Let Me Be Brief: Politics in Medicine

A series of briefs by the Texas Medical Students

By: Shubhang Bhalla, Chelsea Nguyen, and Alejandro Joglar

There are only two possible scenarios: either the Mayans were inept seers, or they ran out of stone. In any case, the predicted end of the world missed its appointment by exactly eight years. With nearly three million deaths globally, COVID-19 has quickly assumed its standing as one of the leading communicable causes of mortality.¹ Despite the novel therapeutics to combat the pandemic, recent scientific models and  health information now report that masks could have prevented nearly 12% of mortality associated with SARS-CoV-2.² Surprisingly, this simple piece of personal protective equipment has become politicized, with some opponents claiming that masks are an infringement on human liberty. In the current sociopolitical climate, we are amid two pandemics: one of SARS-CoV-2 and another of misinformation—both equally harmful. Much like the historical precedent set in 1918 with the formation of     the Anti-Mask League, public health leaders of the twenty-first century must face the challenge of juggling objective science, pandering politics, and devastation left in the wake of the SARS-CoV-2 pandemic.

Public health has been consistently linked to leading political efforts of the time. From the development of environmental regulations, seatbelt laws, and smoking zones, to the contentious debate over mandatory vaccinations, efforts to improve public health sometimes impinge on various political ideologies and interests.³ Often, these debates can be broken down to the fundamental balance of individual autonomy and communal benefits. This intricate relationship between public health and politics has become increasingly strained during the current pandemic. Many critics of the pandemic response argue that by “flattening the curve,” individual autonomy has been infringed upon. Undoubtedly, the pandemic has catalyzed the transformation of established social operations: business closures, online education, and disruptive daily living. However, among what some call “liberty-depriving” mandates, the mandatory mask  usage remains a significantly contentious proposal. Wearing a mask serves to fulfill two broader, complementary goals: individual responsibility and adherence to a common, public paradigm to eradicate the pandemic. Despite its complementary nature, the wearing of masks has become a catalyst for political conflict, becoming a form of divisive political symbolism for the American public.

Today, only twenty-five states currently mandate face masks in public;⁴ however, as restrictions begin to  lift due to mounting public pressure, it is critical to understand that the origins of the mask resistance is the consequence of inconsistent scientific recommendations, actions of political figures, and America’s long-standing principle of liberty. The argument of wearing masks is simple: viruses are transmitted via droplets, and properly constructed masks can prevent the spread of infected droplets. According to the CDC, this is called “source control.”¹ However, the delivery of this message has been muddled. In April, the World Health Organization (WHO) instructed the public not to use masks, while the CDC recommended the opposite. In June, the WHO adjusted its guidance to state that the public should wear nonmedical masks only in specific instances of high risk of infectivity. However, the CDC director touted universal mask wearing as “one of the most powerful weapons” to curb the rates of COVID-19.⁵ The net  result of conflicting recommendations was a divided population who sought concrete guidance from political figures.

Yet, political figures further allowed for festering sentiments against masks to transform into a symbolic ideology. Initially, the conflict arose with protest against government mandates, cited by some as “extensive governmental reach into individual action,” but as the debates shifted towards masks, a new conflict—one of the “culture war”—reigned.⁶ In this battle, masks were described as “muzzles . . . restricting His [God’s] respiration mechanism.”⁶ As these views gained popularity, politicians’ action indirectly supported these protests. Top officials, such as Donald Trump and Mike Pence, sought to erroneously show strength by limiting mask usage or outright denying the need for the equipment. In Montana on September 14, 2020, former Vice President Mike Pence stood in front of a large crowd to support the state’s Republicans. However, many individuals who attended the event, including Mike Pence, were not wearing a mask despite a mask order that was in effect for the surrounding county.⁷ Furthermore, at the national level, Congress denied passing the Masks for All Act of 2020, an initiative to provide high-quality masks for all individuals.⁸ Contradictions between the scientific community, state policy, and actions of key figures downplayed the severity of the virus, influenced public’s perception, and shifted support towards the anti-mask masses.

As of May 19th, approximately 125.5 million people in the United States have been fully vaccinated, either  by the two-dose series by Pfizer and Moderna or Johnson & Johnson’s single-dose vaccine.⁹ Per the CDC, it is predicted that 90% of the total US population will be vaccinated by July 12th.⁹ Despite this incredible progress, it is still important to continue following mask-wearing protocols as new research is being developed about effectiveness of the vaccine. For example, it is still unknown whether fully vaccinated individuals can transmit COVID-19 to unvaccinated individuals.¹⁰ Additionally, the rise of new variants of COVID-19 may influence the effectiveness of vaccines and the spread of COVID-19 among susceptible individuals. The uncertainty surrounding the vaccines and COVID-19 means it is essential to continue following public health mandates, including mask wearing if unvaccinated, social distancing, and following travel and local guidelines regardless of vaccination status. Dr. Anthony Fauci even mentioned during an interview with CNN that it is “possible” that Americans will be wearing masks in 2022.¹¹

As medical students, we can play an important role by engaging with and educating our communities about the most effective methods of maintaining safety during the pandemic. It is important that we talk with our friends and family about why unvaccinated individuals should continue to wear a mask and follow certain precautions and remaining guidelines (ex: wearing masks on public transport) as well as recommending trusted resources for more information, such as the CDC. As new research develops and guidelines change, being a clear and comprehensive line of communication between science and the public is more important than ever before.

1. Infection Control: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) | CDC. Centers Dis Control Prev. Published online 2020:1-4. Accessed May 9, 2021. https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html
2. Matuschek C, Moll F, Fangerau H, et Face masks: Benefits and risks during the COVID-19 crisis. Eur J Med Res. 2020;25(1). doi:10.1186/s40001-020-00430-5
3. Bekker MPM, Greer SL, Azzopardi-Muscat N, McKee M. Public health and politics: How political science can help us move forward. Eur J Public Health. 2018;28(suppl_3):1-2. doi:10.1093/eurpub/cky194
4. Markowitz Does Your State Have a Mask Mandate Due to Coronavirus? AARP. Published 2021. Accessed May 9, 2021. https://www.aarp.org/health/healthy-living/info-2020/states-mask-mandates-coronavirus.ht ml
5. CDC and WHO offer conflicting advice on masks. An expert tells us why. Accessed May 9, 2021. https://abcnews.go.com/Health/cdc-offer-conflicting-advice-masks-expert-tells-us/story?id= 70958380
6. Dyson, (2020). Are they masks or muzzles? Two discussions highlight different opinions | Latest News | starexponent.com. Free Lance Star. https://starexponent.com/news/are-they-masks-or-muzzles
7. The Mask Hypocrisy: How COVID Memos Contradict the White House’s Public Face | Kaiser Health Accessed May 9, 2021. https://khn.org/news/mask-wearing-hypocrisy-how-covid-white-house-memos-contradict-ad ministration-coronavirus-defense-policy/
8. Masks for All Act of 2020 (2020; 116th Congress S. 4339) – GovTrack.us. Accessed May 9, https://www.govtrack.us/congress/bills/116/s4339
9. Covid-19 Vaccinations: County and State Tracker – The New York Times. Accessed May 9, https://www.nytimes.com/interactive/2020/us/covid-19-vaccine-doses.html
10. Center for Disease Control and Prevention. CDC Issues First Set of Guidelines on How Fully Vaccinated People Can Visit Safely with Others. Accessed May 9, 2021. https://www.cdc.gov/media/releases/2021/p0308-vaccinated-guidelines.html
11. Fauci: “Possible” Americans will be wearing masks in 2022 to protect against Covid-19 – Accessed May 9, 2021.