Photo by Andreas Solaro

A chronic case of mask fever

Masking in medical contexts represents the triumph of culture over science

Artillery Row

Over recent weeks there has been a marked reduction in the number of people wearing face coverings in retail settings, hospitality venues and on public transport. Given the ineffectiveness of masks in reducing viral transmission, together with the multiple harms associated with them, this transition is both rational and welcome. Paradoxically, the prominent exceptions to this return to a mask-free society are NHS facilities and venues allied to health. Widespread masking of both staff and patrons persists in all hospitals, health centres and GP practices, and most dentists, opticians and pharmacies.

Face coverings can inflate the risk of pneumonia

A sphere of society where one might reasonably expect a reliance upon evidence-based practice, is now the outlier in persisting with the unscientific and pervasively damaging mass-masking phenomenon. More troublingly, healthcare’s insistence that staff and visitors continue to wear masks constitutes additional risks to the wellbeing of the people who use these services. Some of the general harms of face coverings are likely to be particularly problematic in these settings, including:

Impaired communication

Clear communication is a central requirement for effective healthcare. By muffling speech and hiding non-verbal signals, masks significantly impede the efficiency of information sharing, potentially impairing the professional’s understanding of the clinical problem and the patient’s understanding of the recommended therapeutic intervention. Those with hearing impairment (estimated to be about one-in-six of the UK population), who often rely on lip-reading, will suffer the most. Given that the elderly population are frequent users of health services, those impacted by this mask-induced communication problem will be even higher in these settings. And the consequences of muffled speech in hospitals can sometimes be catastrophic.

Increased risk of falls in the elderly

By blocking parts of the lower peripheral visual field, and causing spectacles to steam up, masks will increase the risk of falls in older people with ongoing mobility difficulties. Injuries, such as fractured femurs, are more prevalent in the elderly. Expecting face coverings from this demographic, the most regular visitors to healthcare facilities, can only exacerbate the risk.

Aggravation of respiratory problems

For patients with existing respiratory problems, the requirement to cover their airways with cloth or plastic will often inflict additional distress. Masks can make breathing more difficult, a problem likely to be more apparent after long periods of wear, such as those routinely experienced in hospital Accident and Emergency departments. Furthermore, face coverings can inflate the risk of acquiring pneumonia and other respiratory diseases. One study found for example that as little as four hours of wearing a cloth or plastic mask increased vulnerability to bacterial infection. There are also the largely unknown risks from the inhalation of micro-plastics and the exposure to contaminants in the textiles.

Re-traumatising those with histories of abuse

Another group of people who will be over-represented in healthcare settings are those who have suffered historical sexual and physical abuse. Many of these victims will be re-traumatised by the requirement to wear face masks, from the somatic sensation of material covering the nose and mouth. Simply the sight of masked people can trigger disturbing memories (“flashbacks”) of assault and degradation. To make matters worse, exercising one’s legal right to go without a face covering is likely to attract harassment and victimisation, particularly when in hospitals and other health-related venues.

Exacerbation of existing mental health problems

A disproportionately high number of attendees at hospitals and GP practices will display existing mental health problems. Many people already tormented by recurrent panic attacks, involving catastrophic thoughts of imminent death and feelings of breathlessness, will find masks very difficult to tolerate. Similarly, those suffering obsessive-compulsive fears about the prospect of contamination, or severe health anxieties, will have their emotional difficulties intensified by regular mask wearing. It is a common misconception that a face covering will provide reassurance on the contrary, habitual wearing will prolong their fears. Many people on the autistic spectrum will be distressed by the expectation and (overt and covert) pressure to wear a mask.

Human connection is the bedrock of the healing process

Lamentably, while face coverings are disappearing from many spheres of daily life, they stubbornly remain evident in healthcare settings, where they are evolving into an integral part of the uniform. Doctors, nurses and allied-health professionals are becoming culturally wedded to masks, where — despite the absence of robust evidence to support their infection-control benefits — they identify people as part of the team fighting against a virus, “working together to beat the enemy”. Service users and their relatives are coerced into joining this war by the requirement to wear a face covering, a symbol that distinguishes ally from foe.

This cultural descent into ubiquitous masks in hospitals and health centres is hugely concerning. In addition to the specific harms associated with them, this ideological trend ignores a fundamental tenet: a positive relationship between professional and patient is an essential ingredient of a healing environment (Norcross, 2011). Warmth, empathy, trust and openness — key elements of a therapeutic relationship — are more difficult to demonstrate when access to facial expressions is impeded.

Many psychological therapy sessions are undertaken in hospitals and GP practices, and — throughout the pandemic — these have often been conducted in environments that require both patient and practitioner to wear a mask. Although little research has been done on the impact of COVID-restrictions on the effectiveness of specialist talking therapy, the limited human connection between two faceless people is likely to be especially problematic, compromising the usefulness of these interventions for people struggling with emotional difficulties.

But the therapeutic damage associated with masks is not limited to the realm of specialist psychological interventions. Human connection is the bedrock of the healing process. As a consequence of the often stymied relationships resulting from masked protagonists, service users of all kinds will experience sub-optimal care: the confused, hard-of-hearing elderly person with memory loss; the apprehensive cancer patient receiving test results; the distressed teenager contemplating deliberate self-harm; and the frightened child in acute pain. Humane healthcare, delivered with demonstrable warmth and compassion, will always be more effective than the robotic version delivered by a faceless professional hidden behind a veneer of sterility.

In the words of one enlightened GP, it’s time to “put the patient first again” by ditching the mask in healthcare settings.

Norcross, J.C. [Ed] (2011). Psychotherapy relationships that work. 2nd edition. New York. Oxford University Press

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