"You Don't Look Sick" Redux

Or, on public health, misinformation, and mortality

I am back on tour with Noah Kahan. Being a touring musician with two chronic illnesses at a time when a contagious respiratory virus is ravaging the world with zero institutional intervention…is scary! The burden to protect myself falls squarely on my shoulders. I wear this mask on planes after a recommendation from Amos Lee in the spring of 2022, and I wear this mask everywhere else—in hotel lobbies and elevators, in the van, backstage at the venue, and any bookstores or supermarkets that I patronize while I’m on the road. My mask really only comes off when I’m onstage and when I’m alone in my hotel room. I do nasal humming every night, which increases nitric oxide production and thus helps fight and prevent viral infection. I eat whole grains and organic fruits and vegetables. I sleep at least eight hours a night except when it is logistically impossible. I hydrate, and then I over-hydrate. I sanitize my hands and my microphone with surgical frequency. I should probably be better about consistently exercising when I’m on the road, but I never professed to be a perfect person. I say all this to illuminate that while my primary job on tour is, you know, to perform music for 45 minutes a night, my secondary job is Illness Prevention & Management.

Getting sick on tour sucks for everyone. Even if your immune system is a perfectly functioning machine, catching a cold and not being able to operate at 100% means a subpar performance at best and a show-canceling inconvenience at worst. For someone like me, getting sick would not only mean the usual symptoms of a cold, or a flu, or a COVID—it would also mean that my body would break out in full body hives. This is to say nothing of the possibility that catching COVID could trigger a whole new slew of autoimmune symptoms. I have never tested positive for COVID (knocks on all available wood), but I wonder, still, if my thyroid condition and my chronic hives were perhaps triggered by a COVID infection that I somehow missed.

Writing this is stressful, and not only because my health anxiety is exacerbated by even writing, reading, or thinking about illness. It’s also stressful because you do not want to read this. It is likely that for you, the pandemic has been over for a long time. You attend crowded indoor events unmasked. You walk around coughing or sneezing because “it’s just a little cold” and you don’t want to miss out on anything after however many months you stuck it out avoiding the masses. You haven’t taken a COVID test in months, maybe years. You do not force your friends to socialize with you out of doors. You do not skip concerts and parties. And when I remind you that there are people like me, you want to look away.

I am not even close to the most COVID-conscious person I’ve heard of. I don’t wear masks outside, and I will attend indoor events that are important to me with a mask on. (I went to exactly one indoor party in 2023 without a mask, and I insisted on daily testing and symptom monitoring for five days afterward, even though my mother, for whom I am the most concerned, said that there was no need. Fortunately, I never developed symptoms, and I always tested negative). I date; I kiss people without always asking for proof of a negative test. I often go to sessions with masks on, but when I know the people I’m working with and trust their awareness of my conditions, sometimes I don’t. When I go online and read posts from people more cautious than I am, I often find their replies and comments filled with vitriol. Every time, it is shocking to me. I wrote the bulk of this essay before city and state governments started pursuing mask bans. What is it about the presence of someone else wearing a mask that seems to make even supposedly leftist individuals so angry? How can people organizing for a free Palestine and climate justice and abortion rights look at a chronically ill or disabled person trying to take care of themselves and start sounding downright conservative? What it boils down to, in my view, is a rage at being reminded of one’s own mortality.

We all know we’re going to die. It’s not a secret. Many of us have come to terms with this. But for some reason, it appears it is a secret that we’re all going to get sick. Sickness is inevitable. Chronic illness will set in at 18, 25, 50. It’ll be the cigarettes; it’ll be the drink; it’ll be the red meat; it’ll be the generational trauma. It’ll be the mono, the flu, the pneumonia that never really goes away. You recover, and you’re never the same. Even if you are lucky enough to live to old age, one or more of your organ systems will fail—what do you think “dying of natural causes” means? I’m not saying this to scare you. I’m saying this to humble you. I wish I had humbled myself. When I was 23, my body betrayed me. She still hasn’t earned my trust back.

