All quotes, at the author's discretion, have been subject to spelling/clarity edits, most frequently pertaining to the expansion of texting shortcuts (e.g., “bc” to “because”), and correcting misspelling when it would lead to significant confusion. If you find yourself prone to medical anxiety, I encourage you to not read this article on the basis of extensive discussion of post-acute risk.
It has been 994 days, at the time of writing this article, since the World Health Organization declared coronavirus (alternatively known as SARS-CoV-2 or COVID-19) a global pandemic. In those 994 days, we have seen numerous prominent mutations of the virus (variants Omicron, Epsilon, Alpha, Eta, Theta, Kappa, Zeta, Mux, Lambda, Beta, and Gamma). Six million, six hundred and twelve thousand, nine hundred and seventy (6,612,970) people have died because of the virus, with tens of millions having contracted the virus (excluding reinfection or non-documented infections), subjecting themselves to what may be years of complications, if not the development of serious chronic or long-term illnesses. Massachusetts is still deemed as having “substantial” transmission rates, and 93.3% of Americans live in areas with substantial—or higher—transmission. “Subjecting themselves” sounds as though they’ve been proactive in contracting the disease. “Leaving them vulnerable to…” maybe?
With my prior knowledge of COVID and post-acute COVID affirmed and expanded by the more intensive research I have done for this piece, wearing a mask seemed not only intuitive, but imperative. And yet, the question, “Why do you still mask?” is frequently posed to me. I have my rationale, but I set out to pose that question, and its inverse, to students at Needham High. I reached out to students I knew personally, who were opting to continue wearing masks, and posted to my Instagram a box where students could submit abbreviated explanations of their choices.
Why aren’t NHS students masking?
While my research and surveying mostly concerned why people do mask, some insights from those not wearing masks clarify the reasoning of that decision. Some responses were from people who suggested they might wear masks in certain situations (e.g., if they felt sick), and some were from people who have fluctuated in their masking habits. One respondent said that they choose not to mask due to “low covid rates in Needham,” though they would wear a mask “in other states/towns and crowded areas.” Numerous respondents indicated that they wear masks when sick, with the aforementioned respondent saying that they are masking as “[their] dad has COVID and [they] don’t want to spread it even [though they’re] vaxxed (vaccinated) and testing regularly.” Other respondents responded similarly: “when I know I’m sick I wear a mask [because] not spreading it is within my control;” “If I’m sick it feels uncomfortable to not wear a mask [as] I don’t wanna get anyone else sick. Also to lower my chances of getting sick if I have a performance coming up;” “I feel safe unmasking for myself, yet if I was super sick, I’d wear one to prevent sick[ness]!;” and finally, “I will be wearing a mask for a while because I have COVID!” above: control”; is correct
Two respondents stated that wearing masks causes sensory discomfort. One individual described “feeling warm/hot” as “the worst sensation in the world,” something made more likely by wearing masks. Another person who I spoke with said that they would prefer to more frequently mask, though their sensory issues make masking uncomfortable or inhibit their ability to participate socially and in school. They stipulated that they wear masks “whenever [they] feel there’s a risk or it would be especially helpful to those around [them] - but it does bother [them] a lot and increase [their] anxiety.” A third respondent stated that their preexisting condition (asthma) made masking inconvenient or uncomfortable, and that they are “triple vaxxed (vaccinated) so [they] feel safe.” They report that when masks were required they “had to bring a rescue inhaler because it was hard to breathe.”
One person responded to my Instagram story that they “wore them (masks) until we were low on stock so now [they] only wear them when [they are] going somewhere that has tons of people (more than in a school environment) or if [they are] gonna be around someone that’s immunocompromised. [they] wore them because [they] just felt safer,” and that their family has decided to reduce mask usage in an effort to conserve PPE “so that people that need them more have enough to get.”
