Why Some Health Care Workers Refuse To Mask And How We Can Fix It

If you’re in health care, chances are you’ve heard one of these statements: “Masking doesn’t work.” “We’re all going to get COVID, so why mask?” Another is “COVID is just like the flu.” Or you’ve even heard, “Those people who died of COVID would have died from something else anyway.” One would think that these were said by people who don’t work in health care. However, these statements were all made to me by health care professionals. I’m stunned every time a health care worker says any variation of the above. At this point, how can anyone not believe that masking is effective or the seriousness of COVID-19?

Multiple studies have shown the efficacy of masking and how it works to reduce the chances of contracting COVID-19. However, a health care worker’s attitude towards PPE use and masking can greatly affect compliance. A study explored health care worker attitudes towards masking and N-95 use. They found that adherence to wearing appropriate PPE was improved by being aware of hospital policies and having signs outside of patient rooms designating airborne precautions. Additionally, hospital cultures where it was the social norm to wear PPE saw increased compliance as well. The study showed that health care workers’ perceived risk of contracting an airborne virus also depended on the hospital setting. The more respiratory illness cases, the higher the perceived risk to health care workers, which leads to improved compliance. Rural hospitals perceive less risk since they see less volume of these cases, thus increasing infection risk. PPE compliance is worse if the patient doesn’t have a formal diagnosis of an airborne respiratory illness.

I spoke with Sociologist Dr. Matthew Facciani, who specializes in misinformation and political bias regarding other reasons why health care workers may not agree with masking or believe the severity of the pandemic. Facciani states that political affiliation can influence how people view the pandemic. The Pew Research Center found that Republicans are less likely to see COVID-19 as a serious threat. Fivethirtyeight and Pew Research Center saw that Republicans were less concerned about unknowingly spreading COVID-19 to others as well as less worried they will get a COVID-19 infection that will require hospitalization. The Pew Research Center also found that 63 percent of Democrats believe a mask should be worn all the time versus a startling 29 percent of Republicans. Lastly, CBS reports 57 percent of Republicans find the number of COVID-19 deaths acceptable. In contrast, only 10 percent of Democrats founds the number of deaths related to COVID-19 acceptable. Facciani has found through his research that Democrats and Republicans can have the same information presented but can interpret this information differently. If the information is unfavorable towards their political party, they may be apt to discount the information. Likewise, if the information is positive, they are more likely to believe this even if the information presented is inaccurate.

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As of 11/01/20, there have been 9.2 million cases of COVID-19 in the U.S. and 230,703 deaths as per the New York Times. Columbia University estimates that 130,000 to 210,000 COVID-19 deaths may have been preventable. They attribute part of the reason for this disproportionally high amount is lack of masking mandates and masking politicization. Despite a multitude of information saying that COVID-19 is a serious and deadly illness, many even in health care believe the concerns regarding the virus are overblown and that masking doesn’t work. It begets the question, why are there individuals in health care ignoring the data about masking and disease prevention?

Facciani states that intelligent people are especially good at rationalizing and cherry-picking information. The question is, how do we combat this rationalization and have difficult conversations regarding masking and COVID-19 misinformation with our peers. Facciani recommends five steps on how to have productive conversations with those who have different beliefs. Facciani recommends being open to having a conversation with others who have different beliefs than our own as the first step. Having conversations with those with varying beliefs can act to help reduce polarized views.

The second step is to listen with compassion. Be genuinely curious about their beliefs and avoid judgment. Attacking or being judgmental about others’ beliefs can trigger defensiveness causing people to shut down. When we’re defensive, we’re less likely to be receptive to new information. Additionally, beliefs are a result of our identity. When you’re trying to have someone acknowledge that their belief is wrong, you’re asking them to reject their community, which can be an integral part of who they are. Thus, making it unlikely that you will be able to change their mind.

The next part of the conversation should focus on relating to each other and find common ground. An example of this could be working in health care or being parents. Once a connection has been established, we’re more likely to be receptive to hearing out others. An example of this would be, “We’re both in health care, and it’s our job to promote a safe environment to reduce harm to our patients and their families.”

Reframing information is an essential following step. Be sure to word your questions carefully. How information is presented makes a difference. You could ask, “How confident are you that masks don’t work?” Facciani provided the example that if someone is frustrated with lockdown measures and masking, you could say, “Businesses will be able to open sooner, and the economy will improve if we control the infection, social distance, and mask.”

The last and essential part of Facciani’s process is to have repeat these previous steps and continue to have conversations. One conversation is unlikely to make a difference. However, multiple conversations over time can help change people’s minds.

As health care providers, we have a unique opportunity to educate others to reduce the disease burden. These discussions can be difficult to have especially when they’re with those in health care. By using the above steps, we can challenge misinformation and, at the same time, foster relationships with our colleagues as we continue to fight COVID-19.

Kristina Scanlan is a palliative care physician.

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