Masks may be liberty-preserving alternative to mandatory vaccines or vax passports

There may be an alternative to mandatory vaccines and the inherent privacy and security concerns of either paper or electronic vaccine passports: allow people to opt out, but normalize the use of masks in densely populated, public, indoor settings when conditions suggest caution is demanded.

In the United States, this requirement should be tied directly to CDC reported rates of dangerous, communicable diseases with wastewater surveillance informing decisions. Medical research should be funded to track the effectiveness of masks against flu and anything else that’s feasible, not just COVID-19.

Ongoing investigation of the role aerosols—and inadequate ventilationplay in spreading common diseases demands equal attention and funding.

I, for one, would not return to an office as of May 2021 without a mask on my face if the space didn’t promise four to six air changes every hour or a fully vaccinated cohort of coworkers! This Wired story is a must read for those who’d like to understand the origins of medicine’s deeply flawed 5 μ myth defining “airborne” pathogens.

While our coronavirus memories are fresh, we owe it to future generations to prepare better for the next global outbreak. It is as inevitable as SARS-CoV-2 was. Fumbling our collective response, however, is not preordained.

We’ve learned a lot during the course of the coronavirus pandemic.

Ample real world evidence is now available suggesting that even simple homemade cloth coverings reduce the risk of infection from at least this one airborne virus. Flu also virtually disappeared during the 2020-21 season, though that could be as readily attributed to social distance and isolation as opposed to masks.

In the absence of the worldwide supply chain disruptions common early in this pandemic, more definitively effective surgical and N95 masks are easily obtained and affordable. Employers with public storefronts should have boxes of them deployed in the workplace in the same way food service companies provide gloves to their workers.

Unfolded ProGear N95 mask sitting in front box of 50 it came in

As with gloves and hairnets in restaurant kitchens, masks should be the immediate, hygienic response to entering the personal space of unknown persons with unknown vaccination status while any community is in the throes of an infectious agent.

Massachusetts’s governor is quoted in a May 7th Boston Globe opinion piece as saying, “some people have ‘very legitimate reasons to be nervous about a government-run program that’s going to put a shot in their arm.’” The same piece goes on to report, “Attorney General Maura Healey… this week repeated her call for public employees to be vaccinated as a condition of their jobs.”

Requiring every public employee in a customer facing position to wear a face mask at work unless s/he chooses to offer verifiable proof of vaccination seems like a cheap, simple, practical solution to me. As every scientifically literate, law-abiding citizen of the United States now knows, wearing a mask is no more difficult* than wearing pants.

Rome, the power house of the ancient world, believed trousers were ridiculous, barbaric garments. Quite literally, Romans, like the Greeks before them, saw pants as uncivilized clothing fit only for uncouth Goths and Vandals. The entire Western world, and most people around the globe, now don trousers without compunction. Masking one’s face requires no greater degree of adaptation!

Most of us could decide which we prefer at work: to wear a mask, or to accept vaccination. Crucially, the public at large ends up protected either way.Redacted official CDC COVID-19 Vaccination Record Card

I think it is likely that I, personally, will never want to fly again without a face covering, if only because I’m so well aware of my own tendency to touch my face and even bite my nails when experiencing anxiety. It’s a terrible habit I’ve never been able to break, but a comfortable face shield or mask would remove almost all of that risk to my health.

There will always be liars and attempted cheats, of course. Responses to those caught committing public health fraud should be proportionate and focused on preventing harm to the community.

Perhaps being fitted with a device designed like the ankle bracelets employed for house arrest for a period of time would work, offering a visible warning to strangers while broadcasting via Bluetooth? a message alerting those in the vicinity of the need to increase social distance. This could be a system that works with individual’s cell phones, or a device required for public occupancy of spaces meeting certain size or density limits rather like the requirement to install smoke alarms and fire sprinklers before opening a hotel or nightclub for business.

