Cancer, COVID-19 and Mask Wearing

Have you thought about how frequently ads for face masks pop up when you are online? If anyone had suggested this to you last year, you would have laughed. I don't think I had ever seen an ad for a face mask, and certainly would not have listed their manufacture as a booming part of the economy.

Back in April, which feels like decades ago, masks were as hard to come by as toilet paper and hand sanitizer. A friend told me about a friend of hers who was making some, and I was lucky to be able to buy a few. We had a couple of paper surgical masks that we used and reused, and I wished that I had even minimal sewing skills in order to make my own.

Now we all have a collection of them: some to wear while exercising, some to wear at the market, maybe one to wear when socially-distancing in a friend's yard. Honestly, I don't much like any of mine and often ask others for recommendations. It is hard to imagine wearing one without discomfort and fogged glasses for hours at a time, and I am full of admiration for all the people who are required to do so.

When I speak with my patients, the topic of mask wearing often comes up. Sometimes, but not too frequently, I hear about the association of masks and illness. We may have fuzzy memories of seeing masked doctors and nurses as we were wheeled into surgery, and some cancer patients regularly wear masks during recovery from a bone marrow transplant or other times when their blood counts are dangerously low. I am working now with two people who had successful bone marrow transplants in the past, and they both have described flashbacks to those months whenever they must wear a mask.

For most of us, the mask conversation is related to the etiquette and the risks. One of the really hard parts about living with the pandemic is how much is unknown, how the information keeps changing, and the recommendations often shift. It is now widely accepted that wearing masks protects the other person and may also protect the wearer.

It is unfortunate that politics has contaminated this public health discussion. Let us agree to accept the bottom line that, as cancer patients or people in recovery or as cancer survivors, we feel more vulnerable and are probably hyper-aware of the need to protect our health. I have one patient, a young woman with metastatic breast cancer, who has said she wishes that she could wear a t-shirt or hand out cards that say: You're not wearing a mask could kill me. Even if we don't feel that scared or angry about it, most of us react when we see others who are not following the rules.

And What Exactly Are the Rules for Wearing Masks?

Although the rules may change as time passes or depending on where you live, essentially you should continue to wear masks inside public spaces and outside when you can't be at least six feet distant from others.

What about walking the dog? Do you wear the mask all the time or just when passing someone? What about when riding a bike or jogging? What about going to a friend's home for an outside cocktail hour or picnic? You clearly have to remove the mask to eat or drink, but should you put it back between bites? And, while you are at your friend's house, are you allowed to go inside to use the bathroom? If so, do you put the mask on then?

From awkward experience, I have learned that it is important to have this conversation with friends before getting together. We all have different ideas about risk and risk tolerance, and it is much better to hear about them in advance. For example, I am comfortable cooking for others and just exercising care when serving, but some people are only comfortable bringing their own food and utensils and beverages. We are all desperate to be together with our friends, and we certainly want to avoid extra tension or distress. Bring it up at the same time that an invitation is being offered or accepted.

One friend described a strategy that she finds helpful. Acknowledging that there is absolutely no science involved in this, she imagines her risk as being similar to a bank account. That is, she has X amount of available risk. When a situation comes up that may not be 100% safe, she things about whether it is worth making a risk withdrawal. Again, this does not at all reflect factual thinking about risk. But it does encourage her to think about the possibility and make a thoughtful decision whether having a haircut or having lunch with a friend is worth the possible risk and discomfort. Some things are worth it, and most, she decides, are not.