Masking and the Self-Inflicted Wounds of Expertise

A broken clock tells the time accurately twice a day, but Donald Trump tells the truth even less often than that. Never on purpose and rarely even by accident. And yet he told an accidental truth recently, one that doesn’t reflect well on him, in saying that some Americans wear masks consistently today because masks have become a symbol of opposition to Trump.

Almost everything that involves the actions of the federal government has been like that since the fall of 2016. What the government does signifies Trump, what it doesn’t do or pointedly refuses to do signifies resistance to his authority. It isn’t instantly true: some policies and actions of the government just continue to signify ordinary operations and the provision of expected services. But the moment Trump becomes even slightly aware of any given policy or action and addresses it even once, the 60-40 divide that now structures two cultural and imaginative sovereignities instantly manifests and the signifiers fall rapidly into Trump’s devouring gravitational pull.

It’s likely true that in any other administration, typical public health discourse about covid-19, including advice on masks, would have been met with some paranoia or resistance, all the more so if masks and the constriction of economic activity were co-identified. It’s also true that Trump is the explosive, catastrophic culmination of thirty years of deliberate Republican subversion of the authority of scientific expertise and the cultivation of the logics of conspiracy theory. Some degree of partisan division in the reaction to various suggestions and orders would have been inevitable even were the President a competent, reasonable adult who believed that the Presidency must at least rhetorically and conceptually be devoted to the leadership of the entire body politic, not an inward-turning constituency of far-right Americans trying to preserve their racial and cultural privileges. No matter what, we would have had a surplus of the sort of fragility, weakness, incoherence and malice that has been on display in public hearings in Florida, California and elsewhere over masking policies. But without Trump, I think that would have been more clearly a fringe sentiment with relatively little weight on the body politic. With him, it is a crushing burden.

But if we hope to eventually emerge from this catastrophic meltdown into a better, more democratic, more just, and more commonsensical nation–perhaps even just into a country that possesses a much larger supply of the adult maturity required to just wear a mask for a year or so in order to safeguard both our own personal health and the health of our fellow citizens, then we have other kinds of work to do as well. One of the major tasks is that experts and educated professionals have got to learn to give up some of their own bad habits. If Republicans have worked to sabotage science and expertise in order to protect their own interests from regulation or constraint, then experts have frequently amplified those ill-meant efforts through their own ineptitude, their own attraction to quack social science and wariness about democratic openness.

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This is an old theme for me at this blog, but the masking debacle provides a fresh example of how deep-seated the problem really is.

The last fifteen years have been replete with examples of how many common assumptions we make about medical therapies, sociological and economic phenomenon, drivers of psychological behavior and experience and much else besides rest on very thin foundations of basic research and on early much-cited work that turns out to be a mixture of conjecture and the manipulation of data. We know much less than we often suppose, and we tend to find that out at very unopportune moments.

In the present moment, for example, it perhaps turns out that we know much less about just how long a virus like covid-19 can be infectious in human respiration, how far it travels, and precisely how much wearing a fabric mask with some form of non-woven filter inside might protect a person who was wearing it properly, in relationship to a variety of atmospheric conditions (indoors, outdoors; strong air movement, little air movement; rapid athletic respiration, ordinary at-rest respiration) etc. There are very legitimate reasons why these are not things we can study well right now in the middle of this situation, and why they are a hard set of variables to measure accurately even when the situation is not urgent.

And yet. It has seemed likely from the very first news of a novel coronavirus spreading rapidly in China that wearing a mask, even a simple fabric or surgical mask, might help slow the spread of the virus and offer some form of protection to the wearer, however humbly or partially so.

The early response of various offices within the US government likely will receive considerable critical attention for the next decade and beyond. Not only did the unspeakably self-centered political imperatives of the Trump Administration intervene at a very early juncture, but also there seems to have been some basic breakdowns in competence and leadership at the CDC and elsewhere.

The question of masks, however, was bungled in a more complicated and diffuse way. It’s now clear that most public health officials and medical experts knew full well from the very first news about covid-19 that even surgical or fabric masks but especially N95 or other rated masks, would provide some measure of personal and collective protection for any wearer. And yet many voices stressed until late March 2020 that masks weren’t useful to the general public, that social isolation was the only effective counter-measure, that no one but medical workers or people in close contact with covid-19 patients should be wearing masks. Why not tell people to wear masks from the outset?

The answer seems to be only very slightly about any degree of uncertainty about the empirical evidence for mask-wearing. What really seems to have driven the reluctance to recommend mask-wearing are three basic propositions:

1) That if the benefits of mask-wearing were acknowledged, this would spur a massive amount of panic buying and hoarding of rated masks, which were after all a commonly available commodity, less for protection against infectious disease and more for protection against inhaling minute particulate matter in woodworking, drywalling and other projects.