One respondent, Hazel Barzilay, who consented to being quoted by name, stated that she “regretfully” opted to stop wearing a mask at the beginning of the year, something she attributed to “low covid rates and lack of mask wearing at NHS.” She reports that she has since reconsidered that choice, sharing that having high-risk family and exposure risk motivated wearing masks again; “I visit my grandparents who are at high risk for COVID exposure, and I in no way want to put them in any harm. Additionally, although the rates are generally lower than last year I am still often in situations where it is easy to catch covid. I am surrounded by a different group of students in each class as well as the hallways and rehearsal - and it's stressful to think how easy it is to catch covid from strangers.”
Alternatively, why mask?
Students who choose to consistently wear masks had comparatively diverse rationale. My preliminary assumption was that people choose to mask due to being immunocompromised/having immunocompromised family/friends, that they felt school was overly crowded and therefore represented significant risk, and that long or post-acute COVID was of concern.
Four students, including Ray Winig, who consented to being quoted by name, shared that protecting immunocompromised community members was a primary motivation for wearing masks. Ray shared that they continue to wear a mask “in order to keep the community safe, being especially mindful of disabled, elderly, very young, and all other high risk community members.” They continued, saying that they “find value in normalizing masking as a practice…in hopes that others that choose generally not to mask may feel less out of place and be encouraged to mask when exposed, sick, or around vulnerable community members.” Another student shared that they mask to protect their immunocompromised family members and those with comorbidities: “I choose to mask based on my circumstances. Both my parents are really at risk if I get covid; my mom is immunocompromised and my dad has multiple comorbidities.” Similar to some students who shared that masking made them stand out from their peers, or feel socially isolated, they shared that they found it at first “awkward and uncomfortable” when they continued to wear masks after the mandate was lifted though they overcame this initial experience with communication: “I talked to some of my friends about it to alleviate some of the awkwardness that I was feeling. When I asked them to wear masks sometimes, most of them were pretty understanding about it. Overall, I think I've had a pretty good experience because most of my friends are really conscious about covid and masking, and they understand my situation.” Another student said they “still choose to wear a mask to protect immunocompromised relatives, peers, and community members.” They felt that “while some people immediately jumped to return to normalcy and a world without masks, [they] found that decision slightly rash and selfish to individuals [for whom that choice] causes deep anxiety and health concerns. Also, it's just not that difficult!" A fourth student shared that they mask because “all of the members of [their] household, [themselves] excluded, have a disease that puts them at high risk of death from COVID.” They also expressed anxiety at the COVID-minimizing antiviral medication, Paxlovid, stating that the severity of their family’s conditions might mean that “taking Paxlovid… is possibly a bad idea— Paxlovid can cause complications that they are at high risk for even without taking it.” They continued to cite both risk of infection and post-infection risk as rationale for mask-wearing, saying that “long-COVID impacts over 1/4 of people infected with COVID, regardless of age or vaccination status. I have had lasting negative COVID symptoms after just 1 infection, and the risk of long-COVID and death greatly increases with reinfection, according to some studies, so reinfection is an unacceptable risk for me.” Similarly, another student described their reasoning as “germs! I don't want other people's germs anywhere near me.”
Related to the sensory concerns of non mask-wearing students, one student stated that “I can mask less when half of my face is covered.” In this case, masking refers to “the artificial performance of social behaviors that are seen as more socially acceptable in a neurotypical society.” For this student, wearing a face mask reduces the social pressure for them to camouflage their neurodiverse traits.
Another student, Parker Fiset, cited a number of motivations for masking. He noted that he finds school to be “a breeding ground for contagious diseases and things [he’d] rather not get. The flu is bad enough, but since [he has] severe asthma, COVID struck really hard both times [he] got it.” He also adds that getting COVID had certain academic consequences: “The first time I got COVID, it was the week right before my 9th grade MCAS tests, the weeks where the teachers really pushed your limits with numerable, tests and rapid-fire papers and everything they didn't get to through the year, and missing about four days of that was horrible and I could barely catch up.” He emphasized that he feels responsible for ensuring others in his community stay healthy: “I would feel horrible getting other people sick, causing them to lose sleep, miss classes, fail quizzes, and that's happened before so I know how it feels. I had some lingering symptoms of COVID, which I didn't know I had yet, and suddenly all my friends had it. In the slim chance this wasn't caused by me, there either have been, or will be other times in which this has/will happen(ed). Wearing a mask greatly decreases those odds of me getting anyone else sick, so that's nice.”
