Face-Covering Controversies, the American Way and Other Fails

To say the COVID-19 pandemic has wrought drastic changes on the way we practice medicine is a galling understatement. Unfortunately one of the stressors on many outpatient physicians since March of this year has been the rash of patient requests for letters of medical necessity to be out of work, or to go back to work after their possible COVID-19 illness, or exposure. These requests run the gamut from the complex and nuanced, to the ridiculous. To stem the flow of this veritable deluge of requests our organization has drafted a form letter from The Clinicians to The Employers, advising them to adhere to the CDC recommendations (which are included in the letter), and generally to please not request letters of medical necessity from clinicians, who are ideally spending their work hours treating actual sick people as opposed to writing letters. It has succeeded in covering a mild to moderate percentage of these requests. 

Recently a patient requested a letter exempting her from masking at her job, in which she works with the public, for psychological reasons. My heart went out to her as I explained my rationale for needing to adhere to infectious protocols during a deadly global pandemic, to which she responded by firing herself from my patient panel. Her request was brought to the next doctor she employed to provide her care (down the hall, within my practice), who heard her plea and held the line. By the end of the consequent ordeal that this caused, our office manager, medical director and the director of primary care became involved in the question of whether it was legal to decline to provide medical exemption from wearing a mask while working in a public area, directly with the public, during a pandemic. (It is.) 

Later while out running an essential errand at a different, large regional chain store I observed most of the employees wearing face shields and masks, and multiple of the employees wearing face shields without masks. Referencing the COVID-19 guidelines for employee and patron safety of several national and regional chain stores I noted that guidelines range from requiring all employees to wear either masks OR face shields, or both if they prefer, while some require just masks. Even others accept “personal face coverings,” which according to news sources have in one publicized instance unfortunately included a confederate flag. Summarizing our data that a face shield generally protects from incoming droplets while masking generally protects from outgoing droplets why do employees working with the public get to choose essentially whether to infect or be infected (likely based largely on physical comfort)? Add to that the strong effect of social pressure and the knowledge that if one clinician exempts an employee from masking, other employees are likely to seek the same and in some cases succeed, it becomes easy to see how containing this virus, in a place where personal liberty is prized above all else, even when it comes to endangering others, can undermine an entire public health initiative. Add in the projected numbers of Americans who report they would not accept a COVID-19 vaccine when one becomes available. Then add to that the breaking news of the US’s withdrawal from the WHO (and therefore our $400 million/year funding, which currently fuels COVID-19 clinical research and vaccine development), it’s difficult to find optimism. Our distinctive American spirit, which has at times been the world’s beacon of dynamism, creativity and progressiveness, now contorted by ignorance and selfish self-pursuits, unable to mobilize into a coherent vision, message or action, spearheaded by a uniquely anti-science, pro-capitalist and individualist (I won’t wax further right now on xenophobic and racist) government, poises us perfectly to continue on our trajectory toward a uniquely impressive failure, measurable directly by loss of human life. 

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Joanna Rulf, DO

Joanna Rulf, DO practices Family Medicine and Integrative Medicine in her second-home state of Maine. Originally from NJ, Joanna graduated from Rutgers University with a degree in English Literature, pursuing a career in the publishing industry in NYC before attending the University of New England College of Osteopathic Medicine from which she graduated in 2009. She completed residency in Family Medicine and fellowship in Integrative Medicine at Maine Medical Center in Portland, ME. During this time she also completed the fellowship curriculum from the University of Arizona Center for Integrative Medicine and received certification in Medical Acupuncture from the Helms Institute for Medical Acupuncture in Phoenix, AZ. Her practice blends the broad spectrum of rural primary care medicine with evidence-based management of a variety of conditions using Osteopathic Manipulative Medicine (OMM), acupuncture, and an array of wellness strategies. The mother of two young children, Joanna has journeyed hard on the quest for work/life balance, mental/physical wellness, and strives to help her patients (and colleagues!) do the same. 

  4 comments for “Face-Covering Controversies, the American Way and Other Fails

  1. Pat
    June 2, 2020 at 9:18 pm

    My home town is about 4 hours west of where King Doug lives, a pretty little Norman Rockwell sort of place, more northern tourists than I would like, but some really cool history.

    I learned this evening that Zazzy’s, a local coffee shop had closed. This place had great brew, roasted their beans on the premises, and had delicious fresh muffins, quiche, and sandwiches to go on the side. Zazzy’s closed, due to the idiotic lockdown imposed by a self-serving, near demented authoritarian governor who once upon a time was also a pediatric neurologist.

    Near my recently hurricane-ravaged town on the gulf coast, a little barbeque restaurant that has provided really tasty food for over 6 years survived the storm, and reopened – and then was killed by the lockdown.

    Nationwide, tens of millions have been directly harmed by the national panic over Covid-19, a panic that was misinformed and unnecessary. As I’ve written repeatedly on this site, no one including myself glossed over a dangerous virus, and the immunosuppressed at-risk should and could have been self-quarantined. The rest of the healthy and productive should have been free to work, recreate, and pursue their lives. Instead, we – all of health care including physicians – were coopted in encouraging a national panic that rapidly became a vehicle for politics.

    Two really good places that I knew well have been killed, their people put out of work by our exhortations and mandates designed to “save lives!” My own family members have been put out of work, and until recently I could not get patients seen in cardiology and surgery offices for urgent problems, due to garbage “safety” precautions pushed by my own profession.

    I did not go into this line of work to be a public nag, a health commissar pushing my prescriptions on everyone else. Though I have treated Covid-19 patients in the ICU, outside of work in the hospital I don’t wear a mask, and won’t, and I laugh at those who do. It is idiotic and unproductive.

    I will not be an agent of fear.

  2. Fred Powell
    June 2, 2020 at 8:15 pm

    Please specify the large scale, peer reviewed trial that proves these masks protect in a statistically significant manner from an 8 micron viral particle.
    I can tell you these surgical masks, even N95, do not protect one from inhaling spray paint, nor grinder metal particles, because they don’t seal. Respirators are a different story, but that’s not what the cdc and others are hounding the rest of us to wear.
    All I ever hear about is evidence based practice. Until these masks have better positive data, I’m not wasting my time with it.

  3. Joanna
    June 2, 2020 at 1:20 pm

    Hey Rick, no problem and happy to help. I know a lot of us are dealing with a lot of heartache over the pandemic and how things have gone. If you feel our administration has reacted in a timely and admirable manner that’s great – less heartache in life is a wonderful thing. In fact I would actually love to be enlightened. My expectation was never for everyone to love what i write or to even read what I write. But if there’s something to be argued I’d love to hear it. Otherwise, peace ✌️

  4. Rick
    June 2, 2020 at 9:17 am

    And there you have it, the entire apocalypse is Trump’s fault.
    Good to have you onboard Joanna. Not.
    Do us a favor and try not to write glowing columns about Antifa, okay?
    In a sense you’ve done me a favor. When I see your name, I’ll be sure not to waste my time reading it. So, thanks.


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