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Shoppers are suing over mandatory mask rules, but doctors don’t buy it

With coronavirus cases spiking across the US, public health officials are urging the population to wear masks in all public areas, a simple measure that could limit the spread of the disease. But while 20 states now have some kind of mask requirement in place, the new rules have been difficult to enforce. Police departments in Ohio and Texas have refused to enforce statewide mandates, and West Virginia’s mask rule leaves enforcement up to businesses, which are often paralyzed by the bizarre politics of the issue.

A minority of the population simply refuses to wear masks and often causes a scene when confronted about it — as countless viral videos have shown. The result is a strange stalemate, with some state and local governments gun shy about the politics of mask mandates and businesses ill-prepared to police the public health practices of their customers. Now, that fight is spilling into court, as anti-mask activists publicly challenge stores’ right to force them to cover their faces.

So far, legal challenges to mask ordinances have had mixed outcomes: a Florida man unsuccessfully tried to claim the local mask requirement was a privacy violation. A group of citizens in Washington state filed a lawsuit claiming Gov. Jay Inslee’s mask rule is a “violation of their freedom of conscience” and thus unconstitutional. But a judge in Louisiana granted a temporary restraining order to a group of businesses in Shreveport, which prevents authorities from enforcing the mayor’s mask requirement there.

In one of the most prominent cases, more than 30 people have filed lawsuits against Pittsburgh-based grocery chain Giant Eagle for its no-exceptions face mask policy, which requires all customers and staff in its Pennsylvania stores to wear face coverings. (Pennsylvania Gov. Tom Wolf issued a mask order on July 1st, although it includes an exception for medical issues.) The shoppers are seeking an injunction that would force Giant Eagle to waive its policy for people with certain medical conditions, saying the grocer’s policy constitutes a violation of the Americans with Disabilities Act.

Company spokesman Dick Roberts told The Pittsburgh Post-Gazette last month that Giant Eagle believes the lawsuits “have no merit,” adding that the grocer has options for guests who don’t want to wear masks, such as curbside pickup, delivery service, and having a staff member shop for them. Neither attorneys representing the shoppers nor attorneys representing Giant Eagle responded to requests for comment.

Medical experts say that there are very few valid medical or psychiatric reasons for someone to not wear a mask. And they’re growing weary of the vague guidance from well-meaning public officials whose open-ended directives leave room for confusion.

Sally Wenzel, the director of the University of Pittsburgh Asthma Institute at UPMC and chair of the Department of Environmental and Occupational Health at the University of Pittsburgh Graduate School of Public Health, says for the standard face coverings most people are using, there’s only a tiny percentage of patients who would not be able to safely wear them.

“I see asthma patients twice a week, and I have yet to have a single patient come in not wearing a mask,” Wenzel said. “They want to wear masks. They want other people to wear masks. One asthma patient complained to me, ‘If I can wear a mask, why can’t everyone else?’”

There’s one caveat: Wenzel says that N95 face masks, the type used by medical professionals which fit snugly on the face, could pose breathing difficulties for some patients with obstructive lung diseases because of how the masks fit and how thick the mesh lining is. But most people aren’t using these masks during a trip to the grocery store, she notes.

Wenzel advises that if a patient’s asthma is so severe that a standard cloth mask prevents them from breathing properly — which she says only includes about 1 percent of asthma patients — then they should be staying home anyway since the risk of them developing severe COVID-19 symptoms may be higher.

The United Food and Commercial Workers International Union is calling for elected officials to “pull their heads out of the sand and make masks mandatory in all 50 states.” The union, which represents 1.3 million food and retail workers, teamed up with health experts in an open letter to governors, Congress, and the Trump administration to urge for a nationwide mask law.

“Without immediate action, these brave workers will continue to get sick and die,” UFCW international president Marc Perrone said in a statement. “Masks are the most powerful tool we have to stop the spread of COVID-19 and keep both workers and shoppers safe.”

There are also few psychiatric conditions that would make wearing a mask harmful, according to Robert Hudak, a psychiatrist at UPMC Western Psychiatric Hospital. He said there are so few people who have a condition that prevents them from wearing a mask that it’s not worth writing exemptions into law.

“I treat lots of doctors and nurses who have anxiety disorders, and who wear masks all the time, and literally no one has ever said ‘I feel afraid wearing a mask in the operating room,’” Hudak said. For patients with panic disorders, he says the issue of mask-wearing just doesn’t come up, he added. “If we all had to breathe through snorkels, that would be a potential issue for someone with an anxiety disorder,” Hudak said. “But mask-wearing is not a trigger for panic attacks.”

He added that the only patients he and his staff may recommend shouldn’t wear face masks are those with profound intellectual disabilities, including those who are non-verbal and have pica, a disorder where people eat items that are not food. “With this type of condition patients will eat anything, pens, paper clips” and could be at risk for trying to eat a face mask as well.

Hudak said the vague guidance from health departments has been largely unhelpful. “It’s incredibly frustrating,” he said. “From the policy side, when they put these ‘exemptions’ in, it’s almost as if they’re trying to be understanding of people but not basing it on any kind of clinical or scientific reasoning. I don’t like to see people mischaracterize anxiety disorders, because it confuses the populace and does a disservice to patients to say people with excessive anxiety can’t wear a mask.”

For people with autism, who can have difficulty processing sensory information and who often find routine to be reassuring, wearing masks could pose challenges and cause discomfort, said Ryan Cramer with UPMC’s Theiss Early Autism Program. But there’s no one-size-fits-all approach. “When we talk about masking, a lot of it has to do with individual response,” Cramer said. “One danger is to make a blanket exclusionary criteria, because there’s a lot of work that goes into preparing and desensitizing someone to stimuli like wearing a mask and maintaining social distance.”

He said, often, it’s more effective to provide visual explanations to people with autism since they can have a tough time processing verbal information. Easing into wearing a mask for short periods of time and reinforcing the experience, like offering a Spider-Man mask instead of a plain one, could help reduce the anxiety for some people with autism.

“Even for those of us who are neurotypical, we may be wearing a mask for the first time ever,” Cramer said. For people with autism, the goal is to help them navigate the new experience to help them wear the mask so they can be out and about and not limited, he added.

Wenzel said there’s no reason anyone without a mask should be in a grocery store like Giant Eagle. “If you have a medical condition, go home, take care of your medical condition,” she said, and use one of the other grocery shopping options. “Masks are not confirmed to help protect us, they’re confirmed to protect others. This has to be a socially wide process where everyone is wearing a mask, not just selective people.”

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