In reading the comments to the feature article “Will your mask in church save a life?” I feel that some important issues have arisen, both within the article, and amongst persons responding to the article. Bringing these issues to the forefront may clarify some of these disconnects and may help bring a more thoughtful approach to some of the more contentious issues.
The first issue is an apparent disconnect between the role of masks in the general public vs their role in a health care setting, such as a hospital or a medical clinic. Because masks are required in health care settings, many lay persons assume the same importance must hold true for the general population. In fact, the science supporting masks in health care settings is very different from the science supporting masks outside such settings. This distinction has been made in the July 2020 edition of Canadian Family Physician (CFP). The two figures outlining masks for the general public and masks for healthcare workers are attached in PDF. We must bear in mind these differences when commenting on the role of masks in a park, a grocery store or a church for example, versus an operating room or a hospital. Therefore, when reading an article on masks, be it a scientific or an opinion piece, it is important to be aware of the setting described in the article.
According to the CFP, surgical masks appropriately worn by the general public may reduce flu-like illness by 4% over a six-week period, compared to wearing no masks. However, no difference was found in laboratory-confirmed influenza and no protection was found by wearing a surgical mask at home in the presence of a sick household member. Since the protection from wearing a mask is so low in this setting, general health care policy has also recommended hand washing and social distancing to augment the low protection afforded by masks. For these intents and purposes, I shall not delve into the pros and cons for social distancing. Appropriate hand washing is obviously a good thing to do and may afford even greater protection than masks.
Healthcare workers should and do wear masks in a healthcare setting. As a physician, I do wear a mask inside my clinic when I am seeing patients, inside my hospital, or inside a nursing home, but I do not wear one in the park or walking down the street or driving in my car, as I see so many others do. Why? Because there is no need – low risk population, low risk environment, no interpersonal contact, adequate distancing…LOW RISK. One does not need science to justify common sense, but science does justify common sense. If I have symptoms, I do not go to work wearing a mask and I do not go to church, either. I do not go anywhere except a testing centre and I stay home until I get my test results. At this stage, and in this climate, everyone should do this if they have symptoms, not just healthcare workers. It’s the responsible and logical thing to do.
The second issue is an apparent population disconnect. The population in a typical social setting is very different from that in an acute health care setting (such as a hospital) which again, is very different from a long-term care setting (such as a nursing home). People in the general population are generally much healthier than those who are hospitalized in acute care institutions, meaning they are more resistant to disease and better able to overcome it. In turn, the hospital population is very different from the nursing home population, as there are substantial differences between acute illness and chronic disease. Yes, there is some overlap, but in general, there is more acute illness in the acute care hospitals and more chronic disease in the long-term care institutions. People who are ill in both these settings are more vulnerable to acquiring new diseases and more likely to succumb to them, but in different ways.
This may seem obvious but what may be less obvious is how much we err when we extrapolate scientific methods, data or recommendations from one population and apply it to another. For example, in Canada, deaths due to Covid-19 did not affect all populations equally. 81% of Covid-19 related deaths have occurred in long-term care institutions and 19% in the remainder of the population (general society and acute care institutions combined). Again, in Canada, there were no deaths due to Covid-19 in those below 20 years of age when I last checked. In other words, a healthy, community dwelling 75 year-old woman has very different health risks, prognosticating factors and life expectancy compared to a 75 year-old woman living in a nursing home. In addition, they do not share the same risk of contracting or dying from Covid-19.
Therefore, it is important to clearly differentiate which population we are referring to when we debate on the issue of mask wearing. The authors of the article “will your mask in Church save a life?” clearly indicated they were referring to the wearing of masks in a specific social setting – a church – and not in an acute care setting or long-term care setting. The article was also written from the point of view that the mask wearer is asymptomatic – not coughing, sneezing or blowing their nose. In this instance, the chances of saving someone else’s life by wearing a mask when the mask wearer is healthy and well, are very low to none. The problem arises when we must assume the unmasked parishioner is actually in good health and is being honest. If I am a 72 year-old frail woman in church, how can I be sure that the unmasked parishioner is truly asymptomatic? Since there is no such guarantee, I may feel uncomfortable in this instance, and I may feel disappointed that my co-parishioner failed to consider my feelings or my frailty. I may then wear a mask to protect myself (not others in this instance) or I may leave and perhaps not attend church for a long time if I was fearful enough.
This brings me to the third, spiritual issue, which is a faith-based disconnect. On the one hand, there are Orthodox Christians who fear contracting the Covid-19 virus from anything inside our churches, be it a candle, an icon, a pew, a book, and even from the Holy Eucharist. At the other extreme, there are those who maintain that none of these holy objects, can transmit disease if they are approached with reverence, faith and love, because these are all vessels which transmit the grace of God to the faithful.
To the first group, I would say that either we believe the Holy Eucharist is the Body and Blood of Christ, or we do not. It’s that simple. If we do not, we should seek the guidance of a good spiritual father to help us align our faith with the Orthodox phronema (mindset). If we do not wish to do this, then perhaps we are not truly Orthodox in the first place. This may sound harsh, but we first need to be honest with ourselves and then we need to decide the direction we are going to take, for we cannot have it both ways.
To the second group, I would say that if we are Orthodox, and we have this much faith, then let us also have an equal measure of love. What do I mean by this? If masks are mandated by the state, until the courts decide otherwise, there are only two options. We either wear the mask in church to avoid church closures, or we stay home until the situation improves. If masks are not mandated, let us acknowledge that others may feel vulnerable for whatever reason. It may be an age issue, a health issue or it may be a faith issue. Rather than judging, let’s ask permission before we grab, hug and kiss and let’s not question their mask if they are wearing one.
On the other hand, it would also be nice if the worried or fearful parishioners did not judge someone else for kissing an icon or the priest’s hand. Someone who is worried about their health does not have to kiss anything or anyone. At the end of the day, the priest will wash his hands, the church council members will wipe down the icons, and everything will be fine and ready for the next worship service. In other words, let us “bear one another’s burdens, and so fulfill the law of Christ.” (Galatians 6:2)
As God made us all to be different and unique, we do not all fit into the same cookie cutters. Our ages, health status, place of residence, spiritual journeys and personal feelings are all different. Why not give ourselves and each other permission to approach this issue by responsibly choosing for ourselves, with the guidance of a good spiritual father, how we approach our worship as individuals instead of trying to force one another to conform to the same standard? After all, isn’t this what economia is supposed to be for? By economia, I am not referring to the multiple spoons at all, for that is un-Orthodox and an entirely different matter; I am referring to the true meaning of economy – the exercise of a little patience, a little forgiveness, a little tolerance, and a lot of love, while we educate, catechize, support and edify one another in our spiritual growth as true Orthodox Christians.
With much love in Christ,
Irene Polidoulis MD
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Unfortunately the medical justification doesn’t cut it because the fundamental question has not been answered or discussed:
Is wearing a mask in the Church right?
Have the Holy Fathers or Theologians provided justification for or against? Plagues were known at the time of St. Gregory the Great and face coverings have been employed for centuries. Surely there is something to address it in the Church’s History that considers the theological implications.
Once that is addressed then we can move on the whether masks should be worn and at that point the medical/microbiological point of view should be considered.
That said, it’s not about whether or not you can get sick in Church, that is a false science vs religion dialectic, but rather what is best for the care of the soul which is much more important than the body.