So why am I (Jesse) masking?
I wear a mask every day. I wear them at school, in stores, and at the gym. I wear them outside when I am with people who request that I do so. I eat outdoors whenever possible. This might appear extreme to many. I can understand how “pandemic-is-over” rhetoric espoused by authorities has led my peers to the conclusion that their communities are safe, and their health risk is mitigated by vaccines.
Many people still masking, are accused of being “COVID nihilists.” This designation strikes me as patronizing and dismissive, but also deeply ignorant. The pandemic is not over. Hundreds of people are dying every day of a virus our governments allow to proliferate. My intentions with communicating the forthcoming data that informs my mask-wearing is not to condemn anyone who opts for a different decision—I believe in a community model of health that involves mutual responsibility, and therefore I do not find value in critiquing the autonomous choices of others. I simply intend to reach those who may, understandably so, not have the capacity to do the breadth of research I have done, but are motivated to understand the dimensions of risk we face in an ongoing pandemic.
I recognize, as my peers who report wearing masks do, that mask wearing is critical for protecting my immunocompromised loved ones and community members, and I trust the self-advocacy of disabled people who implore communities to end “mask-friendly” policies which physically endanger them and socially ostracize them (linked in my sources are a few resources by or interviewing disabled people about COVID policy). I myself have missed opportunities because spaces did not accommodate my needs as someone deeply concerned about the ongoing pandemic. Research shows that masking is the sole best nonpharmacologic predictor of community health (sources linked below), and that masking supersedes vaccines in terms of efficacy in protecting vulnerable individuals from contracting COVID, and is the only way to prevent post-acute COVID, considering evidence that vaccinated COVID patients remain at high-risk.
This segues into a point of perhaps even greater concern. Public health advocates have alleged that COVID is “the greatest mass-disabling event in human history.” A myriad of studies have alleged varying, but equally concerning, rates of contracting post-acute symptoms. One such study reported a range of 1-in-4 to 1-in-5 patients contracting long-COVID, another reported 30% of patients developed post-acute symptoms. Currently, children are not excluded from vulnerability to post-acute symptoms; one study found that anywhere from 5% to 10% of children under 14 develop long-COVID, with rates increasing in 14-and-up populations. Children who developed long-COVID were twice as likely as their peers to develop heart inflammation (myocarditis), heart muscle disease (cardiomyopathy), a blood clot in the lung (acute pulmonary embolism), a blood clot that begins in the vein of the leg or arm (venous thromboembolic event), acute and unspecified renal failure, and type 1 diabetes.
Post-acute COVID (“long-COVID”), which has seemed to be a footnote to discussions of COVID risk, can result in:
Damage to the brain: changes in brain structure, pathological changes similar to Alzeimer’s Disease, brain cell deterioration, cognitive decline, and increase in risk of developing cognitive deficits, dementia, psychotic disorders, epilepsy, or seizures.
Heart and cardiovascular issues: risk of heart disease and stroke, irregular heartbeats, heart failure, and coronary disease, blood clots in lungs, and damage to heart muscle cells.
Kidney functioning issues: reduced kidney function (observed in 35% of patients), increased risk of kidney disease, leading to reliance on dialysis, and post-acute kidney disease risk.
Liver damage: liver damage (observed in 74% of severe cases, and 43% of mild cases), liver functioning impairment and liver fibrosis, and liver abnormalities.
Nervous system disorders: development of dysautonomia (an autonomic nervous system disorder observed in 67% of patients), nerve damage, development of orthostatic intolerance syndromes/hypertension/tachycardia, fatigue, anosmia, hypogeusia, headaches, and hypoxia associated with dysautonomia caused by COVID, and parasympathetic and sympathetic autonomic dysfunction (leading to coordination issues throughout the body).
