In many cities, each night at dusk, grateful residents applaud health care workers. It’s a reminder that in the early phase of the COVID-19 pandemic, doctors and nurses held the front line. All that was required from the rest of us was to stay home, watch Netflix, and learn to bake.
As the economy begins to creak open, the responsibility for managing this pandemic has shifted. Now it is put upon the common citizen to take responsibility for mitigating the next wave by distancing, adhering to social bubbles, and wearing masks. Are we up to it?
Smoking rates did not drop until smoking bans were enacted. Seat belt usage did not exceed 50 per cent in Canada until it was made mandatory in the 1970s. Enormous fines are still needed to prevent some drivers from making highways dangerous for everyone else. We have a poor track record of “doing the right thing.”
It then falls upon government to make compliance obligatory. The state shows its ugly authoritarian side, and liberal democracy trembles. Thus, with the advent of mandatory masking has come vocal and animated resistance.
The public health challenge of reaching mask-resistors is threefold. First, many do not accept the underlying science, nor indeed the entirety of the COVID-19 narrative. Such ideological entrenchment cannot be challenged with evidence, especially when drowned by conspiratorial noise. This is largely an intractable group that is best served by legal compulsion.
Second, we must address selfishness. The rationale behind masks is the protection of others. Cloth masks offer the wearer little personal protection, but rather help reduce overall community transmission. This is distinct from other public health investments. A seat belt protects the wearer and not the person in the other car. And efforts to convince men to wear condoms to protect their partners from STIs, or to convince smokers of the dangers of second-hand smoke, have been unsuccessful.
We must connect social responsibility to personal gain. If enough people wear masks, the community transmission rate declines, further outbreaks become rare, and businesses stay open. Everyone wants to be able to shop at the mall or have a drink on a patio.
Last is risk perception. The probability of getting COVID-19 is low, and the probability of dying from it is also low. This reality has fuelled much anger surrounding the “lockdown,” with many unable to understand why their freedoms were restricted when they are at minimal personal risk.
But this has never been about individual risk. A given COVID-19 patient has a vanishingly small risk of dying. But when scaled up to a population of millions, this translates to tens or hundreds of thousands of deaths, much human suffering, and a stressed health care system.
The threat is not to the individual, but to the community. But we have a culture that is very much set in an individualistic mindset. The possibility of an infected person giving the disease to another person who might give it to a third who then dies is so abstract that it fails to sufficiently compel individual action.
We must convince individuals to make daily changes to their lifestyle in order to enact an unseen theoretical effect on people they will never meet.
Frankly, this is a challenge of imagination. But everyday citizens must rise to this challenge and be worthy of receiving that dusk applause that was once reserved for health care workers. Be heroic. Heroes wear masks.
Raywat Deonandan is an epidemiologist and Associate Professor in the Faculty of Health Sciences, University of Ottawa. firstname.lastname@example.org