Mask Up!

When news broke the other week about a major scientific study shedding new light on the perils of "long COVID," you can be sure it quickly found its way into my inbox. One of my close friends is just slightly further than I am on the side of caution, on the great COVID precautionary measures continuum that stretches all the way from those still maintaining perfect isolation to those gleefully and voluntarily breathing and coughing each day into the faces of total strangers. As such, he is perpetually concerned that I am in danger of backsliding in the direction of a maskless, caution-less existence. He therefore sees to it personally that every new piece of bad news about COVID is brought to my attention. 

And this piece was indeed attention-grabbing, from the headline down. Even relatively "mild" cases of COVID-19, the article reported, could be associated with significant losses of brain tissue and cognitive functioning, and it was unclear how long lasting those effects might be or whether they could ever be reversed. 

Now, a couple caveats are in order here. First, the study's findings were collected at a stage of the pandemic before vaccines were widely available. Therefore, it sheds no light one way or the other on whether immunization or booster shots might guard against these effects. 

Second, the direction of causality in the report could not yet be established. After all, we have known for a long time that one of the symptoms of COVID-19 is a loss of taste and smell; and the loss of gray matter that the study revealed tended to be clustered in the parts of the brain associated with these senses (and—through them—with memory). What the study couldn't clarify was whether COVID damages those regions directly, causing loss of gray matter, or whether COVID first reduces capacity for smell and taste, causing those regions of the brain to atrophy from disuse. If it's the latter, then the neurological damage associated with COVID is more likely to be reversible. 

We all of course had heard stories from the early days of the pandemic about the eerie loss of taste and smell that people seemed to experience once they got the disease. But I confess that, as someone whose sense of smell has been compromised throughout his life by an endless series of allergies, this at first sounded to me like a relatively bearable loss. I have never been a good smeller, pandemic or otherwise. 

But reading through the coverage on this new study, it began to occur to me for the first time just how important these particular nerve endings are. As the articles discussed, smell and taste are also intimately connected with the parts of the brain that give us memory, namely, the limbic system. This is the physiological basis of the famous incident of Proust's madeleine. As Edmund White sums up Proust's theory of "involuntary memory" in his study of the author: "our memory is not like a vase in which all the contents [...] are available simultaneously. No, [...] memories come flooding back to us in their full, sensuous force only when triggered involuntarily by tastes or smells[.]"

It was just such an involuntary memory that famously gave birth to Proust's modernist classic. And so, one has to wonder, in a world of widespread COVID, how many other À la recherche du temps perdu-s that could have been created, that existed only in posse, will now instead go forever unwritten... It's one small, but hopefully illustrative example of the immense lost and wasted human potential caused by the spread of this disease. 

Of course, simply pointing out the tragedy of this disease is not enough in itself to tell us what strategy we should pursue to mitigate it. Public policy is always a matter of trade-offs, and however horrible one danger is, there is always the possibility that certain strategies to confront it could prove to be even worse in their effects. Thus, over the course of the pandemic, I have not always been so whole-heartedly in favor of the strongest possible public health interventions as some of my contemporaries have been. In the early stages of the lock-downs, I worried that collapsing global tourism could take more lives in the developing world in the long run than retaining it, given the economic contraction that resulted... 

I worried about the small business owners and low-wage workers overseas—people who didn't have the luxury of working from home like me, or who lived in countries that didn't have the emergency supports that our Federal Reserve and Congress were able to provide to stave off economic catastrophe and preserve people's livelihoods even while large sectors of the economy were being shut down...

I therefore have had some sympathy from the start with those who said: "the cure can't be worse than the disease" (a phrase that has been forever tainted and ruined by the fact that Trump uttered it, but which really ought to be a non-controversial truism of any public policy issue). I understand equally the people who say now that "we have to learn to live with this virus," and "the virus has become endemic; we can't expect to ever extirpate it wholly, and so we're going to have to find a way to resume some semblance of normal life even in the presence of the virus." They too, it seems to me, have it right, at least up to a point. 

But, over the last few months, a strange turn occurred. When people first started to say, "let's learn to live with the virus; it's become endemic now, and we have to accept it," I assumed they just meant that we shouldn't go back to March 2020-style lock-downs, and I wholly agreed with them. The cost would be too high. But, as people kept saying this, it gradually became clear that what they meant was that we should pursue no public health mitigation steps. That people no longer needed to mask up, for instance, in public, indoors, or in crowded settings. That people didn't need to wear a mask anymore on trains or subways...

This was far harder for me to comprehend. Masking has always been one of the simplest and least restrictive precautionary measures one can take. It may be mildly uncomfortable, but it's fairly easy to get used to, and the protection it provides is well worth the inconvenience. Moreover, masking is 100% compatible with "living our lives" and "going back to normal" and "not shutting down our economy." You don't have to close any small businesses just because the customers are wearing masks. You don't have to suspend all travel and tourism just because the people walking on the beach might be asked to put a mask back on once they return to the hotel lobby... is it really so much to ask? 

Stranger still, it wasn't just the same people who had opposed public health measures from the start who were now turning against masks. One began to hear Democrats and liberals as well, who had condemned Republican state officials just a few months earlier for discouraging masks, now use the same talking points. Over the summer of 2021, at the peak of the Delta surge, Democrats were united in deploring Florida governor Ron DeSantis's refusal to encourage or incentivize mask wearing in his state. Yet, a half year on, with another major surge of infections barely behind us, Democratic state governments and local officials began to adopt the same line. Why? Was there a public health basis for this? Had something changed in the science or our knowledge of the virus to justify such a step? 

