Unfortunately, the new job has sub-standard health insurance coverage that will not cover a pre-existing medical condition, and any surgical costs would have to be paid by the family. Additionally, the family would enjoy the peace of mind knowing that their current healthcare coverage would relieve any (or at least provide minimal) financial responsibility for the parents. There should (barring unforeseen events) be minimal urgent need for the identification of a necessary medical-surgical procedure during the early time of the relocation to the new community In declining the elective surgical procedure at this time, Nathaniel and his family need to recognize an entirely different set of potential consequences.
Emmanuel Levinas1 Introduction During the COVID-19 global pandemic, in combination with handwashing and eye protection, face masks have become necessary apparel for healthcare professionals to prevent transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).2 As the mouth both breathes and speaks, a barrier to potentially infectious respiratory droplets can also be a barrier to communication. The Chinese would place terrifying paper masks over the faces of their children to frighten away the demon believed to cause smallpox.5 In 17th century Europe, physicians who treated victims of the bubonic plague wore protective masks with glass eye apertures and long beak-shaped noses stuffed with aromatic herbs and spices believed-incorrectly-to purify the air they inhaled through the mask.6 In the 20th century, in response to the deployment of poisonous gases in World War I, the Allies developed gas masks consisting of a rubberized fabric face covering supporting two circular eyepieces and fitted with a cannister through which the wearer breathes. The neurobiological basis of this mimetic function is the mirror neuron system, which contributes to empathy, or the ability to share the feelings of others.13 When subjects were shown disgusted, neutral, or pleased facial expressions during fMRI, their selfreported empathy correlated with neural activity in the anterior insula and adjacent frontal operculum, suggesting that these brain regions contribute to the mapping of others' emotional states onto one's own internal emotional state.14 Effect of Masks on Relational Communication It is reasonable, therefore, to ask whether concealing part of the face by wearing face masks hinders nonverbal communication during medical care. In a controlled study of 1030 patients who were randomized to primary care clinical consultations with physicians either wearing or not wearing face masks, a significant negative effect for masks was found in patients' perception of physician empathy.15 They concluded that wearing masks diminished the positive effects of relational continuity.16 Although not empirically verified to date, research mapping regions of facial activation to specific emotions suggests that masks might not only restrict emotional communication in general, but also introduce a negative bias.
