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Why Some People Choose Not to Wear a Mask

From feeling uncool to believing masks are an exercise in compliance, there are many reasons why a minority of people oppose masks while a respiratory virus kills hundreds of thousands of people worldwide

Most people wear a mask as part of their pandemic-altered routine. That’s 83% of Canadians and 67% of Americans by recent estimates. But there is a minority of people who don’t, and their voices and protestations are getting louder. Pushback against the simple face covering often hides many bones of contention.

The people against masks and their mandates make up a varied group. Studies in different countries are highlighting interesting trends within this movement. In Canada, it was people who supported the Bloc Québécois, a federal political party dedicated to promoting Quebec nationalism and sovereignty, who initially lagged behind the adoption of masks at the beginning of the pandemic, but it is now supporters of the Conservative party who, on average, tend to leave masks behind in larger numbers as time goes on. In the United States, imperfect surveys report that people who lean Democrat tend to favour the wearing of masks much more so than those who lean Republican. Researchers observing shoppers in the state of Wisconsin coming and going out of stores noticed that, on average, shoppers who looked like women and those who looked like older adults were more likely to be seen wearing a mask, but this imbalance disappeared when a mask mandate was enacted. Are women and older adults, in general, more likely to adopt protective measures during a pandemic? The literature on the SARS and H1N1 outbreaks is not conclusive on the subject, but many studies did indeed notice a trend, with elderly people, women, more educated individuals, and non-Whites being more likely to wear a mask and wash their hands. Again, these are trends: some women do not wear masks and many conservatives do.

I have seen a fire hose of arguments against the wearing of a mask during the pandemic, but I think these rationalizations can be sorted into five categories. The first has to do with “medical issues.” Some people complain their health condition makes it impossible for them to wear a mask. The Canadian Thoracic Society released a statement that unambiguously debunked the claim that wearing an ordinary face mask would cause a flare-up of an underlying lung condition but that also recommended that individuals who can’t tolerate wearing a mask avoid or minimize situations where they can’t physically distance. Similar recommendations were issued by Asthma Canada. While an N95 mask, which creates a tight seal around the nose and mouth, can make it hard to breathe for people with obstructive lung disease, this should not be the case with surgical masks and face coverings. The Quebec government recognizes that there are genuine exceptions to the mask requirement: people with physical disabilities making it impossible to put on or remove a mask by themselves, people with severe skin conditions aggravated by face coverings, people with facial deformities, and people who cannot understand the requirement or for whom wearing a mask causes significant distress.

The second category relates to people disliking how wearing a mask makes them feel. A study (which has not been peer reviewed yet but which looks methodologically sound) reported that, out of the more than 2,500 surveyed people living in the United States, men more often than women said they felt negative emotions while wearing a face covering, like feeling weak or not cool, although the difference between the genders was not massive. The solution to this line of thinking is unlikely to be shaming, though. Moralistic HIV-prevention campaigns of the past rarely achieved their goal. What we need is to show ways for the people who experience these negative emotions to preserve their values while wearing a mask. Masks with messages like “this mask is as useless as the governor” or “freedom doesn’t look like this” may look silly to many of us, but if they get the job done, I’m not sure there’s reason to complain.

The third category of anti-mask arguments is a pernicious one: distorting the science. A common justification is that COVID-19 is simply no worse than the flu; this is clearly not true. Some anti-mask protesters have even said that masks impair breathing (a claim debunked by many physicians on social media) and that they breed illness, a bad argument that at least goes back to the 1918 San Francisco Anti-Mask League. A letter to the San Francisco Chronicle at the time complained that residents, who had to protect themselves from a pandemic strain of the flu, were being told “to wear masks and breathe foul air.” The solution often brought up, then as of now, is sunshine and nature, and while it is true that you are less likely to catch a respiratory virus while outside, immune systems don’t turn into magical fortresses when exposed to the Sun. Some anti-maskers even go so far as blaming people who got sick on their unhealthy behaviour, as if eating right and spending time outdoors are guarantees of a life free of viral infections. Many pseudoscientific arguments made to denounce the wearing of masks rely on motivated reasoning, this spell our brain falls under when it starts with a conclusion it likes and sorts through information to find supporting data.