Gastrointestinal issues: loss of appetite, nausea, weight loss, abdominal pain, heartburn, dysphagia, altered bowel motility, and irritable bowel syndrome (IBS), infection of gastrointestinal tissue, ulcerative colitis (ulcers in digestive tract), impact to all parts of digestive system.
Immunological issues: immune dysregulation and extended inflammatory response, persistent immune dysregulation, persistent signs of autoimmune disease and presence of antibodies which target healthy cells found a year post-COVID, and rogue antibodies in blood.
Metabolic diseases: impaired blood sugar processing, risk of Type 2 Diabetes elevated by 40%, metabolic rewiring and serotonin, aggravation of pre-existing metabolic disorders, and increased risk of fatty liver disease, associated with metabolic and cardiovascular complications.
Mental health risk: 50% elevation in suicidal ideation post-COVID, COVID link to suicidality, post-acute COVID and suicide risk, link to severe depression and anxiety. All of this is to say: While healthcare access and community protocol is a variable in determining pandemic security, one’s youth, affluence, ability, and optimism does not defend them from COVID. We, as a country, have policies implemented to ensure the mitigation of long-term risk for youth. We have laws which prohibit youth from purchasing alcohol and cigarettes, understanding that children cannot fully accept or consent to the associated risk of possibly debilitating chronic conditions developed from risk-taking behaviors. I then ask—why are communities so reticent to acknowledge the stress we put on our communities' wellbeing when we adopt overly individualistic public health measures? How might we better create a community in which individuals feel accountable for the safety and to the integrity of one another?
I conclude this piece with a quote from someone I spoke to who demonstrated immense concern for the longevity of our community’s health: “This is the concern and risk I deal with every day. I’m often told that I need to chill out and stop worrying about this, but if I’m not worried, I won’t protect myself— that’s how I got COVID in the first place. If my only options are fear and death, I’d rather be alive in 10 years.”
Full-length student accounts (relatively unedited)
“I choose to mask based on my circumstances. Both my parents are really at risk if I get covid; my mom is immunocompromised and my dad has multiple comorbidities. I definitely think it was awkward and uncomfortable last year when I chose to remain masked all the time. I talked to some of my friends about it to alleviate some of the awkwardness that I was feeling. When I asked them to wear masks sometimes, most of them were pretty understanding about it. Overall, I think I've had a pretty good experience because most of my friends are really conscious about covid and masking, and they understand my situation.”
“germs! i don't want other people's germs anywhere near me.”
“i can mask less when half of my face is covered” (explain masking in the context of neurodiversity)
(Hazel Barzilay) “In the beginning of the school year I was wearing a mask every day but began to notice that I was the only person in my classes wearing a mask. Regretfully I decided to stop wearing a mask due to the low covid rates and lack of mask wearing at NHS. However, I've recently decided to start wearing a mask to school again. I frequently visit my grandparents, who are at high risk for COVID exposure, and I in no way want to put them in any harm. Additionally, although the rates are generally lower than last year, I am still often in situations where it is easy to catch covid. I am surrounded by a different group of students in each class as well as the hallways and rehearsal - and it's stressful to think how easy it is to catch covid from strangers.”
"I still choose to wear a mask to protect my immunocompromised relatives, peers, and community members. While some people immediately jumped to return to normalcy and a world without masks, I found that decision slightly rash and selfish to individuals who that causes deep anxiety and health concerns. Also, it's just not that difficult!"
