Ways of Thinking...: Covid, Masking and Vaccines

Using Symbolic Interaction, let's think about the shared meaning among different groups of Americans regarding mask wearing and vaccinations. There are some Americans who have created a shared meaning around the use of masks and vaccines and this shared meaning is that these things should be avoided because of some combination of the following:

they don't work
they are harmful for you
the government is using them to try to control you

These tropes have been cultivated in certain segments of the media and then reinforced through institutions like families, government, employers, etc... This reinforces the meaning that anti-masking has come to be for these people. And, some research shows that push back against this line of thinking can sometimes cause people to cling to these misunderstood principles even tighter. Hopefully, an honest and critical examination using sociological theory can help students understand the issue better.

"Covid only kills a tiny percentage of people, so why should I worry?"

Sometimes people will focus on the fact that you are very unlikely to die from Covid-19 because most people, especially young and healthy people survive it. One of the biggest graphics being passed around lately to support these tropes is this:

This simple-minded trope for arguing against masks & vaccinations ignores the effects of Covid on both the healthcare system and the patients that survive. Many of the patients who get covid will need to be hospitalized before surviving. As hospitals fill up with covid patients, their resources and manpower are used up leaving less for everyone else. This is one of the important reasons that the healthcare officials talk about prevention and "flattening the curve". Sociologist and M.D., Nicholas Christakis explains the importance of preventing covid in this tweeted graphic:

Preventing covid is NOT just to prevent it from harming YOU. It is preventing it from overwhelming the system and spreading like a wildfire. The goal is to keep the peak of the curve below the maximum capability of the healthcare system. See this Vox article and the graph below:

Medium explains flattening the curve and shares this graphic:

via GIPHY

Decorated Army Veteran Dies of Treatable Illness - August 27, 2021 in the United States

Widely reported in various news outlets, from the NY Daily News, a US Army veteran who survived 2 tours in Afghanistan died in Houston because there were no resources to give him the simple treatment he needed. Without it however, he likely went into septic shock and died.

“Texas is f--ed,” Dr. Kakli told the Daily News by phone. “Talk to any doctor in Texas. It’s insane.”

OurWorldinData keeps track of the number of covid patients. Here is a graph from the last week of August 2021:

Life After Covid

But another important nuance to counter the idea that so few people who get Covid-19 die from it, is that many of those who survive the disease continue to live with effects from the disease. Covid is still a relatively new disease so doctors do not have a full understanding of it. However, they do know that covid patients report a host of different issues after surviving the disease. One issue that seems apparent is that Covid-19 affects the body's ability to get enough oxygen. Because oxygen is used throughout the body, there can be numerous effects from oxygen depletion including different organs like brain, heart, kidney and lungs which all may be damaged due to covid. And, the recovery may entail learning to walk again, regaining strength, learning to use the stairs again and learning to think clearly. All of this recovery might mean taking time off work, finding someone to care for the patient as they recover at home, walking around connected to an oxygen machine because you need supplemental oxygen, rearranging furniture at home so the patient doesn't trip on anything and cause a new injury, etc... The point is that yes, you are not likely to die, but you are also gambling with your long-term quality of life and the long-term quality of life for all of those you come into contact with.

Time Magazine explains the most recent study (8/2021) of Long Covid here:

Among those hospitalized for COVID-19, 68% reported at least one continued, COVID-19-related symptom six months after their first symptoms appeared. While this percentage decreased by the 12-month mark, it remained relatively high, at 49%. And overall, patients who had been hospitalized for COVID-19 self-reported being in poorer health and having lower quality of life—including mobility issues— compared to controls.

The most common symptom patients reported 12 months later was fatigue or muscle weakness; other issues included sleep disturbances, changes in taste and smell, dizziness, headache and shortness of breath. Certain symptoms were actually worse at the 12-month mark than they were earlier on in the study: the proportion of patients reporting breathing problems increased slightly, from 26% to 30%, from six months to a year following their first symptoms. The patients also filled out questionnaires about their mental health, and while 23% reported feeling anxious or depressed six months after their first symptoms appeared, 30% did so at a year.

For more on the harrowing experience of surviving Covid, see this post about my own experience.

The third reason why death from Covid should not be the only matter of concern is that the more that covid spreads, the higher likelihood that it will mutate and create new and more dangerous variations. Every time a virus reproduces, it runs the possibility of mutating. The more we allow it to do so, the greater likelihood that it becomes more deadly or resistant to the vaccinations.