No, and people were quite forthright about this: the rationale was wholly, 100% political. New York Times reports cited officials concerned about internal polling, midterm election anxieties, and public opinion that suggested they needed to take a "new tone" on COVID-19 and "relax" public health restrictions so that they didn't sound like "the party of gloom and doom." Nowhere were public health experts saying, "the time has come to take off the masks—it's safe now." But Democrats were worried about losing votes and elections, so—one by one—they lifted the mask mandates anyways, such that there is now scarcely a place in the country where people are expected to wear one in public. In even my own hyper-liberal northeastern city, the mask mandate is over, and my office is planning to go back to in-person work without requiring people to mask up...

But isn't this precisely what we all spent a year-plus condemning Trump and the Republicans for? Politicizing public health, putting votes over saving people's lives, and engaging in the sort of magical thinking that suggests that if we simply clap our hands and believe hard enough that the pandemic is over, then it will simply disappear... Think this is an exaggeration? A February 8 New York Times article described local Democratic officials' reasoning behind their decision to lift the mask mandates. Alarmingly, not a single public health justification was cited. Instead, the report noted that "a series of focus groups were held [... and] advisers were struck by the findings: Across the board, voters shared frustrations over public health measures [...] and a deep desire to return to some sense of normalcy."

Well, of course! Guess what—COVID-19 proves unpopular with voters. The disease is not going to win any elections. But what people are "frustrated" with is the fact that a pandemic illness has changed and upset all of our lives, and I entirely feel the same way. But it's the virus that's the problem, not the few simple steps we can continue to take to protect ourselves against it. And it's nothing but the grossest, Trump-iest magical thinking to believe that we can make the virus go away by simply acting as if it didn't exist. Quite the opposite. If we relax our guard, another surge will be on the way (indeed, it's already starting). 

People respond: but we can't keep on wearing masks forever. Actually, we can, at least in certain crowded settings, indoors, and on public transit. People say: but we have to relax restrictions when case counts dip, to show that we're responsive to changing circumstances. But no, we don't. The very success of mitigation steps in slowing down one surge is not a reason to willfully invite the next one by abandoning those same measures. As my cautious friend put it: in the event of a cholera outbreak, the wise and scientifically-informed public health response is not to wait until it recedes slightly, and then rush out to tell people: "okay, it's gone for now, you can start defecating in the drinking water again!"

Public health crises can in fact create new social norms and lead to permanent changes in behavior. Does this mean that we never go back to "normal"? Well, not exactly. It does mean that we have to accept that the world was changed irrevocably by the crisis, and that life cannot be perfectly recreated the way it was before. But this also doesn't mean that we have to forfeit everything of value in our lives. Think about the AIDS pandemic. Did AIDS change everything about people's lives? No. The world did not end; society as we knew it did not collapse as a result of the disease. But it did lead to some new social norms and quasi-permanent changes in behavior—particularly regarding unprotected sex. 

We can live with those changes; just as we could learn to live with a new social norm that expects people to mask up when going into crowds, shared indoor spaces, and public transit. 

But no. No one is up for it, it would seem. Aside from a few tired and overwhelmed public health crusaders on Twitter, no one is really advocating for masks anymore. Not the government; not our local or state-level elected leadership; not Democrats any more than Republicans. Our president and vice president, who came to office pledging to "follow the science," and "trust public health experts," and "put facts above politics" have increasingly done the opposite, as the months have gone on and public opinion shifted. 

Indeed, they just staged an elaborate State of the Union ritual in which everyone was visibly mask-free. As the Times reported, they dropped the White House mask mandate that very day specifically in order to host a crowded reception after Biden's address, in which people would not be covering their faces. Their goal was evidently to send a message that Democrats don't wear masks any more than Republicans do, because they are afraid of being tarred as the party of public health restrictions (yet another way—like their continued use of Trump-era anti-asylum restrictions—in which they have acted like craven political animals who drop their own promises and forget their prior words as soon as the focus groups disapprove of them). 

In seeing all the Republicans turn against masking, and then—one by one—all the Democrats do so too, one has the feeling of living through a bad science fiction scenario—an Invasion of the Body Snatchers-esque process by which the alien hive mind has gradually colonized each person until all one's former allies have been turned and re-programmed. I think of Eugène Ionesco's surrealist satire, Rhinoceros, in which the people of a French town find themselves turning one by one into the titular rhinos. After fighting against this fate at first, the townspeople eventually decide to throw up their hands and embrace "rhinocerization," concluding that it is too much work to resist; until in the end there is only one man left standing.  

Ionesco's play is a powerful metaphor for the spread of any bad idea (the playwright had fascism specifically in mind at the time he wrote it). But, when one sees people follow this same pattern of behavior in response to a literal contagion, the play seems even more on-point that before. As the plague of rhinocerization spreads through the town, Ionesco's characters run through the whole series of attitudes we have seen people adopt in response to COVID-19. Fatalism, misplaced humor, denial and minimization. "It's not so bad," they say; "it has to happen to all of us eventually"; "oh, why do you take it all so seriously?"

It would be one thing if masking really were just an individual choice, and people could choose to take their own risks at their pleasure. But the fewer people are wearing masks, the less effective any individual's mask is going to be in the first place. Choosing to embrace rhinocerization in order to "get it over with" therefore puts everyone else at greater risk of the same fate. 

And it is all utterly needless! The trade-offs are so minimal! I agree, we have to go on with our lives. I agree, we can't let COVID-19 control every aspect of our existences. But no one's saying that. All I'm saying is that, when you go indoors with a group of people, put on a mask! It won't hurt you! It won't deprive you of the ability to travel or meet people or have fun! All it will do is fog up your glasses and happen to save your own and other people's lives! Wear a mask.