To wear a mask or not to wear one.

It’s developed into one of the enduring debates of the COVID-19 pandemic. And in the eyes of many, it’s more a matter of motive than need that drives the debate.

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The issue was front and center Tuesday, May 19, with Shelby County Health Department Director Alisa Haushalter discussing it at the daily COVID-19 task force briefing before the Memphis City Council later in the day approved on second reading an ordinance that would require wearing a mask in public places across the city.

And a day earlier, the Shelby County Commission approved a resolution urging the Health Department to make face coverings and masks mandatory.

The Health Department issued a new directive Monday, May 18, as the Memphis area moved into Phase 2 of its reopening plan. The new directive, which applies countywide, recommends wearing a mask or covering. But the word “recommend” as opposed to “require” is still open for debate, Haushalter says. 

“Dr. Randolph and I will continue to explore the movement from use of the word ‘recommend' to ‘require,'” Haushalter said, referring to Health Director Dr. Bruce Randolph. “As of today, our position is we would prefer to use that stronger language at a time where it is deemed most necessary. We want to focus right now on educating the public.”

The debate draws in other experts as well.

“I’m in favor of the spirit of the law, but I think the letter of the law presents significant problems,” said Dr. Stephen Threlkeld, an infectious diseases expert at Baptist Memorial Healthcare-Memphis.

He says there is an “over-simplification” of the issue into those who wear masks and those who don’t.

Threlkeld counts three groups, adding those who don’t wear masks properly.

“And you can look at any video clip or any photograph or better yet, go to the supermarkets and look around you,” he said. “Most people are touching their masks very frequently because they are somewhat irritating. And then they touch their surroundings. And then they come back and touch their mask again, thus creating a separate danger to themselves and potentially to others.”

Among medical professionals such as Threlkeld, there’s little debate about whether masks help lessen transmission of the virus. Dr. Jeff Warren, the City Council member who sponsored the pending council ordinance, cites guidance from the Centers for Disease Control and Prevention that encourage masks and face coverings.

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Yet Threlkeld notes the World Health Organization has yet to recommend universal mask use because of the misuse of masks. The CDC, he said, was pushed to universal masking by the threat of asymptomatic carriers.

At the same time, Threlkeld is concerned that hand hygiene seems to have taken a back seat in the argument.

“In the face of wearing masks, we need to redouble our efforts to clean our hands carefully, resist the urge to touch our face and to maintain the proper distancing,” he said. “There is a tendency to become over-confident and move closer to other people because you think are you are more protected by wearing masks.”

Improper use of any tool, including masks, can have untended consequences, he says.

“We don’t know that masks are more important than hand hygiene and distancing. We just don’t know that,” he said, adding that someone in the checkout line a day ago could have touched his or her face mask and then touched a magazine or package of candy and left the virus.

“The person without a mask would have been a danger to you for a short time in the close-proximity issue. There are risks out there that we probably are not paying enough attention to,” Threlkeld said.

Dr. Scott Strome, dean of the college of medicine at the University of Tennessee Health Science Center, describes himself as “100% supportive of people wearing masks.”

It’s the motivation that is up for discussion with him.

“Ideally, we would like our community to come to an agreement that it is the best practice because we think it will save lives. I really hope people come to that decision by themselves,” he told The Daily Memphian.

“I don’t know that I think we can force people. Just like we don’t force people to not smoke when we know they have a higher incidence of disease and mortality. I don’t know that we can force them to wear a mask. But please, don’t confuse that with the idea I want everyone to wear a mask, because I do.”

But Haushalter cites a different precedent – seat belts.

The federal law putting seat belts in cars dates to 1968. But New York was the first state to have a law requiring seat belt use in 1984.

”It’s important we create a social environment where masks are the norm,” she said. “We are going to really encourage businesses to set their own policies to require people to wear masks. If it’s a fashion statement, people are more likely to wear masks, so we encourage people to get creative with their masks and we believe that will help move people to wearing more masks and facial coverings in public.”

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Previously, Haushalter has expressed some reservations about a mask requirement, citing violent reactions to even the voluntary wearing of masks in other cities and states. This week, she talked of a “greater evaluation” and surveying who is and who isn’t covering their faces.

“The only people who would really be close to you all the time are those who live with you on a regular basis. When you’re around everybody else, you should wear a mask,” she said.

“If you’re out taking a hike in the woods, walking your dog and there is no one around, you don’t need to put the mask on. But if someone comes up and wants to engage in conversation, you should put your mask on. So really, it’s thinking about that more intimate social contact and proximity to other people.”

Among City Council members, Warren has been touting the importance of masks all along.

“If we open this up and everyone does what they are supposed to and they wash their hands and keep their distance and they cover their faces and make sure they don’t transmit this as we open things up, we may not need this to even be brought into law,” Warren said of the mask measure during a lively May 5 council discussion.

Two days into Phase 2, Warren Tuesday was still sticking to his guns on the need for the ordinance. He said there could be some tweaks or other changes before third and final reading at the June 2 council session.

Council member Ford Canale says he agrees with the need for face masks and face coverings.

“My only concern was that he would burden the Memphis Police Department if they had to write citations,” Canale said during the May 5 discussion. He also questioned “the burden on the impoverished part of our community.”

Warren said Police Director Michael Rallings has raised similar concerns.

Council member JB Smiley said he too is for face masks and coverings. “My concern with it is, we would be fining a community that is already suffering,” he said.

Since the council discussion, the supply of masks locally from various sources has grown through community efforts and a flow of face masks through commercial pipelines.

The council fielded a handful of written comments that were read at the end of a lengthy online meeting Tuesday evening about various issues, including several about the mask issue.

Patti Possel, a Republican candidate for the Tennessee Legislature in the November general elections, wrote that she has made masks for friends. But she says a requirement or ordinance would be irresponsible because the effectiveness of masks varies as the styles vary.

“An ordinance that might encourage using a general purpose mask of unknown safety and effect for a medical purpose will give the public a false sense of security that encourages behavior that harms the public health and defeats its intended purpose,” Possel wrote.