The primary solution is to normalize the continued use of masks in dense situations where we crowd together with unknown persons. The secondary need is for public spaces to meet reasonable, updated standards for safety in light of our current understanding of risk in the post-COVID-19 world.

Once COVID-19 vaccines are fully approved by the FDA, I do believe that employees who work specifically with the most vulnerable population should be required to accept vaccination or leave those particular roles.

Aides in nursing homes should not be able to opt out of coronavirus vaccines, nor the flu vaccine in normal years, nor should nurses serving the immune-compromised. Prison guards—who work with populations literally unable to escape from unvaccinated sources of exposure—are another obvious group whose personal choices should not be allowed to endanger the lives or health of others.

The actual conditions of employment for such positions demand a workforce that doesn’t subject other people to unnecessary risk so easily mitigated by inoculation. Case in point: the unvaccinated Kentucky health care worker who caused the death of three elderly residents of the nursing home where s/he worked. To pretend otherwise makes a mockery of both human decency and common sense.

In another example: a recent study published in JAMA showed that 46% of organ transplant patients produced zero antibodies after a complete 2 shot course of SARS-CoV-2 mRNA vaccine. It’s unreasonable that such individuals should be unknowingly subjected to the ministrations—however well-intentioned—of unvaccinated health care workers, certainly not without the immune-compromised patient’s being informed of their relative risk and given the opportunity to offer fully informed consent to taking said risk.

Face masks could also offer an effective solution for the conflict between public school vaccination requirements and anti-vaxxer parents currently allowed in some states to claim religious or other non-medical exemptions for their children.

Further research might prove that masks are not effective against every disease against which we have mandatory childhood vaccinations, but face coverings could potentially eliminate the friction between parent choice and community health in the context of the vital public good which is free, universal education.

Where freedom is the prize—and outbreaks of vaccine-preventable childhood infectious disease remain rare in America—I’d argue that the value of face masks as an alternative to mandatory injections is well worth exploring.Disposable surgical mask

Western medical science was patently wrong, before COVID-19, when it declaimed that face coverings offered no protection from infectious disease. We still aren’t sure if they protect the wearer so much as those in the vicinity of a masked, sick individual, but we do have substantial evidence that widespread adoption of masks can protect populations during a deadly outbreak.

Perhaps most importantly, where even the most well-vetted, safest vaccine or medication carries some tiny risk of harm to its recipient, wearing an appropriate, well-fitting mask correctly has virtually zero chance of injuring anyone. Low cost interventions with few side effects are ideal public health measures.

Asian nations which had internalized the historical lessons of earlier epidemics had it right; many** normalized face coverings during flu season. Now we know better, too. Science proves its inherent value when we incorporate new data into our body of knowledge, especially when we recognize data challenging existing beliefs and ingrained patterns of behavior.

This BMJ editorial (PDF) highlights the danger of clinging to false understandings. This opinion piece by Dr. Zeynep Tufekci is well worth a read on the subject of organizations lurching only slowly toward acceptance of new information challenging medical and scientific preconceptions.

Before the next pandemic, we should take great pains to study when, where, and how cheap, medically risk-free facial coverings work to effectively control the spread of disease. How many thousands fewer would have died if we’d deployed masks as a solution worldwide in days instead of months in 2020?

This is not merely a political issue. It is a matter of public health. Where solutions exist that preserve both life and liberty, we owe it to democracy—and humanity—to explore every possible compromise.

Per the CDC, roughly 1000 flu cases were diagnosed during the pandemic 2020-21 season vs. more than 65,000 cases in the more typical 2019-20 season.

* As with trousers, some are the wrong size, and some are more comfortable on a particular body than others. Trial and error may be required to find the perfect fit for a given individual. Compared with the effort necessary to remediate infecting a susceptible individual with a life-threatening disease, this process is, at worst, a trivial inconvenience.

