Why Do Some People Refuse To Wear A Mask During the COVID-19 Crisis?

I was preparing to spend a few days with Ralph at his summer home, which is about an hour west of me.  I tapped his address into my iPhone, put the phone into Violet the campervan’s phone holder, and started my journey.  Since I was bringing dinner, I made a quick detour to the Fresh Thyme Market, a small grocery store just down the street. Being lazy, I left the phone in its holder during my grocery adventure. When I returned to the camper, I tossed steaks,  watermelon, and salad into the 12-volt fridge and hopped into the driver’s seat to continue my journey.  I looked up at my phone and saw a bright fluorescent green vertical line across the screen.  Crap, my phone’s display was busted! Over the short time that I visited Ralph, that single line morphed into multiple lines making reading anything on the screen impossible.

On my return home, I investigated my repair options. I contacted Apple customer support, who told me that the screen needed to be replaced and that the estimated cost for the repair would be an astounding $560.00! My iPhone X is three years old, but I’m not ready to buy a new one, so I explored aftermarket options and found a store in Naperville that would replace the screen for $150.00… a much more realistic price. They said that they could replace the display in under an hour, which sealed the deal.

There were no surprises with the repair, but I was surprised by what I saw in the small and cramped shop.  Both technicians were mask-free, as were three customers.  One of the customers was sitting in a chair waiting for a repair suggesting that his exposure time in the store was significant.

Yesterday I took Violet in for routine service at my local Dodge dealer.  The staff was wearing masks (although several had their noses sticking out).  However, two customers were mask-free. In Illinois, we are required to wear masks in confined spaces like retail stores and shops, so why were all of these people ignoring the law?

When I read the news, I see photos of people in bars, churches, and nightclubs all shoulder to shoulder and all mask free.  I recently saw pictures of several political rallies where both the candidate and the majority of the audience were bare-faced.  

We are in the midst of a worldwide disease pandemic.  Entire countries have shut down, almost half of a million people have died worldwide, and one hundred and twenty-four thousand souls have been lost in the US alone.  That is more US deaths than during the entire First World War.

We are gaining more knowledge about this illness.  A few medical treatments are starting to emerge that may help some patients.  We are getting a better understanding of the best treatment practices.  Worldwide efforts to develop a vaccine are in hyperdrive.  However, we are nowhere near a cure.

Countries have tackled the spread of this disease in different ways.  Their varied approaches have given us a window into what works and what doesn’t contain the virus.  Unsurprisingly, the most beneficial methods are those that we have known about and used for over 100 years.  Those methods include social distancing and isolation, hand washing, contact tracing, and wearing a mask when you can’t control social distance. Regions that have successfully implemented these changes have had greater success at containing the virus than places that have been laxer.  

In the US, we have had conflicting information concerning the virus and how that impacts opening the economy.  Also, there seems to be a stream of half-baked recommendations that confuse the general population. A YouTube video from a Michigan family practice doc that foolishly recommended washing fruits and vegetables in soapy water had over 20 million views in its first week. Even the premier source of infectious disease information, the CDC, erroneously told citizens not to wear masks, only to have to backpedal on that wrong information. 

Any competent physician knows that wearing an appropriate mask can help prevent the transmission of disease both to and from the mask wearer.  Most citizens don’t have access to medical-grade masks and have to make do with “dust” style hardware store masks or homemade cloth masks.  These masks dramatically reduce the spread of COVID-19 from the wearer and depending on the composition of the mask, offer some protection to the user from getting the virus from an infected individual.  

The most contagious places to catch this coronavirus are indoor locations, with poor air circulation.  The higher the density of people in these places, the higher the chance of infection.  Indoor parties, crowded bars, packed in-house church services, and the like are high risk and should be avoided at this time.  However, there are other places like grocery stores that can’t be avoided by most. That is why everyone must wear a mask when you can’t control social distance.  If everyone wears a mask, we can dramatically reduce the rates of viral spread.  This is not a theoretical idea; it is a proven fact.  Wearing a mask is a no brainer.  So why are people actively refusing to do this?

Before I explore this question, I need to examine other phenomena present in this country.  We have lost nuance, and have become a country of absolutes.  For instance, some have taken social isolation to the extreme, and others have entirely cast it to the wind.  We have developed an “us vs. them” mentality when it comes to many things in daily life.  We have lost the ability to work together.  We have become more concerned with personal gain over what benefits our greater society. We have developed a culture of mistrust.  We have become an “all-in” society.  If someone believes in one tenant that a particular group espouses, then they are expected to become a follower of all of the other ideologies that the group promotes. We have assumed a “contest” view of life that supports that the only way one group can prosper is by decimating another group, which then becomes the opposition. We believe that the ends justify the means, no matter how dangerous the ways are.

As a Christian, I find such splitting behaviors abhorrent.  As a psychiatrist, I understand them to be destructive and dangerous. These ideologies play into many of our decisions, including our willingness or unwillingness to wear a mask. The question is, how do these beliefs and other factors cause us to take a position that is so contrary to our well being?

Masks are uncomfortable, that is a fact.  They are hot; they fog up your glasses; they make it difficult to be understood. As a physician, I can tell you that just about everyone quickly adjusts to these inconveniences.  But, yes, they do suck.

When I was researching this post, I came across articles that noted that people refused to wear masks because they felt that wearing one made them look weak.  This is one of those reasons that are hard for me to comprehend.  Why would a mask make anyone look weak?  Wearing one makes them look responsible, and their actions help the wellness of their fellow citizens. In my mind, mask wearers are strong and patriotic.  