“i wear a mask when i am sick and am thinking about it for upcoming flu season”
“my dad has COVID and I don’t want to spread it even [though] I’m vaxxed (vaccinated) and testing regularly” ; “low covid rates in Needham, but I’d still mask in other states/towns and crowded areas”
“Hmm my logic is when I know I’m sick I wear a mask [because] not spreading it is within my control”
“If I’m sick it feels uncomfortable to not wear a mask [as] I don’t wanna get anyone else sick. Also to lower my chances of getting sick if I have a performance coming up”
(Parker Fiset) “(Goes from highest --> lowest priority)
Why do I wear a mask in school as opposed to some other places sometimes? (Goes from highest --> lowest priority)
I really really reallyyyy don't want to get sick, and I've come to acknowledge that school at times can be a breeding ground for contagious diseases and things I'd rather not get. The flu is bad enough, but since I have severe asthma, COVID struck really hard both times I got it, with the first time leaving me immobilized to my bed for two days in a row (ok, I could crawl to the bathroom when I needed to, but it was super hard to walk, my whole body felt extremely weak). Not only is this bad for my more vulnerable mother and grandparents, but I missed a heavy amount of school work. The first time I got COVID, it was the week right before my 9th grade MCAS tests, the weeks where the teachers really pushed your limits with numerable tests and rapid-fire papers and everything they didn't get to through the year, and missing about 4 days of that was horrible and I could barely catch up. The second time was a normal 10th grade week, and it was still really bad too.
I would feel horrible getting other people sick, causing them to lose sleep, miss classes, fail quizzes, and that's happened before so I know how it feels. I had some lingering symptoms of COVID, which I didn't know I had yet, and suddenly all my friends had it. In the slim chance this wasn't caused by me, there either have been, or will be other times in which this has/will happen(ed). Wearing a mask greatly decreases those odds of me getting anyone else sick, so that's nice.
(I guess these are just "nice" things that aren't really that important, but still notable I guess, it's mainly these first two):
It conceals my face, which I find nice sometimes, and it hides any acne I might not want to show to the world.
It's hard to break out of the habit. If I wear a mask, every day, it's hard for me one day to decide "maybe I don't wear one." (which I *do* wear a mask everyday, but I was
(I guess these are just "nice" things that aren't really that important, but still notable I guess, it's mainly these first two):
I guess this is fine, but it's a nice reminder to those who believe "COVID is over, we don't need to wear masks anymore" that, sure the pandemic lockdown is over, and masks aren't really necessary anymore, but it's still a good idea to be cautious and remember that it's still out there. Not saying everyone should wear a mask, just saying they should be vigilant before thinking they're immune and don't need to worry about it
*it's easier to judge ppl, you don't need to take it seriously, hence the grammar, hee hee*
Allergies
“I wore them until we were low on stock so now I only wear them when I’m going somewhere that has tons of people (more than in a school environment) or if I’m gonna be around someone that’s immunocompromised. I wore them because I just felt safer.” ; “We don’t have enough for me to wear one every day anymore, we could buy more but since vaccines are out, my parents aren’t buying more unless they’re urgently necessary. Not saying that they’re anti-mask, it’s just that they don’t want tons of new ones around especially so that people that need them more have enough to get!”
“I feel safe unmasking for myself, yet if I was super sick, I’d wear one to prevent getting sick!”
“I haven’t been masking nearly as much as I wish I would, the main reason being sensory issues with masks. It’s not so severe that I never wear a mask - I do whenever I feel there’s a risk or it would be especially helpful to those around me - but it does bother me a lot and increase my anxiety.”
“A big part that’s not talked about is the societal pressure not to because others aren’t, as well as when you do people always asking why are you wearing a mask; leads to stress”
“I will be wearing a mask for awhile because I have COVID!”
“Uncomfy without mask in crowded place and people (especially at school) are gross”
“Feeling warm/hot is the worst sensation in the world and masks make it a lot more likely”
“To be honest I totally see arguments for both sides… but even with the mask mandate most people don’t wear them / don’t wear them properly, and so a lot of people don’t see the point. I think if there were better education as to why we should wear masks, I’d totally be down to wear one and help enforce the mandate… unfortunately there are always going to be people who will refuse to wear them.”