Per the Boston Globe: One of the major senior care operators in the state of Massachusetts came to a similar conclusion before COVID-19, though the quote perversely suggests that the organization was more interested in shaming staff members as opposed to protecting elderly residents:

“A year before the pandemic, Hebrew SeniorLife required flu shots for the first time for staff. Administrators achieved 100 percent compliance by imposing what seemed at the time an onerous condition: Holdouts would be required to wear masks 24/7 during flu season.

‘That was totally embarrassing then, but not now,” Woolf said. “We don’t have that hammer anymore.’”

In my opinion, after legitimate scientific studies were conducted to confirm that mask use by unvaccinated staff protects vulnerable patients to an equivalent level as vaccinated staff with faces uncovered, this could be a sufficient and highly appropriate alternative to mandatory shots in some cases.

Voluntary residential situations for children under age 18 should probably be held to a higher standard, in my opinion, and strictly require vaccinations for all but medically exempt participants. Absent direct parental supervision, it seems unreasonable to subject anyone else’s child to unnecessary risk due to personal choices that contradict the best current medical advice.

** Routine wearing of masks was imported to Japan from Western nations who’d adopted them as one response to the influenza pandemic of 1918-19. Unlike we Americans, Japanese culture never dropped them as a reasonable personal response to being contagious after the urgency of the Great Influenza subsided.

This Huffington Post article suggests that the Chinese adopted protective face coverings even earlier: “In 1910 and 1911, citizens were encouraged to wear masks to combat the pneumonic plague outbreak in Manchuria.”

The article goes on to point out that other Asian nations picked up the habit of covering faces during outbreaks due specifically to the SARS epidemic of 2002-2003. I’ve read that Koreans, in particular, actually viewed masks in a somewhat negative light as a foreign, Japanese import before the first SARS crisis.

Outdoor school, in person amidst COVID-19, looks like this

Nervous families want to know if sending kids back to “in person” school during a pandemic is safe, and if it is worth the risk. Here’s what I’ve seen at my child’s school in September 2020.

I write this post first acknowledging my position as a parent with every conceivable advantage. Having been on site every day since two days after Labor Day, I can share what the autumn of COVID-19 looks like at one small New England institution serving elementary and middle grade students.

Red autumn plant by fence - 1

Decision 2020: Remote or in person education

My younger child, who prefers learning in a group, was given the option by his school to attend in person or remotely. Our community has low COVID-19 infections rates that makes this a reasonable choice. Even better, “in person” classes would be conducted outdoors until the weather turns cold when autumn segues into winter.

In accordance with advice from the department of health, DS2‘s school is requiring* the kids to:

  1. maintain social distance at all times and
  2. to wear masks any time they aren’t seated at their assigned desks for working or eating.

Lectern with laptop and whiteboard propped on mobile tool cart outsideMy child requested a return to in person school, and we agreed that he may go until they move indoors with the caveat that any surge in local virus outbreaks or lax enforcement of health protocols at school could change our position.

Even with low COVID-19 infection rates, I would not send my asthmatic son to school indoors at this point in time. We also have two elderly adults in our household, both with significant underlying medical conditions on the CDC’s watch list, so I’m on higher alert than I would be if I had only our nuclear family to consider.

Because I am a full time parent, I volunteered to help the teachers keep an eye on the children during lunch- and free-time. Recess inherently lacks the strict visual supervision of class time. My selfish reason for doing this is to make sure my kid isn’t more exposed in reality than official policy might suggest.

Setting self-concern aside, however, I also proposed myself for this new volunteer position because I knew that our teachers would have all of their usual work to do in addition to enforcing a slew of new rules that combine novelty with literal life and death consequences. Showing up and lending a hand seemed the very least I could do. My time is my own to spend and three other adults would remain present at my house to support my teen with his online work.

When I walk the playground for an hour and a half, the teachers have an opportunity to take a real break and eat lunch in peace. The kids still benefit from having a grown up—me!— available to remind them to replace their masks after they eat, and my extra set of eyes helps even the most active among them to maintain social distancing no matter how vigorously they are defending a fort, swinging on the tire swing, or digging a giant pit.