Wearing a mask highlights that things are not back to normal. This is undoubtedly true, but the reality is that things are NOT normal. Denial isn’t the name for the longest river in Africa (…old AA joke).  

Some people feel that wearing a mask is anti-God.  How masks and God are connected is anyone’s guess.  I know that early on, some religious leaders said that God would protect their churches and congregations, which may play into this belief.  I also watched a video of citizens voicing their concerns about mandatory mask-wearing during a Miami city council meeting.  One individual said that the council was doing the work of the devil by requiring masks.  The citizen seemed firm in her belief but did not give any evidence as to why she held them.

The wearing of a mask has taken on political implications.  Statistically, Democrats are more likely to wear a mask than Republicans. Masks seem to have become weaponized in this regard.  I recently viewed photos of a rally in an Arizona church that was packed with over 3000 young people.  They were shoulder to shoulder, and I estimate that the number of mask wearers was under 5%.  I hope that this meeting doesn’t turn out to be the source of a super-spreader infection, but that certainly could happen.  Placing politics over health is a real tragedy.  

Some people strongly feel that wearing a mask is a personal choice. “If I get sick and die, it is my choice,” they imply. As individuals, we are allowed to do stupid things, as long as they don’t impact others.  We can smoke cigarettes, which are known to cause many diseases, but we can no longer smoke in public places because this would harm others. Shouldn’t that same logic apply to wearing masks?

Some don’t wear masks because they think that COVID-19 is overblown or a hoax.  Some groups have promoted these false ideas, and a person’s local experience additionally amplifies them. I have heard people say, “I don’t know of anyone who has gotten COVID-19,” as if this limited information can be generalized to the entire population.  Alabama Governor Kay Ivy famously said, “Y’all, we are not Louisiana, we are not New York state, we are not California. Right now is not the time to order people to shelter in place.” I guess the idea was that the virus was somehow not impacting Alabama at that moment, so WTF.  Sadly, if you take a look at the number of Alabama cases, they are on a steep increase. These numbers would likely have been significantly lower if there had been better direction from officials in that state.  

Some refuse to wear masks for reasons that seem entirely bizarre.  Watching the same Miami city council meeting, I witnessed one furious man, saying that he would defend our flag to the death, implying that wearing masks was somehow going to destroy our country.  This, along with the idea that Satanists are promoting masks, just seems crazy.  It is challenging to explain crazy.

Some are afraid that wearing a mask damages our economy.  Well, this is sort of right… but indirectly.  The global pandemic is harming our economy, and wearing a mask reminds us of that pandemic. Wearing a mask may make certain activities more complicated, like going out for dinner on a date. However, the more we control the virus, the sooner our economy will return to normal. 

So what is the solution?

We have not had a unified message about the necessity of wearing a mask.  This needs to be done on all levels of government and from both sides of the aisle.  We know that wearing masks can reduce the number of infections as well as the number of deaths due to COVID-19.  All people who have a voice need to be echoing this reality.

We need to emphasize the benefits of wearing a mask with transparent statistics.  One study showed that if everyone wore masks, the rate of infection would drop to 1/12th of a population where no one wore a mask.  As an example, let’s say that 100 individuals contract the virus in a non-mask wearing group.  In a statistically identical group of mask wearers, only eight individuals would get sick. Staying well benefits the economy.

Similarly, we need to publicize situations and cases where lack of safeguards, including masks, has caused outbreaks, and we need to personalize these situations.  It is one thing to say that 53% of participants became ill when they attended a choir practice in Washington. However, these numbers would be much more compelling if actual people told their stories about this event.  I am in no way trying to exploit victims of this disease, but I’m confident that many individuals would gladly speak up about their COVID experience if they felt that it would help others.  Numbers always have more impact when they are attached to a relatable situation or person. 

We have to model good behavior.  Our officials should all be wearing masks in public settings, and they all should be practicing social distancing. “Do as I say, not as I do,” doesn’t fly.

We need to nationalize standards.  Yes, we have guidelines, and yes, a cookie-cutter approach doesn’t work well in a country as vast as the US.  However, standards can be customized to accommodate different needs and regions. Let’s say you want to bake a chocolate cake.  You will have the best results if you follow a standard recipe.  However, you can customize your results to fit your needs.  A little more chocolate?  A little less sugar?  A different frosting?  Any reasonable changes will still result in a good cake.  Imagine a scenario where 100 people need to bake 100 chocolate cakes, but they aren’t given a recipe.  Some will have baking knowledge; others won’t.  In the end, there will be many different cakes, but many of those will be inedible. 

The cost of non-compliance must be emphasized.  What is the actual price to the economy if we can’t get this virus under control?  What is the emotional damage of losing a loved one? We need reasonable guidelines, and these can change as we gain more knowledge.  It is unreasonable to expect everyone to stay behind closed doors, but it is foolish to open up the country altogether.  Our leaders need to not only inform us but to re-emphasize what we can and can’t do.  We were able to mobilize our country during WWII by using various methods that emphasized safety, patriotism, and sacrifice for the greater good.  Many feel that the WWII generation was our greatest generation ever.  People think proudly about those individuals and their sacrifices.  How is it that we are divided over a potentially more deadly crisis? This does not have to be the case. We need leaders who can lead and have the ability to place the needs of the greater society above short-term gains. 



My broken phone got me thinking about mask non-compliance.
Some masks are better than others, but any mask is better than no mask!