“So we beat on, boats against the current, borne back ceaselessly into the past.” This is the last line of F. Scott Fitzgerald’s classic novel The Great Gatsby. It suggests that it is futile to attempt to move forward, to reach one’s dreams, to make progress. A less depressing interpretation is that the themes of progress are recurrent; that we must always strive to improve; that the battle with entropy is real. Both interpretations can be applied to the events of the last three months. The conflicts of racial injustice continue. Wide divisions of political opinion are older than our republic. Even viral pandemics are not new.
It could also describe the current mask/no mask debate. On one end of the anti-mask spectrum are those who think it is just another government conspiracy to limit freedom and self-identity. On the other are those who are accused of just not caring. It is difficult for me (and probably for most of the readers of this blog) to understand why this seemingly straight forward solution is so problematic and divisive. But, as I have described previously, passion for and against masks leads to entrenched responses and only serves to energize the contrarians. Instead, I suggest we lead any argument by acknowledging strongly held beliefs and unpassionately educate with science and data. It just might undermine the intransigent passion of the facially naked.
While many government organizations are recommending masks, we must not assume that they are immune to promoting bad policy. The CDC website has hospital guidelines that state:
Screen everyone (patients, HCP, visitors) entering the healthcare facility for symptoms consistent with COVID-19 or exposure to others with SARS-CoV-2 infection and ensure they are practicing source control.
The problem here is that the number of symptomatic COVID-19 patients who present with fever varies tremendously but is generally low. And fever in asymptomatic patients, well, by definition, is not present. COVID positive healthcare providers presenting to work most likely will be in the asymptomatic category. Moreover, the logistics and cost of providing temperature screening and/or symptom questions to all employees is unrealistic. The inevitable lines and bottlenecks at hospital employee entries would preclude social distancing and cause delays. Fast, infrared thermometers are generally inaccurate, so even someone reading normal may, in fact, be febrile. The number of employees required to provide surveillance at entry points is a financial burden that cash-strapped systems can’t handle. And, anecdotal reports from those systems that have employed such active screening have identified only a few fevers from among thousands. In short, neither the science nor the cost-benefit analysis justifies this screening practice.
This sort of poor, or perhaps just unrealistic, policy leads to shaking heads, hours of effort trying to create compliance solutions, frustration, and ultimately distrust. Worse, it feeds the passion of the mask naysayers.
Jeffrey G. Chipman, MD, FACS
Frank B. Cerra Professor of Critical Care Surgery
Vice-chair of Education
Division Head, Critical Care and Acute Care Surgery, University of Minnesota
Executive Medical Director, Critical Care Domain, M Health Fairview