Is This the Hill To Die On?

By Chuck Dinerstein, MD, MBA — Aug 17, 2021
The pushback over mask mandates has been fierce. It’s been portrayed in the media as another skirmish in the political and cultural wars. And while there’s an element of truth to that, framing all of the COVID controversies as political can lead us very much astray.
Image by Larry White from Pixabay

In large part, those willing to wear masks and those not are entrenched in their beliefs; probably the same for those on either side of the vaccination and social distancing debates. These two groups of metaphorical combatants are committed to their fight. But are these entrenched positions worth dying for?

Florida and Texas both can serve as bellwethers of the masking hill. In Texas, Governor Greg Abbott issued an executive order prohibiting localities from issuing mask mandates and been backed up by judges in Dallas and Bexar Counties, who have issued temporary restraining orders (TRO).'

“[officials] cannot be precluded from implementing the mitigation strategies he believes are sound, reliable and backed by scientific evidence.”


As anticipated, Governor Abbott’s “determination to protect the rights and freedoms of all Texas people has not been shaken.” [1]

To gain a bit of perspective, the number of cases in Texas is 48 per 100,000 – 23% higher than the US average. Hospitalizations are 36 in 100,000 – 63% higher, and deaths 0.54 per 100,000 – 170% higher. [2] According to Health and Human Services, slightly more than 90% of Texas’ ICU beds are full, and overall hospital capacity is 78%. Hospitalizations are only marginally higher than our national average, by 4%, but the critical care utilization is very worrisome. First, WHEN 90% of beds ARE filled, there is little room to care for victims of accidents, and to maintain "open beds," the hospital is forced to reduce “elective” surgery. [3] More importantly, that 90% aggregate is unevenly distributed, so many hospitals may have only a bed or two beds available.

The narrative versus a different reality

As I said, the narrative pits those worried about health consequences against those worried about liberties. Consider the words of Governor De Santis of Florida.

“We can either have a free society, or we can have a biomedical security state, And I can tell you, Florida, we’re a free state.”

Or the words of US (?) Education Secretary Miguel Cardona,

“The Department stands with these dedicated educators who are working to safely reopen schools and maintain safe in-person instruction.”

To my mind, the argument is not based upon being a Republican or Democrat, even though political affiliation is mentioned every time the subject of masks and other non-pharmacologic interventions arise. The argument is not about being fearful or fearless, as I misspoke the other day. It is about what you fear more. No one fearful of COVID-19 in their immediate life will fail to get vaccinated, even if they are Republicans. And no one who is fearful of the overreach and intrusion of government is going to wear a mask, even if they are Democrats. No one will die on the hill of vaccination or masks based upon political affiliation; they decide based upon their fears. Their political affiliation is not causal; it is an excellent example of why in scientific papers, association does not always mean causal. 

Our built-in sympathetic nervous system frequently dictates our behavior – we don’t call it "fight or flight" for no reason. Our instinct, honed over millennia, is to fight or flee – for those like Governor Abbott who are more fearful of losing their liberties than of becoming a victim of COVID-19, mask mandates are to be resisted at all cost. For those more fearful of the virus and less concerned about government intrusion, mask mandates are to be accepted if not embraced.

Thinking Fast and Slow by Daniel Kahneman discusses our decision-making. We initially respond with our instincts – sympathetic fight or flight – but then we can analyze our situation and think more slowly. Fast thinking suggests, and slow thinking confirms and reinforces. But the fast thinking of our intuition, of our fears, may not be countered by our more reflective selves. Any one of us who has given in to the temptation of dessert while dieting knows which thought system is really in charge – at least in that instance.

We should stop framing our COVID concerns and conversation around politics and group affiliation. When faced with the existential loss of our lives or liberty, we are acting from fear, not a consideration of “the welfare state” or “compassionate conservatism.” FDR facing an existential economic crisis for our nation, said it best,

“let me assert my firm belief that the only thing we have to fear is...fear itself — nameless, unreasoning, unjustified terror which paralyzes needed efforts to convert retreat into advance.”

We will be a great deal less divisive if we recognize our fears and the fears of those who seem to be our opponents.


[1] Texas Counties Win Court Orders Blocking Governor’s Mask Ban Bloomberg News

[2] Coronavirus in the US: Latest Map and Case Count NY Times August 13th – Remember folks, the numbers change daily.

[3] “Elective” surgery is a bit of a catchall phrase. Operating on your cancer can be elective if it is not life-threatening at the moment. The only genuinely elective surgery might be cosmetic. Some surgery lies in between; call it urgent.


Chuck Dinerstein, MD, MBA

Director of Medicine

Dr. Charles Dinerstein, M.D., MBA, FACS is Director of Medicine at the American Council on Science and Health. He has over 25 years of experience as a vascular surgeon.

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