COVID-19 School Lesson 1: Create defined spaces minding social distance for everything fascinating

Here’s my first take-away advice for other adults, teachers and parents: kids who are engrossed in something are going to forget to mind their social distance. The younger the kid, the quicker this occurs. If awesome projects are happening, do everything you can to set up “stations of awesomeness” that are fixed to locations six feet apart!

An example at our school? The science teacher brought in several live frogs for a lesson. Afterwards, multiple kids wanted to hold the tiny creatures as the teacher cleared away equipment to her car. While each child did a great job waiting his or her turn, they were drawn closer as if by magnets whilst waiting. They started out sitting at opposite corners of a large blanket where they’d been assigned for the lesson, but nothing prevented the forward creep of excitement that all parents know from their own young kids. Blanket spread on lawn with pumpkin, pencils, etc.

Separate frog habitats on individual, smaller towels with “waiting spots” assigned on other, distanced towels (one per kid) would have worked better than the larger blanket which was fine for a teacher-directed lesson with direct supervision. Visual distancing cues are good; physical barriers are better; using both together is best!

None of us wants to prevent kids from the deep concentration of fascination with their work, but we adults must step up to keep them safe while they are in a state of flow. “Six feet” is a pretty vague concept to any elementary school student; it’s utterly meaningless to one who’s distracted!

COVID-19 School Lesson 2: Kids need masks that fit well, especially once they are in motion

Another tip I’d offer parents is to watch your child play in the yard or at a park for a solid hour or so with a new mask on. It becomes very obvious on the playground when someone’s mask is ill-fitting.

Disposable surgical maskWatching the children organically form into a whooping, running mass as they re-accustomed themselves to being together was one of the most heart-lifting things I’ve seen since the pandemic began. These kids are thrilled to be in each other’s company again, and the joy of play was plain on every covered face. I felt terrible each time I had to interrupt a game to remind a kid that his mask was slipping.

The same kid would struggle to follow the rules on one day but not the next for what appeared to be a non-behavioral reason: one mask fit that kid’s face better than the other.

Some of the little kids show up wearing masks that are too large and therefore floppy. Three older kids on different days tried using neck gaiters as face coverings, but each was constantly adjusting his tube of cloth as those simply don’t stay up once a child is in motion. Gaiters are not a good option for school face covering.

5 styles of cloth face mask next to surgical maskTry to get your kid to jog around the block in a new mask before sending her with it to “in person” school. A kid with a mask that doesn’t fit well—or feel comfortable—is being set up for discipline and failure. There are many mask styles available now, so keep looking until you find one your child can tolerate.

A certain young child behaved beautifully every day but one; when I asked him what was going on with his mask that day, he admitted that it smelled funny. Mom and Dad, if you’re thinking of trying a new laundry detergent, consider doing the experiment on a Friday night and having the kids try on their masks well before school begins on Monday morning.

Another thing I wish every worried parent knew is how well the youngest kids are adapting to wearing a mask all day, every day. It already seems natural to most of them! From what I’ve seen, the littlest children acclimated quickly to what was just one more “first” in their short lives.

Our middle-group kids seem to be the most resistant to the need to wear masks. It’s tough growing into your “question authority” phase during a pandemic, plus these kids are better used to school and life without face coverings. I appreciate that our school is taking a hard line about the necessity of protecting others by taking precautions, but I feel for the rebellious ones.

Schools, make sure your pupils know when and where they are allowed to step aside for a mask break without breaking the rules. Some kids need to exercise this kind of autonomy more than others, or more often. Give them a way to do it safely when you can.

COVID-19 School Lesson 3: Educators who worked hard are now working HARDER

Though some people bemoan “lazy” teachers who took the job to get summers off, I think those are mostly people who’ve never managed groups of kids!