If you can understand why we should be concerned about Covid spreading even if it doesn't result in death, then you can understand that it might be important to prevent it from spreading. The 2 biggest tools that we have to prevent the spread are vaccines and masks, both of which have taken on symbolic meaning that has nothing to do with the actual science but instead has to do with one's political identity. Here is a critical and nuanced explanation of vaccines followed by masks.

Vaccines

The first part that is interesting to me is the social construction and sociological imagination around opposition to vaccines. The history of vaccines goes back to the American Revolution when George Washington ordered his troops to get inoculated from small pox. He was losing more troops to small pox than to the British and so, he ordered his troops to put their country first and get vaccinated. Although vaccinations were a patriotic duty demanded by the general, they were not without controversy. However, vaccine science was as young as the new country was back then. Despite the infancy of the science, vaccines were required in some schools as early as 1809! Since then, vaccine science has come a long way. And for decades, schools have been requiring at least 5 vaccinations! Despite these truths, in 2021 after more than two centuries of research and more than 500,000 Americans have died of covid, there is a vehement opposition to vaccines. Why now? The development of this particular vaccine occurred within a particularly hyper-partisan time when institutions sought ideological opposition to political opponents regardless of truth or consequences. These institutions then give credence to these ideas simply because they are entrenched institutions in American society. Furthermore, the hyper-partisanship has filtered down to an individual level in which individuals embrace their party affiliation and actively seek out oppositional ideas. There is shared meaning among these individual that suddenly see the covid vaccine as part of a larger representation of party affiliation.

Masks

Besides anti-vaccination, opposition to mask wearing is also interesting using the social construction of reality and sociological imagination. It is notable that the wearing of masks has been criticized only during this current political atmosphere and even then, it is only the wearing of masks under attack. The medical community has been promoting the use of masks in the prevention of infection for decades. Doctors, nurses and healthcare workers have all worn masks around at-risk people for decades to prevent infection from spreading. This has never been opposed before. But suddenly this decades-old practice is being called into question, now, at this particular moment. And, the specific charge of masks taking away freedom is interesting to me too. For those who share the belief that masking means taking away freedom, why do they

not question the practice of wearing clothing? No shirt, no shoes, no service has been a popular mantra for restaurants and stores for decades. And swimming pools have required swim caps and kitchens have required hairnets for decades. Why are masks drawing the line? Ironically, the phrase No shirt, no shoes, no service was also a social construction created for similar political reasons! And the idea doesn't stop at clothing. There are myriad restrictions placed on everyday life such as: wear a seatbelt, smoke outside away from the entrance, follow the speed limit, stop for red lights, pay taxes, follow building codes, label food expiration dates, etc...

Most of these restrictions are designed to keep the public safe. So why are masks being questioned? Using the ideas of sociological imagination and social construction of reality, we can see that opposition to masking and vaccines has only been opposed at this time and in this specific way. The meaning of opposing these has been created for both political and economic expediency by institutions, like Republicans and Fox News seeking to find political opposition to the Biden Administration. These are widely followed institutions that, because they are so enmeshed in society, hold sway over the meaning of masks. And that social meaning has become reified by institutions and people that parrot the tropes they have heard recently around masks and vaccines.

Examining the Research Critically

Critical examination of research is an important aspect of sociology. That means thinking with nuance and complexity and asking questions. Too many Americans do not engage in a critical understanding of the research behind mask wearing. And not only is the first research below sociological, it confirms the importance of social perception in the prevention of disease spread.

From Stella Quah, a sociologist at the University of Singapore

In this research about a 2006 outbreak of a SARS virus, she found that public perception matters and how the public is educated plays a role in minimizing the risk.

A comparative analysis of the 2002-2003 infectious disease outbreak, severe acute respiratory syndrome (SARS), and the HIV/AIDS epidemic that has affected the world over the past two decades reveals the significant role of socio-cultural beliefs and attitudes in the shaping of people's lifestyles and approaches to the control and prevention of epidemics. The main research question is: what can we learn from the SARS experience about effective prevention of HIV/AIDS? The sources of data include population figures on the development of these epidemics and findings from two sociological studies of representative samples of Singapore's multi-ethnic population. The comparative study illustrates the impact of cultural beliefs and attitudes in shaping the public image of these two different infectious diseases; the relevance of public image of the disease for effective prevention and control of epidemics.

Masks and O2 Levels

Some critics ask, "How do we know that masks are not harmful? Do they make you breathe in your own CO2?"

