Secondary Gain

As you may imagine, we have difficulty with some patients wearing masks, because well, they are not in their best mind at the moment and don’t always think well even when they mean well.  Unsurprisingly, those are also the patients we have the hardest time getting to remember handwashing and hand sanitizer.  I wondered if that is true of the population in general, just more visible in a psychiatric population.  Are the people who don’t wear masks also the people who wash their hands less?  The latter is much more important.  Some say that mask-wearing was never that important, but I think even the most skeptical are still pro-handwashing. On an individual basis, that would make intuitive sense.  The people who are really cautious by nature were likely already more germ-conscious, but even if this is a temporary phenomenon for others, the ones who mask are likely to be more careful about washing and distancing.  The people who think it’s all a crock and there isn’t much danger and don’t mask would be less likely to have increased their hand-washing and hand-sanitiser above previous levels. Whether they were careful or not careful before is unknown and I wouldn’t jump to conclusions about it. I do have to suspect that on average this would be a group that already washed its hands less, but whether that was generally true or mostly the result of a terrible subgroup that brought the average down I wouldn’t guess. 

  

This would be an unsurprising result, but look what it immediately leads to.  If the mask-avoiders are also avoiding enhanced washing, then the cautious will stay away from them.  They have provided an unintentional signal to the rest of us. I don't pay much attention to this stuff. Or, I'm pretty sure I'm not in much danger and don't have it, so you probably aren't in any danger from me. Or, I wasn't really thinking about safety and illness and social norms when I left the house this morning, or I want others to know I am a brave person, not a timid one who can be told what to do by the government. I'm essentially a teenager masquerading as a libertarian. Or worst of all, I want to announce how ridiculous the rest of you are, and shove it in your faces. I have seen such comments at sites I know many of you go to, and I have talked to such people at work and on my walks.  If that seems harsh, at least know that I am not making this up.  Real people.

Next, does mask-wearing provide any reminder to wash more often or be cautious not to crowd others?  Does it cue us overall to take things more seriously?  I don’t know this to be true, but I have an interesting parallel.  When I fast and pray, I don’t pray more often because of good intentions.  I pray more often because I feel a pang of hunger and go “Oh, right.  I’m fasting in order to pray more.  Guess I’ll pray now.”  It would be an interesting set of experiments to see whether wearing a mask ourselves or seeing other people wearing masks, or both, or neither, caused us to wash our hands more often, or remember to stand back a little farther.  Masks have limited primary value, though it can be cumulative if everyone in an environment is wearing good ones properly.  Whether they have secondary value is an interesting question.  That might provide some explanation why some countries that have lots of masking have low infection rates, even though each individual mask isn’t much help.  It reminds everyone to wash and distance, which are more important.  If this is true, I’d like to find a reminder that is less uncomfortable, thanks. I do about 5 out of about 7.5 hours with a mask when I’m at work, and it sucks.

I want to stress this is a maybe.  It’s plausible, but I don’t have anything to back it up.