Further Suggestions on the Lifestyle Approach to Covid-19

By Paul E. Lemanski, MD, MS, FACP

In my last article on Covid-19, I argued for a more balanced approach to control of the infection that would avoid repeated widespread, draconian lockdowns and stay-at-home orders with consequent further damage to the economy. I showed how such economic damage itself would have a significant health consequence. This more balanced approach relied on risk-stratifying the population, reserving targeted lockdowns, extensive testing, and stay-at-home orders only for those older and sicker individuals at higher risk. The majority of the population at lower risk would rely on proven lifestyle- based risk mitigation strategies including universal masking, social distancing, handwashing, targeted quarantine, and contact tracing to keep the rate of new infections low. 

Such a low rate of infection would allow the economy to reopen, children to return to school, and Americans to return to a more normal life. I emphasized that such an approach would only work if the great majority of folks actually implemented such mitigation strategies.

Unfortunately, such lifestyle-based strategies are proving a challenge for many and rates of new infections are increasing in a number of states. Even more disturbing is a belief that such strategies – especially mandated masking – is somehow taking away our freedom. This belief is gaining hold despite increasing scientific evidence that masking works extremely well as a risk mitigation strategy. The CDC has estimated that if 90% of the population masked, then up to 70,000 lives could be saved by the end of this year. Moreover, if we adopted universal masking, within two months new infection rates could be reduced to the extremely low levels needed to safely open schools. I am speaking about a temporary adoption of mask wearing – and I don’t like it either – as the price to pay to return us to some semblance of normality. 

Freedom is NOT now and has never been “do whatever you like.” We are not free to scream fire in a theater, if there is no fire, despite a constitutional protection of free speech. We are not free to refuse to pay taxes. We are not free to drive cars without registration or license or at any speed we choose or with seat belts not buckled. In times of war or national emergency, if there is universal conscription, we do not have a right to refuse to be drafted. While a gross oversimplification, when I was young, we used to say your rights end at the end of my nose – meaning free speech, finger-pointing and gesticulating is fine, but you have no right to physically contact my nose or body and assault me. Yet, in the present circumstance, an unmasked infected individual, especially closer than six feet, may indeed be assaulting you to the extent of putting your life at risk.

In my opinion, until a vaccine is available, masking needs to be universal or nearly so. I do not like wearing a mask any more than anyone else, but I see no other reasonable option for a public health crisis that threatens to kill greater than 300,000 Americans this year, and has the potential to return us to the economic pain and suffering of the Great Depression. Is masking such a high price to pay to avoid those consequences? Those refusing to mask simply should not put others at risk by being in ANY indoors space with others or coming within six-feet of them outside. If they do so, local authorities will need to determine how the situation can be adjudicated. Certainly, reasonable accommodations for legitimate reasons should be considered such as drive through pickups at restaurants, pharmacies and grocery stores.

The implementation of masking has been botched badly by mixed messages. On the basis of the increasing, irrefutable scientific evidence of its profound benefit as a risk mitigation strategy, we need to change the message. In my opinion, ALL Federal and state officials need to be seen masked in public under ALL circumstances. They need to lead by example. I am not – as a physician – in favor of arresting or fining those refusing to mask. Rather we should be appealing to their desire to avoid lockdowns, open up the economy as soon as possible, and open our schools. Because the scientific evidence on the benefit of masking, folks need to see masking as the way out of this nightmare for our country. In this way they become part of the solution. 

In short, we need to appeal ultimately to their sense of patriotism and love of country. Far from being corny, if our elected officials made the wearing of masks a patriotic duty, similar to buying war bonds during WW2 or enlisting in the service after 911, Americans would respond as they have in any crisis-with a can-do attitude. Federal government officials from the President on down and state officials from the Governor on down must put the country – and not political considerations – first and request explicitly and unequivocally that Americans mask for the good of the country. If asked by our leaders to sacrifice for the good of the country, I am confident the great majority of the American people will do so and put this nightmare behind us.

Paul E. Lemanski, MD, MS, FACP is a board-certified internist practicing internal medicine and lifestyle medicine in Albany (centerforpreventivemedicine.com). Paul has a master’s degree in human nutrition, he’s an assistant clinical professor of medicine at Albany Medical College, and a fellow of the American College of Physicians.