People Aren’t ‘Addicted’ to Wearing Masks, They’re Traumatized

There’s a glaring omission from the discussion about why some “can’t quit” pandemic behaviors: the mental and emotional toll of the last year.
May 11, 2021, 2:32pm
A woman wearing a mask walks down a busy street.
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Around a month ago, Lauren Albanese went to the mall with her uncle and dad. It was the first time since the pandemic began that the 27-year-old from Staten Island had been around people outside her household. 

As they entered, Albanese froze. All the people around her seemed to move in slow motion. Her dad spoke to her, but she couldn’t hear his words. “My body completely shut down, triggered by simply being around people,” she said. “I still feel like I don't have control over myself and how my body reacts after everything that's happened.”

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Albanese tested positive for COVID-19 three days after her grandmother died, on April 8, 2020. “Not a day goes by when I don’t think about the events that took place over a year ago,” Albanese said.

Visual memories flood her mind: The difficulty of picking up her grandmother’s ashes due to crematory backlogs. Getting extremely sick herself, while trying to grieve. The inability to have a funeral. Her grandma's assisted-living facility dumping all of her grandmother’s possessions, including her grandfather’s ashes, into boxes. When she left the hospital the day her grandma died and saw a line of people outside the hospital who weren’t permitted to enter. “They just wanted to be near the building that housed their loved ones,” Albanese said. 

Needless to say, it hasn’t been easy for Albanese to adjust “back to normal." And as the United States improves its COVID-19 situation, with daily case numbers a fraction of what they were during the January peak (largely due to vaccinations), there's been a small but vocal backlash against those who, like Albanese, aren't swiftly shaking off the events or newly acquired safety behaviors of the past year. 

There have been warnings of the dangers of "extreme COVID caution," and FiveThirtyEight's Nate Silver tweeting, “I'd argue one sign of *irrationality* is if a person doesn't change their behavior much after being vaccinated.” This viewpoint was best summarized in an article from Emma Green in The Atlantic called "The Liberals Who Can’t Quit Lockdown."

“Lurking among the jubilant Americans venturing back out to bars and planning their summer-wedding travel is a different group: liberals who aren’t quite ready to let go of pandemic restrictions,” she wrote. “For this subset, diligence against COVID-19 remains an expression of political identity—even when that means overestimating the disease’s risks or setting limits far more strict than what public-health guidelines permit.”

There's a glaring omission from this discussion about why people “can’t quit” pandemic behaviors: the mental and emotional toll of the last year. After what many have been through—death, grief, isolation, stress, anxiety, unemployment, trauma—people are going to have some feelings around transitioning back to a less cautious way of life.

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This doesn’t mean that they reject the CDC guidelines or are wielding progressivism as a weapon. It means some people need a little extra time to put their masks away as they stroll around the park—and they should take it. Especially since, broadly speaking, on a policy level, states are opening up, and have concrete plans to continue doing so in the coming months. If anyone is being overly cautious, it's happening on an individual level, and—unlike the individual choice to not get vaccinated—it's an individual behavior that doesn't incur any meaningful risk for others. 

An especially cruel element of being told you're not moving on fast enough is that all of the usual ways of grieving were put on hold last year, or severely truncated. “As the rest of vaccinated America begins its summer of bacchanalia, rescheduling long-awaited dinner parties and medium-size weddings, the most hard-core pandemic progressives are left, Cassandra-like, to preach their peers’ folly,” Green wrote. 

Albanese isn't sitting around preaching to others, she said. She's just dealing, something she couldn't fully do while the pandemic raged around her last year. 

“I’m still very much living in a reality where COVID-19 is a part of me,” she said. “It's a part of my story at a deeper level. We're all dealing with the physical and psychological impact of losing people we love in such a tragic way."

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There are other reasons why people may be hanging onto COVID precautions. Some people have unvaccinated children who, though at low risk, don't have zero risk. Others may be immunocompromised or worried about the uncertainty around variants. Individual risk tolerance varies, and since the pandemic is certainly not over, it's understandable if people's tolerances still rest at different levels.

But in general, there are two groups of people who are most likely to return to normal life more slowly—and their reasons have to do with mental health and trauma, said Steven Taylor, a psychiatrist at the University of British Columbia. They are people who had mental health concerns before the pandemic, like anxiety or OCD, and those who had highly stressful or traumatic experiences: people who had COVID themselves, have long COVID, or lost someone due to COVID. These groups deserve our compassion, and patience. 

Large-scale disasters are nearly always accompanied by increases in mental health concerns, like depression, PTSD, and anxiety. In May of 2020, Taylor and his colleagues estimated that at least 10 percent of people would develop COVID stress syndrome. Actually, about four in 10 adults in the U.S. reported symptoms of depressive disorder and anxiety during the pandemic, which is an increase from one in 10 between January and June in 2019. In a study from February of this year, 30 percent of people who had an acute COVID infection had PTSD. 


