The SARS-CoV-2 pandemic is placing limitations on the global supply of medical grade PPE. In a previous blog, I discussed some moral responsibilities of the public during a public health emergency. One of the points, about the appropriate use of face masks by the public, is causing a lot of confusion due to updates the CDC recently made to its recommendations.
Current CDC recommendations state the public should wear a “cloth face covering in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies)”.
Previous recommendations that asymptomatic people (i.e. the general public) should not wear medical masks have not changed. Healthy people should not be using medical masks unless they are caring for a person with (or suspected to have) COVID-19. Symptomatic people, whether diagnosed or not, should be self-isolating to avoid spreading the virus to others.
In light of this new recommendation, the aim of this blog is to examine some ethical and practical concerns it raises.
Rational use of resources—most importantly, the public should not be buying N95 or surgical masks. All medical grade equipment should be directed to those caring for people who are ill. Hospital administrators and medical providers are having to make difficult decisions regarding the ethical allocation of scare medical resources. It is obvious that when those resources include ventilators the decisions made are a matter of life or death. More covert are the implications imposed by limitations on the supply of PPE. Hospitals are forced to consider extreme situations such as universal do-not-resuscitate orders for patients with COVID-19 if there is a lack of PPE to ensure protection of healthcare providers. The misuse of PPE during a pandemic can exacerbate shortages and lead to increases in mortality rates as hospitals are forced to move toward activation of triage protocols as scarcities increase.
Justice and equality—wearing homemade face coverings or handkerchiefs, when entering a grocery store or pharmacy, do not carry the same associations for everyone. Some black men, given prevalent racial stereotypes and profiling present in US society, have raised concerns about following this recommendation. Combining these concerns with the health disparities that Black Americans already face and the disproportionate rates in which they are dying from COVID-19, represent ethically troublesome implications of the CDC’s recommendation.
Education—improper use of cloth face coverings can lead to increased exposure and/or a false sense of security. I have personally witnessed all of the don’ts, by both customers and grocery/pharmacy personnel, depicted in this NYT article of how NOT to wear a mask during my limited outings to obtain groceries and medications. Failure to properly educate the public could be putting more people at risk who do not understand or do not have access to obtaining appropriate education regarding the donning, doffing, and washing of a cloth face covering.
Trust—implementation of recommendations that seem to counter previous advice, or the advice of other global agencies, without ensuring transparency of the change, erodes the public trust as well as the authority of that agency. Recommendations that do not have the full support of the country’s leaders sends mixed messages to the public, further reducing trust.
Wash your hands— do not let wearing a face covering give you a false sense of security. The best way to prevent the spread of this and other viruses is still proper hand hygiene. The limited protection that public wearing of a cloth face covering provides only works in combination with hand washing and social distancing.
During this unprecedented time, recommendations by government agencies ought to follow strict ethical and practical frameworks. The nation cannot afford the spread of misinformation nor the implementation of ethically questionable recommendations. Erosion of trust, justice, and equality will have a lasting effect on our nation moving forward.
The views expressed in this content represent the perspective and opinions of the author and may or may not represent the position of Indiana University School of Medicine.
Graduate Assistant, IUSM Center for Bioethics
Heather is currently pursuing a graduate degree of bioethics at IUPUI. She is also a GA in the IUSM Center for Bioethics and the Brand Fellowship for Bioethics recipients for 2019-20.