Did you have to do an obstacle course in your high school gym class? I don’t remember if I did, it was so long ago. But from my school years, I vaguely remember an image of Gomer Pyle struggling through the boot camp obstacle course. An obstacle is “something that impedes, stands in the way of, or holds up progress.” Well, not progress really, but change from one state to another. There can be obstacles to regress as well as progress. Obstacles do not have to be physical barriers between locations, they can be attitudes or beliefs. Obstacles to change from one state to another can even be a state itself. Being heavier than water is an obstacle to floating.
Our Ohio governor and our director of the state health department have talked about creating obstacles to the spread of coronavirus infection: social distancing, hand washing, and face masks. They say these three obstacles, in series, create a Swiss cheese effect. One slice of Swiss cheese will let something through the holes, but two or three slices placed one on top of the other may result in some of the holes being closed, creating an obstacle to passage. It’s a great analogy, but I think the obstacle course analogy is also apt. We can’t think of the coronavirus as having a goal, but it does have to change states (locations) to cause disease. It has to get from one person’s respiratory tract to another’s to cause an infection. Social distancing, hand washing, and face masks are obstacles for the coronavirus. When used together, they are an obstacle course. Seems like building such an obstacle course would be good idea, don’t you think?
Then why don’t people want to build a coronavirus obstacle course between themselves and the virus? Why do we see people crowd into bars, stores, and other venues faces bare? Sometimes, there may be obstacles to building a coronavirus obstacle course. Physical distancing from others may be difficult without the cooperation of the others. Hand washing is more under the control of the individual but depends on the availability of facilities and materials. I can carry my own hand sanitizer, but it’s heavy to wear around the neck, and sometimes I forget, and there are no facilities. There are fewer obstacles to wearing a mask. It is under the individual’s control. You put it on and it’s there. I put mine on in the car, tie it around my neck, and let it fall in front of my face until I need it. I don’t have to worry about losing it, not having it with me, or someone providing it.
When there are obstacles to building a multi-barrier coronavirus obstacle course, a mask is an easy, controllable last and first defense. It’s a first obstacle to spreading the disease and a last obstacle to getting the disease. So, why don’t people want to wear a mask? What are the obstacles, especially when people are about to enter a situation where physical distancing and hand washing facilities may not be available?
In a blog posted to KevinMD, Ashten Duncan notes that the question cannot be answered simply. You can read his brief reviews of two theories, the health belief model and social cognitive theory here. The health belief model posits several factors that influence people to accept or reject health recommendations. One of the factors that is crucial is a “cue” to act. This cue maybe something internal, like not feeling well, or something external, like a recommendation from a respected person. For instance, a person might be more likely to stop smoking if they were advised to by their physician, or if they were feeling short of breath. The second theory, social cognitive theory, is more straightforward. This theory suggests that peoples learn their behavior by observation of others, seeing someone setting an example.
These two theories have an important Intersection when it comes to our last and first obstacle to coronavirus infection, the face mask. Our public health and political officials can take advantage of that intersection: make the recommendation and set the example. The CDC has made the recommendation. In Ohio, the governor and the health department director have made the recommendation (see above). Setting the example probably serves double by being a visual cue to act as well as a learning opportunity. Unfortunately, some of our public officials have not been so anxious to set the example. What are the physical, attitudinal, or state obstacles to our leaders wearing face masks? A question for another time. Until that time, the current thinking is that wearing a face mask can save lives. In as much as mask wearing allows people to return to work safely, it improves the economy. There is no legitimate obstacle I can think of to our leaders setting an example by wearing face masks. Their reluctance to do so is an obstacle to convincing the public to do so and their failure to do so is a failure of leadership.