Reasoning can be motivated by the belief that personal freedom is paramount, the fourth category of arguments. Some people claim not to be against masks per se but against governments (and sometimes businesses) mandating their adoption. It’s always funny to me that these same people presumably stop at red lights and stick to the right lane when driving but a new, freedom-eroding mandate during their lifetime is their back-breaking straw. It may boil down to a concept known as “reactance,” which is a knee-jerk reaction we all have, to varying degrees, when we feel our freedom is being limited. Waving the flag for freedom has become very popular with another reactionary group, the anti-vaccination movement.

Many conversations with anti-maskers as reported by journalists seem to devolve into the fifth and deepest category of arguments: that this is all part of a government conspiracy. Some outspoken anti-maskers believe this is just an exercise in compliance, with some erroneously claiming that Bill Gates is behind this entire pandemic. A recent French survey of 800 members of anti-mask Facebook groups conducted by Antoine Bristielle, a doctorate student at the French school Sciences Po Grenoble, is particularly alarming. He found that 52% of those surveyed said they believed in a global Zionist plot, an antisemitic conspiracy theory, compared to 22% of the general French population. These Facebook group members were also twice as likely as the general population to believe in the Great Replacement narrative, the far-right conspiracy theory that white people in Europe are being driven to extinction and replaced by immigrants. Grand conspiracy theories have always been with us but they tend to draw in more adherents in periods of great social anxiety, and a pandemic certainly qualifies as such.

So how do we get mask resisters to cover their nose and mouth in the middle of a serious public health crisis? There is no magic bullet. Shaming, as much as it can make us feel righteous, can backfire. Mask mandates seem to work well. Leading by example can be powerful. If I’m a conservative man who feels foolish wearing a mask, seeing other conservative men putting on a mask may encourage me to do so as well, which is why Trump publicly tweeting that masks have been called “patriotic” can be compelling to his followers. Making a variety of masks easily available can also help with uptake by removing one barrier to adoption. As for public figures and organizations spreading anti-mask propaganda, they must be publicly criticized, their statistics shown to be misleading and their bad logic exposed. Their harmful deception must be unmasked.

For those who want to delve deeper into “Fact-checking specific claims made about masks", click here

A flyer spreading misinformation about masks and COVID-19 is being distributed by unknown people in Montreal. It reads like a fire hose of false claims and deceptive statistics, a technique that lends credibility to pseudoscience and makes the work of tracking down and refuting all of these claims very time consuming. I decided to address the main anti-mask arguments listed in this flyer.

Claim: Experts say masks may interfere with normal breathing. It’s always possible to find the odd duck who goes against the grain for personal or political reasons, but no reasonable healthcare professional would argue that regular masks impair breathing. Surgeons and their staff regularly wear masks for hours on end with no impact on their oxygen levels. Medical masks filter out large particles like water droplets, but not tiny oxygen molecules. Some have argued that trapped moisture from the breath will make it harder to breathe through the mask, but this has been tested using N95 masks, which are much tighter around the nose and mouth than regular medical masks, and the researchers concluded that it was “unlikely that exhaled moisture will add significantly to the breathing resistance” of these masks after wearing them nonstop for four hours.

Claim: Masks can infect you by storing moisture. A wet mask will likely not work well as a barrier against microbes, which is why it should be discarded when wet, or washed and left to dry if reusable, as public health agencies recommend.

Claim: Masks can compromise your immune system. False. Our immune system is an incredibly rich and complex interplay of cells and chemical signals. Wearing a mask to go shopping has no impact on this system.

Claim: Masks can become contaminated from repeated use or misuse. This is true. But misusing a condom can also have serious consequences: this is not an argument against recommending their proper use.

Take-home message:
- Even though people who don’t wear a mask during the COVID-19 pandemic tend to be younger, to be men, and to lean conservative politically, their group is actually quite diverse
- The justifications used for not wearing a mask usually fit into five categories: claiming medical issues, experiencing negative feelings while wearing a mask, distorting the science, affirming personal freedom, and alleging that mask-wearing is part of a government conspiracy to tame the population
- Solutions include mask mandates, leading by example, making masks widely available, avoiding shaming, and pushing back against blatant mask misinformation


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