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Allysa Dittmar still remembers the day clearly. While undergoing a hospital procedure in 2017, the doctors, suited up in their surgical gowns and masks, asked her a number of pre-op questions. But she couldn’t understand their words or give them answers. Dittmar is deaf and relies on lip reading, sign language, and other visual cues to communicate. The interpreter for the hospital never showed up due to a clerical error. Eventually, the medical staff just stopped trying to talk to her, and instead moved her body around for her as if she were a doll. It was dehumanizing and disorienting, she recalls.

Dittmar’s experience might ring familiar to others. Close to 15 percent of the adult US population reports some difficulty hearing—an issue that’s gotten little attention as mask wearing becomes the necessary new norm. With nose and mouth coverings, individuals who are deaf, hard of hearing, or speak foreign languages will have a harder time relying on lip movements and facial expressions to understand the discourse around them. Dittmar’s story shows that this issue predates COVID-19—but the pandemic has brought it to scale, while adding the challenge of managing infection.

“Not being able to see facial expressions with masks has always been a problem for the deaf and hard of hearing,” says Aaron Hsu, the CEO of ClearMask. He and Dittmar, whose background is in public health and policy, co-founded the company three years ago to design one of the first transparent surgical masks with full face visibility. “It took a pandemic for people to realize consciously and explicitly that seeing someone’s face is so important,” he adds.

It’s an issue of universal design, says Bernard Hurwitz, an administrator at the National Technical Institute for the Deaf (NTID) at the Rochester Institute of Technology. Universal design, he explains, is the idea that all products and systems can be adjusted regardless of the user’s age, disabilities, or other features. For example, the textured floor tiles in subway stations alert people with limited vision when they’re getting close to the edge of the platform—but even people with full sight benefit from knowing what that safe and acceptable distance is.

When the world started wearing masks, they didn’t think about who they were leaving behind, Hurwitz, who is hard of hearing himself, says. As a result, Personal Protective Equipment options have largely been built around the needs of the general public. “We always have to consider accessible alternatives for vulnerable or marginalized populations,” says May Chu, a clinical professor at the University of Colorado, who was previously an advisor for the Centers for Disease Control and Prevention (CDC). “We’re still learning as we go.” Clear masks are a great idea, she adds, but there’s still relatively little research on their effectiveness in preventing viral spread. They’re usually made of plastic rather than cotton, which makes them harder to breathe through and clean. Not to mention that polymer products often fog up, blocking the view and negating the purpose of the transparent mask.

Regardless, Chu stresses that “public health is for all,” and that scientists need to pour more willpower and resources into designing accessible masks. Tiki, LEAF, and iMASC claim that their silicone and plastic coverings filter SARS-CoV-2, but their products haven’t been approved by the CDC or World Health Organization. Meanwhile, a search for “clear face masks” yields dozens of DIY results on Etsy.

Availability might be the biggest barrier to getting more people to wear clear masks, but it isn’t the only one. Hsu concedes that cost is a major factor: Buyers who snap up surgical masks for less than a dollar apiece might think twice about spending $4 on a ClearMask. They’re even more likely to balk at the $61 price tag on the LEAF mask. But Hsu also points out that it’s important to think about the value gained from a more expensive and accessible product, even in situations that aren’t strictly COVID-related. “If you’re having your first child via C-section and your partner’s there with you and has to wear a mask in the operating room, how much is it worth to be able to see your each others’ faces and expressions?” he asks.

Often the burden to spur change for accessibility falls on marginalized groups. But for clear masks to benefit deaf or hard of hearing individuals, others need to wear them, too, Hsu says. That’s a message Hurwitz thinks needs to spread more widely. Right now, the public doesn’t know about clear masks or finds them off-putting. But with a little education, he says, people might accept them as readily as regular masks. “The potential gains are tremendous: A clear mask makes things accessible for a small segment of the population, but you end up benefiting everybody by doing so.” That’s why he and his colleagues at NTID pushed for the Rochester Institute of Technology to provide clear masks for all staff, faculty, and students—around 20,000 people total.

To Hurwitz, it was crucial that the university make clear masks available for everyone to reduce other-ing. “We didn’t want people to walk around campus, see someone with a clear mask and say, ‘oh, that person is deaf or hard of hearing; that person is from NTID.’ If everyone is wearing a clear mask, then you can’t tell, and that’s the goal of integration.” The university jumped on board quickly. “We’re very proud of that,” Hurwitz says, “though it will take some convincing for those who like having that cloak of invisibility with a regular mask.”

For Hurwitz and other disability advocates, putting on a more accessible mask means showing solidarity in the face of a crisis. If everyone is willing to take a step towards compromise, the world will not only be more accepting, it could also be one step closer to defeating COVID-19.

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