2) That the general public would not know how to properly wear any mask, whether a simple fabric mask with non-woven filters or a rated mask, in order to insure actual protection from infection–that the masks only conferred meaningful protection if fitted correctly, if not touched constantly by hands during a period of exposure, if the mask-wearer did not touch their face otherwise, if rigorous hand-washing preceded and followed mask-wearing, and if some form of protective eyewear were also worn–and would hence not receive the expected protection from even non-rated masks.

3) That wearing masks might give people a false sense of security and prompt them to circumvent the more critical and impactful forms of social distancing and isolation that were (accurately) seen as more critical to mitigating the damage of the pandemic.

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There are two basic problems with the line of reasoning embedded in those propositions. The first is that they reflect how profoundly unwilling educated professionals are to speak to democratic publics in a way that notionally imagines them as capable of understanding more complicated procedures and more complicated facts.

I know what you are saying: well, have you watched the YouTube videos of people testifying angrily about masks, in which they appear to be barely capable of understanding how to tie their own shoes, let alone how to deal with a public health emergency like this pandemic? Yes, and yes, those folks are appalling and yes they seem to represent a larger group of Americans.

The problem in part is that their behavior and the public culture of educated professionals have involved in relational tandem to one another–and to be caught up in the expression of and enforcement of social stratification. Because we expect people to be irrational and incapable of understanding, we offer partial explanations, exaggerations and half-true representations of research findings and recommended procedures and justify doing so on the grounds that it is urgent to get the outcomes we need to prevent some greater harm–to get people to behave properly, to get funds allocated, to get policies enacted. But it is not a secret that we are doing so. The news gets out that we amplified early reports of famine in order to get the aid allocated in time to make a difference, that we amplified the impact of one variable in the causation of a complicated social problem because it’s the only one we can meaningfully act upon, and so on. The people we’re trying to nudge or change or move know they’re being nudged. They know it from our affect, they know it from their own fractured understandings of the information flowing around them, they know it because it’s a habit with a long history. So they amplify their resistance in turn, even before the Republicans manipulate them or Donald Trump malevolently encourages them.

And in turn what this does is also commit experts to an increasingly unreal or inaccurate understanding of social outcomes in a way that corrodes their own expertise. The experts start to be vulnerable to manipulation by other experts who provide convenient justifying explanations for nudging or manipulation. “Make the plates half as big and it’s like magic! People eat less, obesity falls, the republic is saved! You don’t have to actually talk to people any more or try to understand them in complex terms!” Most of that thinking rests on junk modelling and Malcolm Gladwell-level simplifications once you peel it back and take a close look.

Even when the causes of behavior are in some sense simple, so many experts look away if it turns out the causes are in the wrong domain or are something they themselves are ideologically forbidden to speak to with any clarity. Take for example the fear of hoarding in the early reluctance to clearly recommend mask usage. It’s true that hoarding was a problem and it’s clear it could have been far worse still had the general public come to believe that owning a package of N95 masks was as important as stocking up on toilet paper or making a sourdough starter.

But what’s the problem there? It’s not in the least bit irrational under our present capitalist dispensation to buy up as much of a commodity that you suspect is about to gain dramatically in value. Buy low, sell high is a commandment under capitalism. In our present crisis, we’ve all felt outrage at the men who fill storage units full of hand sanitizer and PPE and called them hoarders. But they’re just the down-market proles that the nightly news feels comfortable mocking. There’s been just as much up-market hoarding, but there we call it business. The President of the United States has helped fill the troughs for various hogfests with his promotion of hydroxychloroquine and so on, but beyond that, organized profiteering has unfolded on more spectacular and yet sanctified scales.

At whatever scales, if the problem is hoarding rather than altruism in a public health crisis, if the problem is someone pursuing profit instead of saving lives, then name the problem for what it is: capitalism as we know it and live it. That’s not ideology or philosophy, it’s plain empirical fact. It’s fine to say that you are facing a problem whose cause is utterly beyond your capacity to address and beyond your expertise to understand. It is not fine to avoid doing that in order to launder the problem so that it comes out being something you know how to describe and feel you can do something to affect. In this case that “something” is to offer a half-truth (masks aren’t useful) in the thought that it might impede or slow down a basically rational response that threatens your capacity to act in a crisis.

I keep saying that expertise needs to respect and emulate the basic idea of the Hippocratic Oath, most centrally: first, do no harm. It is less harmful to name a problem for what it is, even when you cannot deal with it as such and your expertise does not really extend to it. It is less harmful to tell democratic publics what you know to the extent that you know it than to try and amplify, exaggerate or truncate what you know because you’re sure (with some justification) that they will not understand the full story if you lay it out. I understand the impulses that drive expert engagements with publics, but those impulses, even with the best of intentions, end up fueling a fire that far more malicious actors have been building for decades.