The Ugly American Unmasked

After 20 months of working solely and continuously in a COVID Intensive Care Unit, one cannot help but develop a type of COVID Stockholm syndrome, where venturing out into the world is measured in terms of risk of infection. So, it was with great trepidation that I approached a long-awaited dive trip to the Galapagos.

While not the first time I had been there, it remains one of the pinnacles of diving adventures. However, that was not during a life-threatening pandemic that had left me exhausted and focused on the health hazards of traveling.

While the first COVID wave was met with tremendous public support for those of us in the frontline, the band has long since stopped playing. Today, the majority of those in the ICU are the unvaccinated.

Still, we have regularly been confronted by naysayers questioning the validity of our therapies, the veracity of scientific evidence, and the ongoing need for infectious precautions. Venturing out into an unmasked world seemed profoundly challenging.

However, upon discovering that Ecuador required vaccination and a negative COVID test to enter, I felt greatly relieved but realized I still needed to be vigilant and thoughtful.

The Isla Hotel in Puerto Ayora was a delightfully welcoming place to meet fellow travelers and get reacquainted with Ecuador. It is the law to wear masks in Ecuador, and people gladly abided by the requirements knowing and acknowledging the vagaries of a potentially lethal disease.

The new government had been elected on a promise of an aggressive vaccination policy and had largely exceeded expectations. Whether it be in the fields tending to crops, driving their cars, or out enjoying the day, irrespective of age, Ecuadorians adhered to safe practices such as masking. While the CDC statistics have demonstrated that the pandemic's early days had largely overwhelmed the system, the country now seemed to be on a different trajectory in part due to a sense of social responsibility, civic duty, and governmental policies.

On the morning of our departure to the dive boat, Tiburon Explorer, we gathered together at the hotel, where we finally met as a group. There were four Europeans and eight Americans. The policy/etiquette for the boat is that masking is compulsory for everyone.

The crew was spectacular in their respect for this policy, understanding that travelers could be potential carriers of the virus, that breakthrough infections occur, that mutations were an ongoing concern, and that ensuring safety was paramount for all involved. It was a very clear statement that our safety was a priority.

It came as no surprise then as to the demarcation of adherents to the masking policy; four of the eight Americans largely refused to wear masks. They were vocal in their opposition and gleeful in their rebellion.

"We're vaccinated; we didn't pay all this money to wear masks on vacation," they would say, adding, "most people I know had just a bad cold when they had COVID; this is fearmongering."

Clearly, the lethality of the disease and breakthrough infections were not something they cared to acknowledge; that would be surrendering to fear, ignorance and exaggeration according to their narrative, even though they themselves had been vaccinated.

Thoughts of protecting or addressing the concerns of the crew never entered their rebellion. Importantly, not everyone is on a level playing field when it comes to COVID vaccine protection. Ecuador has pursued a vaccination policy that utilized any and every vaccine available, irrespective of its origin and efficacy, clinically inferior or otherwise. In other words, the crew still remained potentially vulnerable.

Not surprisingly, the crew was largely despondent as to their options in dealing with the unmasked passengers as they did not wish to endanger their tips by alienating their clients. Consequently, the dive groups quickly divided into those who would and those who would not tolerate such behavior.

By wearing masks, we were not only protecting ourselves. Instead, we were respecting and protecting the crew. Was this such a huge sacrifice during a global pandemic? Clearly, for some, it was.

As a COVID frontline clinician, I realize that the policies in relation to COVID have been far from perfect. Nonetheless, when one is a guest in a foreign country, it is important to respect their efforts and citizens in dealing with a disease that has caused widespread tragedy and unspeakable suffering. Sadly, COVID remains a serious and ongoing threat.

The vaccine has saved countless lives and has been one factor in moving forward but is undermined by social irresponsibility and narcissistic behavior. The crews of boats and staff of resorts that devote themselves to our care, safety, and enjoyment deserve better.

If only there were a vaccine for stupidity.

- Max Weinmann MD