One of the more depressing aspects of the COVID-19 pandemic has been the way that it has revealed just how politicized public health has become, including fights over relatively benign requirements such as wearing a mask in public buildings. The politicization of public health mandates is not new (nothing involving public policy can escape some degree of politics), but what is unprecedented is the level of politicization we are seeing now, including the Americans With Disabilities Act (ADA, as you will see. Indeed, I first noted this a few years back when it became apparent that school vaccine mandates were becoming increasingly politicized as a result of antivaxxers’ successful messaging to the right wing by portraying school vaccine mandates as government overreach and an assault on “parental rights” and “health freedom”. Indeed, by 2015 and the second Republican Presidential Debate, several GOP candidates were blatantly pandering to the antivaccine movement by expressing support for “parental rights” and support for widely applied “personal belief exemptions” to school vaccine mandates. It wasn’t long before several powerful right wing antivaccine groups, such as Texans for Vaccine Choice and Michigan for Vaccine Choice were wielding considerable influence in Republican Primaries at the local level in some states, which saw a significant number of antivaccine legislators elected and working to block any attempt to eliminate nonmedical exemptions to school vaccine mandates.
I suppose that I shouldn’t be surprised, then (although I am a little bit) that the same politicization has infected the response to COVID-19, in particular, the discussion over whether mandates requiring mask wearing as a strategy to slow the spread of coronavirus. I will also admit that my knowledge of history was a little lacking, as I did not know that during the 1918 influenza pandemic there was resistance to mask wearing and that there was even an Anti-Mask League (also dubbed the “Sanitary Spartacans“) formed in 1919 in San Francisco. History repeats, only more intensely than 100 years ago. Also, there wasn’t the Americans With Disabilities Act (ADA) for antimaskers to abuse then, as there is now.
Given that I’ve recently discussed the evidence in favor of wearing facemasks in order to slow the spread of coronavirus and that Steve Novella updated that evidence last week, I’m more interested in looking at the myths that those opposing masks have cited in order to claim that, not only do masks not stop transmission of COVID-19, but that they cause harm. The evidence is now pretty strong and getting stronger that the use of facemasks decreases the risk of transmitting COVID-19, including a recent study suggesting that countries that mandated facemask use early have done better in the pandemic. There will never be a randomized controlled clinical trial of this (indeed, given what we know, it’s unlikely that such a trial would now be ethical, given the lack of clinical equipoise), but observational evidence has become more convincing. And, yes, it is true that public health officials shot themselves in the foot, messaging-wise, with mixed messages, starting out discouraging facemask use, only to do an about-face and support the use of masks. Indeed, as I discussed last time, anti-mask advocates recently weaponized the World Health Organization’s initial recommendation not to wear a mask unless you’re sick or around sick people.
Let’s start with one lie in particular that antimask advocates have been peddling (and are still peddling) to try to trick store and restaurant owners into thinking that the ADA says that they don’t have to wear a mask. For instance, take a look at this woman ranting in Trader Joes in the video in this Tweet that she has a “medical condition” that makes it impossible for her to wear a facemask:
This is a common claim, so common that you might have seen this card that mask refusers have been spreading around social media and that some of them have been using to try to trick shop and restaurant owners into believing that they have a legitimate medical condition that precludes mask use. (Of course, I couldn’t help but note that the Trader Joe’s woman didn’t have any noticeable respiratory issues, given how loud and long she could yell.)
Here is the card:
Superficially the card appears official (although official cards issued by the federal government usually have better design and lamination), but in reality it’s the sort of thing anyone with a color printer and a laminating machine could produce. Moreover, the “Freedom to Breath Agency” is most definitely not a government agency. As this news story notes:
The card looks semi-legitimate, especially if the person showing the card has a laminating machine – but it’s absolutely unofficial an unenforceable in any legal capacity. As noted by the Department of Justice, the card may include a message suggesting that exemption from face mask rules is allowed because of the Americans with Disabilities Act (ADA) – but it’s all a sham.
It turns out that the person who originated this card is someone named Lenka Koloma, who publishes claims like this about COVID-19:
Virus is created in each and every living organism at any given time. Virus is a way how [sic] your cells cleanse themselves of toxic material that has been absorbed from an external environment. This a wonderful, natural process of your body’s intelligence for self-preserving functions.