“I wear a mask—a KN95 respirator, to be specific—because I don’t want to catch or spread COVID. One-way masking isn’t known to be the most effective. In 2021, some scientists estimated that it would take under 1.5 hours for someone wearing a KN95 to receive an infectious dose of the virus if exposed— and this was before omicron. If this is true, have a long block near someone infected, and I’d be screwed. But that’s far better than being almost certain to contract COVID within just a few minutes of speaking to an infected person, even when feet apart— which is the risk when not wearing a mask.
Some places, like some Canadian provinces, have removed isolation and mask recommendations for people who test positive for COVID, and employers are using this to penalize their employees for staying home when infected. I have no doubt that people who KNOW they’re infected will go unmasked in public by choice as well, since the message the news is feeding us about COVID is that it’s just a cold, and giving someone a cold because you didn’t wear a mask isn’t considered bad.
All of the members of my household, myself excluded, have a disease that puts them at high risk of death from COVID and also means taking Paxlovid (which is used to decrease risk of death for high-risk individuals) is possibly a bad idea— Paxlovid can cause complications that they are at high risk for even without taking it.
Long COVID impacts over 1/4 of people infected with COVID, regardless of age or vaccination status. I have had lasting negative COVID symptoms after just 1 infection, and the risk of long COVID and death greatly increase with reinfection, according to some studies, so reinfection is an unacceptable risk for me.
Additionally, the immune damage caused by COVID infection has been compared to AIDS even in mainstream news articles at this point. COVID, like HIV, causes viral persistence, meaning the virus hangs out in your organs and continues to replicate even when you aren’t considered sick with it. This leads to long term complications as late as a decade later with HIV. We’ve only had COVID-19 for 3 years.
Most people have gotten COVID at least once, and we are seeing the impacts. The WHO has declared the likelihood of rare fungal infections becoming widely spread, which would be indicative of an immunocompromised population. Multiple countries have a pediatric hospitalization crisis, and the idea that these kids sick because they weren’t exposed to illness during lockdown is ridiculous— many of these kids were born AFTER lockdown, or are from red states, and the notion that babies and toddlers won’t be healthy if they don’t contract respiratory illnesses is one of the stupidest things I’ve ever heard.
I would drop out of school if I was allowed to. I think letting kids attend school and activities during this pandemic while there isn’t universal masking is incredibly irresponsible (if not downright evil), setting most of them up for long-term, severe disability. I think the same of working in-person, and of vacationing. There is a high chance of my family members and friends dying prematurely if someone had COVID unknowingly and wasn’t wearing a mask, and I can’t forgive that.
This is the concern and risk I deal with every day. I’m often told that I need to chill out and stop worrying about this, but if I’m not worried, I won’t protect myself— that’s how I got COVID in the first place. If my only options are fear and death, I’d rather be alive in 10 years.
Also, COVID causes [damage] to the brain, even with “mild” infection, and can also be neurodegenerative, causing SAND (sars-cov-2 associated neurocognitive disorder, like HAND after HIV infection), which can include the onset of dementia. I don’t want to catch a neurodegenerative pathogen at school, of all places.”
(Ray Winig) “I choose to mask in order to keep my community safe, being especially mindful of disabled, elderly, very young, and all other high risk community members. I also find value in normalizing masking as a practice in spaces I enter, in hopes that others that choose generally not to mask may feel less out of place and be encouraged to mask when exposed, sick, or around vulnerable community members.”
“I'm not from NHS, but I'm a high school student in a nearby town who chooses to always mask and I eat outside even in the cold. I mask because I know covid rates, though much lower than during the spikes that came after some variants, are still relatively high, even much higher than the flu is right now, so it is quite easy that I could get covid if I didn't mask. And the risk of infection could go up without me knowing, as new variants are developing constantly. This wouldn't be a problem if the virus were like a cold, and didn't have deadly or long-lasting impacts, but it is unknown many of the long-term impacts of covid, and there are studies suggesting it could impair many critical functions for a long time or maybe a lifetime. It also has a much higher death rate than something like the flu, even now. For these reasons I don't want to get it nor spread it. I also feel the obligation of I get it to isolate for the recommended 5 days, and this would greatly impair my life.”