Masks can sometimes be uncomfortable and hot and they might even prevent you from getting a deep breath. However, there is a simple way to see that the mask is not hurting your ability to respirate enough oxygen. Get a small device called a pulse oximeter that is available at any pharmacy or at any doctor's office. It measures how much oxygen is getting into you. The average person should be above 92 probably closer to 100. A simple experiment can show that masking does not prevent you from getting enough oxygen. Simply put on the device and get your O2 level. Then, with a mask on, run around or do jumping jacks and take your : level again. You will see a similar O2 level.

Pulseox devices are useful because if a person gets Covid-19 then you may see a drop in O2 levels even before you feel gravely ill. When your pulseox level is no longer getting to 90, you may need to get to the hospital for supplemental O2.

Masks and Germs
Another simple-minded rhetorical criticism of masks is that if you analyze masks you will find that they are dirty including germs like bacteria and pneumonia. Yes! That is because they are working! If the germs are on the outside it is because the mask prevented you from breathing in the germs. Conversely, if the germs are on the inside, then the mask prevented you from breathing out the germs into the air around you! Additionally, this is why there are recommended guidelines for how you take the mask on and off and how you touch it. And if you want to be extra cautious, change your mask often.

Efficacy of Masks

Some people claim that there is no evidence of masks working or that the guidelines have changed.

First of all, the guidelines have changed because this is a new virus and researchers are learning about it every day and as it evolves. For examples, researchers now know that it is a much more airborne virus than at first. This means it is more likely to be spread by being breathed in. Secondly, there was a time at the onset of the virus when the CDC in general and Dr. Fauci in particular were afraid that there was not enough medical grade masks (N95). That is why he said that people should wear a mask but not necessarily an N95 mask. We are beyond that point. However, the evidence for why masks work must be culled and critically analyzed because there are many variables: what kind of mask? how is it being worn? where is the location of mask wearing occurring - indoors? outdoors? in a crowded space? how long was the mask wearer in that space? what is the level of community spread in this location? All of these questions are important and it is difficult to measure and duplicate all of them. However, there is much evidence that points to the efficacy of mask wearing.

Studying Mask Wearing is difficult but still conclusive

There is much evidence that masks help but again, you must understand the evidence clearly with complexity and nuance.

From Nature.com this article explains the difficulty in examining "mask-wearing". Again the importance of nuance in that phrase "mask wearing:" Who is wearing the mask? What kind of mask? How are they wearing it? What is the circumstances they are wearing it in? How much covid is present in the population? From the the article, despite these important questions that bring context to understanding what one means by "mask wearing,"

science supports using masks, with recent studies suggesting that they could save lives in different ways: research shows that they cut down the chances of both transmitting and catching the coronavirus, and some studies hint that masks might reduce the severity of infection if people do contract the disease. But being more definitive about how well they work or when to use them gets complicated.

This 2020 news report from NPR also explains that,

most of the studies in the analysis looked at face mask use in health care, not community, settings. And they were observational, not the gold standard of science, a randomized controlled trial, which would be "very unethical in a pandemic," says Jeffrey Shaman, an epidemiologist at Columbia University. Still, he says the fact that there is a benefit from masks is clear.

Controlled settings show mask efficacy

So the above article explains that it is difficult to measure "mask wearing" generally, but this research shows that in a controlled setting of a hospital, with a regulated type of mask, it was indeed effective.

community mask use by well people could be beneficial, particularly for COVID-19, where transmission may be pre-symptomatic. The studies of masks as source control also suggest a benefit, and may be important during the COVID-19 pandemic in universal community face mask use as well as in health care settings. Trials in healthcare workers support the use of respirators continuously during a shift. This may prevent health worker infections and deaths from COVID-19, as aerosolisation in the hospital setting has been documented.

Uncontrolled evidence

This article explains the results of a study of an outbreak in California where masking is not required and a teacher spread Covid to half of his class. From the article,

Among the teacher’s 24 students, 22 were tested and 12 tested positive for the coronavirus, according to the report, written by county health officials and experts with UC Berkeley, UC Davis and UC Santa Cruz.

Four parents of children at the school were later infected in the outbreak, which involved the Delta variant, according to the report. Of the infected parents, one was unvaccinated, while three were vaccinated. Vaccinated parents in the outbreak experienced symptoms including fever, chills, cough, headache and loss of smell.