Virus is produced when your body is exposed to any unfavorable conditions that create stress on your system. Such stressors are:
1/ Environmental toxins – smoking, alcohol, processed food, industrial chemicals (BPA, PCB, fluoride, parabens, aluminum, lead, mercury and the remaining 80,000+ chemicals in our world)
3/ Emotional Stress (such as fear of disease and/or death)
4/ Physical Injury
5/ Ionized Radiation
6/ Electromagnetic Radiation ( such as 5G)
Longtime readers will likely find the claim that the body produces viruses in response to various stressors to be a familiar one. It’s the sort of thing that Robert O. Young, a cancer quack and germ theory denialist, used to claim all the time. You might recall that he was finally arrested and convicted after many years of selling snake oil to desperate cancer patients and that he lost a $105 million lawsuit by a woman whose breast cancer progressed under his treatment. Indeed, Young used to like to claim that viruses were “molecular acids“:
The point being that viruses are molecular liquids or gases (venom) that can be created by chemical imbalances in humans, plants and animals (by malnutrition or toxic acidic food and/or drink consumption), also created in humans, plants and animal glands, sometimes used in defense (snake venom) or emergency (overactive adrenals), also can be crystallized in laboratories, rarely, if ever crystallized in vivo, and foolish to call viruses contagious when viruses are nothing more than acidic liquids or gases from biological transformation or rotting matter.
It’s funny how germ theory denialism of this sort permeates so much of alternative medicine. That’s why it’s not surprising that germ theory denial is coupled with denial of the efficacy of masks. In any event, the US Attorney’s Office for the Middle District of North Carolina issued a denial:
The Department of Justice also warned people:
The Department of Justice has been made aware of postings or flyers on the internet regarding the Americans with Disabilities Act (ADA) and the use of face masks due to the COVID-19 pandemic, many of which include the Department of Justice’s seal.
These postings were not issued by the Department and are not endorsed by the Department.
The Department urges the public not to rely on the information contained in these postings and to visit ADA.gov for ADA information issued by the Department.
Nor was the above card the only example of such fraudulent “medical exemption” cards:
And, meanwhile, various right wing groups are trying to weaponize the ADA against stores enforcing mask wearing:
This incident goes to show how far anti-mask activists will go to try to misuse and abuse a law for their own purpose. Of course, the ADA does not mean that business owners must allow maskless people into their buildings, particularly during a pandemic and even more so when there is a lawful order from the governor for shopkeepers to require masks:
If a person with a disability is not able to wear a face mask, state and local government agencies and private businesses must consider reasonable modifications to a face mask policy so that the person with the disability can participate in, or benefit from, the programs offered or goods and services that are provided. A reasonable modification means changing policies, practices, and procedures, if needed, to provide goods, services, facilities, privileges, advantages, or accommodations to an individual with a disability. The requirement to modify a policy, practice, or procedure does not include individuals without disabilities, as they are not protected under the ADA.
Examples of reasonable modifications to a face mask policy
- Allow a person to wear a scarf, loose face covering, or full face shield instead of a face mask;
- Allow customers to order online with curbside pick-up or no contact delivery in a timely manner;
- Allow customers to order by phone with curb-side pick-up or no contact delivery in a timely manner;
- Allow a person to wait in a car for an appointment and enter the building when called or texted; or
- Offer appointments by telephone or video calls.
During a pandemic, it’s not too hard to see how that last one could apply to those refusing to wear a mask. As for legitimate medical reasons not to wear a mask, contrary to what the anti-mask brigade will claim, the list is quite short:
- People with severe (not mild) respiratory ailments, such as asthma, chronic obstructive pulmonary disease (COPD), or cystic fibrosis.
- People with post-traumatic stress disorder, severe anxiety, or claustrophobia, for whom masks can cause severe anxiety or even fear.
- Some people with autism, who are sensitive to touch and texture and for whom covering the nose and mouth with fabric can cause sensory overload, feelings of panic, and extreme anxiety.
- Persons who have extreme difficulty putting on and removing a mask without assistance.
That’s really about it, and even many of these people can learn to function with a mask. Personally, my favorite response to this mask exemption card would be this brilliant riposte:
Sadly, facemasks have become yet one more flashpoint, one more symbol, in the culture wars, and it doesn’t help that President Trump himself recently explicitly said that some Americans wear facemasks not as a means of preventing the spread of COVID-19 but rather “to signal disapproval” of him and that so many are portraying wearing masks as somehow unmanly, leading one columnist to lament that it’s “worrisome that, in order for us to survive as a species, spouses and daughters or sons must scour Etsy for Venom-themed masks so that their 52-year-old packaging-engineer husbands and fathers can feel gender-secure when they pop out to Safeway for some milk.” Indeed, over on his own blog, our fearless leader discussed the facemask war that has erupted around the country. Seemingly every day, I come across videos of people ranting and spewing misinformation against masks while they refuse to wear one:
You’ll find ugly (and sometimes racist) memes implying that mask wearing is cowardly:
Or that mask wearing is a sign of emasculation or submission:
Or that mask wearing is about control, not public health:
Mandates to wear masks to slow the spread of COVID-19 have even been likened to the masks that slaves were sometimes forced to wear:
And then I saw this:
I can’t even. First, antivaxxers appropriated the yellow Star of David; now antimaskers. Sadly, it makes sense, given how frequently they are the same people.