You do not want to hear this. You want to believe that it will not happen to you. It is becoming harder and harder to believe this. The apathy of the American government (and most governments worldwide) toward the chronically ill and the disabled means that more and more of us will start falling into those demographics; if the government cared about sick people, we would have better air filtration, and vaccines and medications and testing would be free (or at least more affordable), and the most powerful elected officials in the nation would not be pretending that the threat of COVID has passed. It has not. While case counting is much less rigorous than it was a couple years ago, intrepid scientists are tracking wastewater data, and it bears out the uncomfortable truth that COVID continues to spike in seasonal waves, year after year. Chronically ill and disabled people are being told they have no right to exist in public space, while presently healthy and able-bodied people live in denial that the ongoing mass disabling event will never cause them long-term illness or disability. People who clamored and clawed to get the first dose of the vaccine are declining boosters, are saying things like “back during COVID,” are asking me why I am still wearing a mask.

I am sorry that this is the truth. I am sorry that this is never going away. Because of climate change and its attendant zoonotic disease spillover, there will be another pandemic. It will be milder than COVID, or it will be much, much worse. If it happens sooner rather than later, mitigation fatigue will cause many, many people to avoid taking basic precautions out of sheer frustration. A rare silver lining is that this constant emergence of novel disease means ample data points for epidemiologists and medical professionals to study new ways of treating and curing them. The cloud that bears that silver lining: thousands if not millions of people will die along the way.

All hope is not lost. You do not need to lock yourself inside and never see another human being again. There is a middle ground. If you’re at all interested, here are the habits I’ve adopted in the last three years to keep myself safe:

• Wearing a mask indoors. The exceptions to this are: when I’m only going to be inside for a five minutes or less (like picking up a drink in a coffee shop), when I am performing (for obvious reasons), when I am alone or in a small group with people I can be confident are not contagious, when I am in a room with multiple doors and windows open for ventilation (and/or if there as a HEPA filter running at all times, although this of course does not apply in doctor’s offices, where I am always masked). Even in some of the excepted situations, I will still wear a mask depending on my comfort level with the other people around me.

• Avoiding indoor crowds when possible. As I said, I attended exactly one unmasked indoor party in 2023, and since developing my chronic illnesses, I will say no to almost all indoor parties and shows. Of course, when I do attend something—if it’s especially important to me or to a loved one—I almost always wear a KN95 the entire time. Also, due to my chronic illnesses, I can’t eat food at restaurants anyway, but when I join friends for restaurant outings, I often make the reservations in advance and specifically request outdoor seating. If for whatever reason I find myself at an indoor restaurant, again, I wear a KN95 the entire time.

• Practicing daily nasal humming and also using CPC mouthwash nightly. There’s limited clinical data out there about how effective CPC mouthwash is at preventing disease, but it’s often recommended for people who have already contracted a disease to reduce their viral load, so I like using it prophylactically as well (plus, using mouthwash is good anyway, so it might as well have some disease-fighting power).

• Avoiding sick people. This seems obvious, and yet I know so few people who do it. If I go to a session and the person I’m writing with tells me they’re sick, I might just leave and cancel it altogether, or failing that, I’ll put on a KN95. If a friend tells me they’re not feeling well, I cancel the plans. If I’m in a coffee shop or pharmacy and there’s someone coughing, I might also leave, even if I’m already wearing a mask. Basically, any place that I’m in electively, if someone is actively displaying symptoms, I will get the hell out. I know that it’s possible or even likely that the person is not contagious, but I see no point in taking the risk.

• Washing my hands and using hand sanitizer. Again, not a novel concept, but the hand-washing frenzy of 2020 has clearly died down. I take hand sanitizer with me everywhere, and I especially sanitize before putting a mask on, after taking one off, and before eating or taking medication. Also, I purchased a UV phone cleaner (I believe it was this one), because if you weren’t already aware, your smartphone is one of the dirtiest things you interact with on a daily basis. I don’t use my UV sanitizer every day, but I definitely use it after getting off a plane, or after exercising when I know my phone’s been exposed to a lot of sweat and dirt, or after I let someone else use it.

• Asking for testing. I don’t do this that much, but depending on how much risky behavior a person has been engaging in, I might ask them to take a COVID test before we spend time together in close quarters (and I might even take one too as a courtesy). And of course, if I’m ever feeling symptoms, I immediately let people know and cancel plans.

If you are a chronically ill and/or disabled follower of mine: I stand with you. I am so sorry that the government and the world at large has tried to minimize our suffering. I am sorry for every time you have been ignored or shouted at for asking for basic decency and care. I am sorry for every dismissive doctor, for every callous partner, for every ignorant friend. I am sorry for what you have missed out on in the name of protecting yourself. I wish you love. I wish you safety. I wish you remission.