“This outbreak of COVID-19 that originated with an unvaccinated teacher highlights the importance of vaccinating school staff members who are in close indoor contact with children ineligible for vaccination,” the authors of the report wrote. “The outbreak’s attack rate highlights the Delta variant’s increased transmissibility and potential for rapid spread, especially in unvaccinated populations such as schoolchildren too young for vaccination.”

The scientists who wrote the report said the results show why it is so important that universal masking inside schools is widely recommended; in California, masking is required in indoor school settings.

Healthcare experts agree and provide myriad evidence that masks work

Finally the University of San Francisco provides this explanation of how masks work and the evidence supporting their efficacy. From the explanation,

There are several strands of evidence supporting the efficacy of masks.

One category of evidence comes from laboratory studies of respiratory droplets and the ability of various masks to block them. An experiment using high-speed video found that hundreds of droplets ranging from 20 to 500 micrometers were generated when saying a simple phrase, but that nearly all these droplets were blocked when the mouth was covered by a damp washcloth. Another study of people who had influenza or the common cold found that wearing a surgical mask significantly reduced the amount of these respiratory viruses emitted in droplets and aerosols.

But the strongest evidence in favor of masks come from studies of real-world scenarios. “The most important thing are the epidemiologic data,” said Rutherford. Because it would be unethical to assign people to not wear a mask during a pandemic, the epidemiological evidence has come from so-called “experiments of nature.”

A recent study published in Health Affairs, for example, compared the COVID-19 growth rate before and after mask mandates in 15 states and the District of Columbia. It found that mask mandates led to a slowdown in daily COVID-19 growth rate, which became more apparent over time. The first five days after a mandate, the daily growth rate slowed by 0.9 percentage-points compared to the five days prior to the mandate; at three weeks, the daily growth rate had slowed by 2 percentage-points.

University of North Carolina sociology professor and MD, Zeynap Tufekci, reviews the literature (Jan 2021) around mask wearing and develops a framework for examining it as well as makes recommendations here. In short,

The preponderance of evidence indicates that mask wearing reduces transmissibility
Public mask wearing is most effective at reducing spread of the virus when compliance is high.
We recommend mask wearing by infectious people (“source control”)
We recommend that public officials and governments strongly encourage the use of widespread face masks in public, including the use of appropriate regulation.

From JohnsHopkins, Proper Mask Wearing Matters,

Anytime you are wearing a mask, make sure:

It is worn consistently and appropriately. A mask that is frequently pulled down to breathe or talk, or is worn under the nose, is not effective.
The mask conforms to your face without gaps — it is important that most of the air you breathe in and out flows through the mask rather than around the mask through gaps at the sides, top or bottom.
It is made from several layers of tightly woven fabric in order to be an effective filter.
The mask has a flexible nose bridge to conform to the face and prevent fogging of eyeglasses.
It stays in place during talking and moving, so it can be worn without slipping and so it does not require you to touch it frequently.
The mask is comfortable enough to wear without adjusting it for the amount of time you need to keep it on.

Following current mask-wearing guidelines is still important as we race to stop viral transmission and get everyone vaccinated before more variants of the virus emerge and threaten the progress we have made.

"But masks don't guarantee prevention..."

A lot of what is recommended is not 100% but very few issues are zero sum or black and white.

Masking and vaccines limit but does not eliminate the likelihood of getting ill from covid. There are lots of ways that we try to limit our risk - going inside because of risk of lightning, cooking raw meat, going to the basement during tornado warnings. None of these are a 100% protection, but they limit the risk. Masking is similar. And of course, how you mask matters. Wearing the right mask in the correct way in the right situations all matter. This graphic from the Washington Post explains the different levels of protection:

Instant Covid's Gonna' Get You

And in a twist of irony, a leader of the TExas anti-mask movement died from Covid. From The Hill:

The leader of an anti-mask movement in Texas has died from COVID-19.

Caleb Wallace, 30, who created the San Angelo Freedom Defenders, a group that held a rally to combat "COVID-19 tyranny," died after spending more than a month in the hospital, according to a message posted by his wife, Jessica Wallace, on a GoFundMe page to raise money to cover his hospital bills. He initially refused to go to the hospital and get tested for the virus, instead opting to take ivermectin — an anti-parasite medication used mostly in livestock that the Food and Drug Administration recently urged people not to take to treat COVID-19 — along with high doses of Vitamin C, zinc aspirin and an inhaler.

This final anecdote helps to reinforce the shared meaning around masking and covid. People are willing to treat themselves with a horse medication but not FDA-approved, doctor-recommended masking and vaccinations.