unlikely to lead to hypercapnia, the response from the CDC leaves open the possibility that they could lead to hypercapnia, especially for those who wear masks for “longer stints.”

The potential risks outlined above could lead a reasonable person to question whether the risks of wearing a mask outweigh any perceived benefit; more than that, it may lead some to conclude that encouraging others to wear masks is unloving if they consider the risks of wearing a mask to be greater than the risk of not wearing one. Others may still conclude that wearing masks is the most loving decision they can make. My aim here is simply to show that there is not a consensus on whether or not masks are effective at slowing the spread of COVID-19 and that there are potential risks, which may result in believers reaching different conclusions as to what actions are most loving.

A Radical Way to Love the Vulnerable

Even if masks worked well to slow the spread of COVID-19 and posed zero risk of adverse effects, it could still be argued that the wearing of masks by the general population is unloving to some of the most vulnerable around us. At first glance, such an argument seems absurd, but upon further inspection it actually has some merit. Here’s why:

Several months ago, the stated goal of the lockdowns and social distancing (and presumably masks today) was to “flatten the curve” in order to prevent hospitals from being overwhelmed. Slowing the spread in this way would hopefully ensure that no one would die from an otherwise preventable cause. However, even when the epidemic was raging in New York, the state never ran out of ventilators, and many hospital beds went unused. Here’s how this relates to masks today:

As long as hospitals are not overwhelmed, it may actually be more loving to the elderly and to the immunocompromised to let the virus run its course and for healthy individuals to contract the virus as quickly as possible, thus giving some chance at herd immunity sooner rather than later (significantly, some believe the threshold for herd immunity is much lower than first thought). Following this line of thinking, reaching some form of herd immunity would be the best way (the only way?) that the weakest among us would be able to fully reintegrate into society and feel safe doing so. Related to masks, if they were genuinely effective at slowing the spread, this would actually prolong the isolation of the most vulnerable.

Isolated and Forgotten

I drove by a long-term care facility about two weeks ago. Underneath the name of the facility in big block letters were the words “NO VISITORS.” While most of our lives have been seriously interrupted these past 4 months, and while some of us have been even more isolated due to being immunocompromised, most residents of long-term care facilities have been completely cut off from their loved ones and have gone nearly 4 months without seeing any of their friends or family. And as long as we are prolonging a chance at herd immunity, it may be many more months before they can see or hug those they love. The depth of loneliness that these already-isolated individuals must feel is hard to imagine. 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. Still others are forced to spend wedding anniversaries apart, while others are rarely even able to call their loved ones. In one heartbreaking situation of which I am personally aware, a husband and wife who lived in a long-term care facility together were separated because the husband needed to be moved to a different wing of the facility for therapy. Over a period of a month, the husband’s health continued to decline, and he was in and out of the hospital before passing away last week. Even though he was clearly nearing death, his wife was prohibited from seeing him for the last four weeks of his life due to COVID restrictions. Friends and members from their church attended a memorial service for her husband earlier this week, but she was prohibited from attending that service due to these same restrictions. No goodbyes before death; no closure after.

I know that many who work in long-term care facilities are doing the best they can to protect their residents; I also know that many of these restrictive policies are dictated by state and local health officials — policies over which facilities may have no control. But these sorts of restrictions have a devastating impact on residents and their families, leading to deepening depression, despair, and death. How many elderly image bearers will die in the coming days without the chance to hug their loved ones and tell them goodbye? And how many have already passed away with no one by their side? Some believers may oppose masks because they believe herd immunity is the best hope for residents of these facilities to be reunited with their loved ones, and they desire to reach whatever herd immunity is possible as quickly as possible in order to alleviate the horrible loneliness felt by these elderly image bearers.

To be clear, I don’t believe it’s an obligation for anyone to intentionally contract COVID in an effort to bring about greater herd immunity, but if I really wanted to lay down my life for my weaker neighbors, this could arguably be a way to do it. All said, in the same way that many who advocate for masks do so out of a desire to protect the weak (both elderly and immunocompromised), at least some who oppose masks oppose them out of a desire to love and protect the weak. Both positions are driven by love of neighbor, but because of different underlying beliefs about the best way to get through COVID-19, different people may reach different conclusions on whether wearing masks is the most loving choice.

A Plea for Humility and Charity

So what should believers conclude about the choice to wear masks? Each believer should weigh the potential benefits and risks of wearing them, all the while being motivated by a desire to love others and glorify Christ. But whatever decisions individual believers may reach on this issue, we must be careful not to moralize our personal convictions or to harshly judge other believers who may reach different conclusions. We should certainly encourage one another to love our neighbors as ourselves and to prioritize the interests of others, but we must seek to be charitable when we reach different conclusions on how to do this, believing the best in our brothers and sisters and allowing for Christian liberty on the way we seek to love our neighbors. The Apostle Paul deserves the last word as we consider how to bear with others who have different convictions on masks:

“1 As for the one who is weak in faith, welcome him, but not to quarrel over opinions. 2 One person believes he may eat anything, while the weak person eats only vegetables. 3 Let not the one who eats despise the one who abstains, and let not the one who abstains pass judgment on the one who eats, for God has welcomed him. 4 Who are you to pass judgment on the servant of another? It is before his own master that he stands or falls. And he will be upheld, for the Lord is able to make him stand.

5 One person esteems one day as better than another, while another esteems all days alike. Each one should be fully convinced in his own mind. 6 The one who observes the day, observes it in honor of the Lord. The one who eats, eats in honor of the Lord, since he gives thanks to God, while the one who abstains, abstains in honor of the Lord and gives thanks to God. 7 For none of us lives to himself, and none of us dies to himself. 8 For if we live, we live to the Lord, and if we die, we die to the Lord. So then, whether we live or whether we die, we are the Lord’s.

9 For to this end Christ died and lived again, that he might be Lord both of the dead and of the living.

10 Why do you pass judgment on your brother? Or you, why do you despise your brother? For we will all stand before the judgment seat of God; 11 for it is written,

“As I live, says the Lord, every knee shall bow to me,

and every tongue shall confess to God.”

12 So then each of us will give an account of himself to God.” (Romans 14:1–12)