Professional educators tend to be people who sincerely want to help children achieve their potential. COVID-19 has foisted a lot of extra work onto teachers, none of it within the normal scope of training for the job. Oh, yes, and getting it wrong runs the risk of making children sick. I have to believe it is the rare educator who enjoys hurting children.

I am spending only about a quarter of the school day being vigilant on behalf of the pupils on our playground, and I am exhuasted by the time I get home from this duty. Sure, I live with chronic illness, so I’m hardly a model of vigor and vim, but keeping watch takes a lot out of anyone who cares about her charges.

Desk with plexiglass barrier - 1

Our school’s leader is a handy type. He was able to add plexiglass partitions to the kids’ work tables himself. This woodworking task was done during his “summer vacation.”

Don’t worry: the plexi extends above the wooden supports by another two times their length, but that’s hard to see on a small screen. The barrier extends well above the kids’ faces.

School tents for COVID-19 - 1On a fine September morning, tents nestled alongside a red-painted barn appear positively idyllic. School started with each child finding his desk ready for him, each with a personal bin for books and papers. The same fellow had to source and procure these new materials after doing the planning to figure out what was needed and how to pay for it.

Another bit of summer, consumed by COVID-19…

Upon arrival at school, kids help carry furniture and bins out of the barn to prepare for the new day.

But within the first week, a light rain highlighted a weakness of a certain style of canopy. Attempts to reach the manufacturer for parts proved that equipment bought from retail stores by small businesses—our school, in this case—often can’t be repaired economically.

A painful lesson for a tiny school without endowments or rich benefactors. Also, many extra hours of work outside the school day for a full time teacher.

Dismantled tent frame and fabric next to remaining erect EZ-Up style canopyOf course, there is more to weather than rain. When the breeze picked up, kids realized that outdoor classrooms require heavier jackets much earlier in the season.

And, it turns out, large sheets of plexiglass have their own issues with the wind!

Plexiglass vs. wind nature weather - 1

All of these little headaches have to be multiplied by the teachers’ love for their students and commitment to their well-being. They care if they get this right, and they want to keep the children safe.

At our school, most of the adults have years of experience doing the same jobs… in the same classrooms with their supplies just so. Though the school hasn’t moved, the transition to working outside the doors requires constant adjustments. That kind of effort consumes energy as well as time.

I suspect every member of the staff at our school feels like s/he is working a brand new job in a whole new environment while teaching. That is stressful, and that’s in addition to the requirement that these caring educators remember to remind kids as young as six years old to keep their distance and keep their masks on.

There’s no specific tip for this observation except to remind parents to be kinder than ever to their children’s teachers. Recognize that none of us has a monopoly on pandemic-induced stress. You and I may not have the same worst stressors during these crazy times, but odds are we both face some.

Two weeks into the new school year, I asked my son two questions this morning.

Are you able to learn in your socially distanced, outdoor classroom while wearing a mask?

Yes, he said. He’s learning just as well as always.

Then I asked him about socializing and play. Even with his mom on the playground annoying his peers, even with reminders and occasional rebukes about space and facial coverings, I asked him, is he having fun with his friends?

Yes, my son replied. He’s really happy to be back at school amongst other kids, even with the necessary restrictions.

For us, for now, in person education for this child is a risk worth taking.

Our employed household members continue to earn their usual paychecks, and both have the option to work from home. My home educated teen is attending all of the usual courses that we elect to outsource online. We have enough rooms for all this work to be conducted with relative privacy, and we had the means to upgrade our internet infrastructure over the summer to eliminate technical roadblocks we experienced in the spring.

I am counting my blessings, and they are myriad!

*Another change is the requirement to pack out all lunch detritus instead of disposing of potentially contaminated trash at school, and the kids no longer have access to a kitchenette for reheating their meals. My interest in waste free lunches and re-usable containers is serving us well. Hot food in insulated thermal jars is already receiving a warm welcome, and it is only mild September!