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We’ve just been through a collective trauma, said Sandro Galea, a physician and epidemiologist at Boston University's School of Public Health. “It is unsurprising that many, in this context, find themselves struggling to let go of the norms and practices that have come to define this experience,” he said. “With so much out of our hands, behaviors such as masking, distancing, and cleaning surfaces represent some of the few aspects of this pandemic which have been in our power to control, lending some structure to a chaotic time.” 

A defining feature of the pandemic has also been inequality. In a study Galea conducted last summer, he and his colleagues found that the burden of depression landed heaviest on those who with the lowest income and savings, and those who were more directly exposed to the stresses of the pandemic, like essential workers. 

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This inequality shapes both mental and physical health, defining how people were affected, and also the nature of people’s long-term responses. “Those who are in a more privileged socioeconomic position—those who can telecommute, order all they need online, and rest easy with a cushion of savings in the bank—have had a very different experience than, say, the Amazon delivery driver who has had to go to work in person each day to make ends meet,” Galea said. 

Sophia Carter, an 18-year-old in Oklahoma, was the oldest of five siblings. Now she’s the oldest of four after her 13-year-old sister, Anna, died of COVID-19 last July. Anna had an autoimmune disease, limited scleroderma, or CREST syndrome. 

Carter said that her community in the Bible Belt opened up pretty quickly in the spring of 2020. By June, she was able to go to Oklahoma City and celebrate an anniversary. Many people didn't wear masks when they went out. On July 1, her dad got a promotion at work, and they had a small gathering to celebrate. They had another get-together on July 4. She doesn’t know if her sister got infected at either those gatherings, but by the Sunday after the 4th, when it came time to go to church, Anna stayed home because she wasn’t feeling well. 

By Friday, when Carter came home from work around 3 p.m., she found Anna in her bed. “She looked so tired,” Carter said, and tucked a blanket over her sister’s legs and feet. That night, when Carter left to babysit for a nearby family, she got a call from her mom. Crying, her mom told her she had to come home and watch her baby brother, because she was bringing Anna to the hospital. “I cried worse then than I did later, because I realized in that moment she was dying,” Carter said. 

Anna died just hours after arriving at the hospital. Carter’s family spent the night together huddled on the couch. The next day, they all tested positive for COVID-19. “All six of us, my parents, me, and my three other siblings,” she said. “I’m certain that if Anna had not died, we would not have known that we had it at all,” Carter said.

What happened to Anna changed the way Carter thinks about mask wearing and social distancing. She's painfully aware that there are other people out there more susceptible to the virus, like Anna was. Even though she’s fully vaccinated, Carter still wears her mask wherever she goes. 

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“A huge reason that I still wear my mask is to honor and respect Anna,” Carter said. 

For many, getting their vaccination is a joyous occasion, a defining moment in which they feel safer and begin to change their behaviors. But for others, it’s a bittersweet rememberance of those who didn’t get their chance to be vaccinated, and can bring on new kinds of emotional distress. Upon hearing the news that children aged 12 to 15 could be vaccinated, Carter reflected on how Anna would have been eligible soon. “She didn’t have the option to do that, or continue her life,” she said.

Albanese had a similar reaction when she got her vaccine. When she got her first vaccine dose, she broke down crying. She got her shot on the anniversary of when she had COVID. 

“It shook me to my core,” she said. “I’m happy to be able to get vaccinated and to protect myself and others. But you can't help but think about what could have been for all of those people that didn't have that same opportunity.”

One of Green’s arguments in the Atlantic piece is that the people are holding onto COVID protocols first and foremost to uphold their political identities. Do politics play a role? Sure. But that doesn't mean that the wariness around leaving behind cautionary measures isn't more about anxiety than about political identity. 

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Throughout the pandemic, some people, largely on the right, have refused to wear masks, denied the severity of the outbreak, and are now resisting getting the vaccine.  “Some conservatives refused to wear masks or stay home, because of skepticism about the severity of the disease or a refusal to give up their freedoms,” Green acknowledges. “But this is a different story, about progressives who stressed the scientific evidence, and then veered away from it.”

These stories are intimately related, though, and cannot be divorced from one another. Social distancing and mask wearing became cultural and social signifiers: I believe in the virus and I'm taking it seriously. If someone isn’t wearing a mask, it’s not a given that person is fully vaccinated or is following the updated CDC protocols. It could mean that person has decided not to get the vaccine, or that they haven’t been adhering to mask guidelines from the very beginning.

This stress and uncertainty around COVID behavioral social signaling can exacerbate those who are grieving. “We’ve been faced with being around people who don't want to get vaccinated, who haven't wanted to wear a mask since the very beginning and say awful things and make jokes about how they're immune or have nature's vaccine,” Albanese said. “Those are all triggers for me.” 

People who never adopted COVID-19 measures strictly in the first place might also have an easier time letting them go, which could be another reason why they seem baffled at the difficulty others are having breaking their habits. “It’s possible that conservatives, even if they complied with restrictions publicly, never really internalized these restrictions in the same way many liberals did,” said Ingrid Haas, an associate professor of political science at the University of Nebraska-Lincoln. “If you don’t really view the pandemic as threatening and think the response has been overblown, then you’re just going through the motions rather than internalizing the importance of the restrictions.” 

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Importantly, individual hesitations, caused by political reasons or otherwise, are largely not reflected in policy in the U.S. A survey from March found that nearly half of all schools were open full time, and a federal survey showed that only 12 percent of elementary and middle schools and a minority of high schools remain closed. The CDC recently changed its guidelines to say that most outdoor activities no longer need a mask. Even states with the most stringent COVID restrictions, like Massachusetts and California, have outlined how their policies will be loosening over the coming months. 

Green suggested that individual vigilance has consequences, like “policies and behaviors that aren’t supported by evidence, such as banning access to playgrounds, closing beaches, and refusing to reopen schools for in-person learning.” But these policies have all been lifted. California has now opened its playgrounds. New York City’s beaches will open Memorial Day weekend. Brookline, Massachusetts, which Green criticized for keeping its local outdoor mask mandate in place, decided to lift that mandate last week

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In general, focusing too much on politics doesn't capture the whole picture, said Thomas Talhelm, an associate professor of behavioral science at the University of Chicago's Booth School of Business. His work examines correlations between politics and personality, like openness to experience. But personality traits never perfectly predict people’s political leanings based on their personality—they're just one factor. “Things like trauma, conscientiousness or fastidiousness would play a role too," he said. 

Frani, a 35-year-old in New York City using a pseudonym, was fortunate not to lose someone close to her in the last year. But being surrounded by death, even if it doesn't personally impact you, is a big deal. In the spring of last year, she immersed herself in articles about people who died from COVID-19.

“I still have fears that my husband will die even though we're vaccinated,” she said. “Just because I've read so many stories about people's husbands dying. Or I have fears that my child will be that one kid who gets the rare syndrome, and visions of myself in the hospital. I have an overactive imagination. I tend to be anxious and impressionable. But I think a lot of people, not just me, are going through similar thoughts.”

For now, she is still wearing her mask outside and wiping down her groceries, just like she's been doing since the beginning of COVID-19. She knows the CDC says it's OK not to do those things, and she believes it. But she's still going to need a little time. 

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Part of it has to do with what The Atlantic's Katherine Wu called "post-vaccine inertia." Throughout the last year, public health advice has changed many times—which is a good thing. It’s been continually updated to reflect current knowledge. But each time we change our behaviors, it comes with a whole slurry of new risk calculations to make for ourselves and others. 

“As researchers learn more about the coronavirus and the vaccines, the rules of immune existence are changing at breakneck speed, and my emotional valence just can’t keep pace,” Wu wrote. “I will soon be sludged down in a pit of post-vaccination inertia, and I expect to be mired there for weeks.”

Frani also thinks it's a bit obtuse to zero in on people being “overly cautious” when the pandemic is still causing so much loss around the world. “It’s obnoxious, the sort of glee and readiness of which we’re abandoning masks when we see what's going on in India,” she said. “Of course we're all happy that things are going well here. But it’s so cringey to me that in the same breath someone would have the audacity to say, ’You're being too safe,’ when they are people praying for anything resembling this sort of safety that we have here in other parts of the world.”

In the U.S., if the situation continues to improve and vaccination continues, any people harboring more cautious behaviors will likely see those fade away on their own, without the need for any hand-wringing from others. 

“As time goes on and people become accustomed to living in a ‘post-pandemic’ world, the precautionary behaviors will become less frequent,” Taylor said. “That is, even anxious people will tend to drop their safety behaviors such as mask wearing and excessive cleaning of surfaces.”

And telling people to jump back into the deep end of normalcy isn’t the best approach, nor is berating them. “If you’re anxious about discontinuing mask wearing, then a gradual approach will be easier rather than doing it cold turkey,” he said. “We can show compassion by not making a fuss or a big deal if someone chooses to wear a mask, wash surfaces, not shake hands, or refuses to go into crowded indoor places.”

In a little under two weeks, Albanese will be fully vaccinated, but she will be giving herself the time and space she needs, partly for herself, but also for others who are struggling. “There are people like me that are walking around for the first time trying to take in this world without our loved ones in it,” she said. “And I'm going to wear my mask to let them know so that they could feel safer.”

She's found support in online groups, like COVID Survivors for Change, Faces of COVID victims, and COVID-19 Moral Support for Family and Friends; these groups are filled with people who intimately understand why walking into a crowded space might bring on a panic attack. “I'm not asking everyone to feel the same way as me,” Albanese said. “Actually, I don't want anybody to have to feel the same way as me. But how I handle this should be respected.” 

Follow Shayla Love on Twitter.