No outfit is complete without a mask these days.
Recommended by the Centers for Disease Control and Prevention and sometimes required by businesses, face coverings have become a new social standard in many parts of America. But while masks serve as barriers to the spread of COVID-19, they've also become an additional barrier in communicating for those who are deaf and hard of hearing.
"The best word to describe it would be a challenge," Brenda Schertz, a senior lecturer of American Sign Language at Cornell University, said in an ASL-interpreted phone call with NBC News. With 48 million Americans who are deaf or hard of hearing, according to a 2011 Johns Hopkins University study, the problem affects a significant part of the population on a daily level.
"Going into the grocery story or the bank or really any other public place, we are heavily dependent on facial expression and visual cues on peoples' faces, and some of us can lip-read ... and no longer do we have access to that, because everyone has masks on."
Schertz described how, recently, she had a new washing machine delivered to her home and had intended for the delivery men to take her old washing machine with them. But there was a "communication breakdown," she said, and because everyone was wearing masks, she couldn't understand what they were trying to say. The old washing machine stayed put, and she had to call Lowe's back to understand what happened.
"It was just something that was no big deal, but I had a huge communication breakdown," Schertz said.
Similarly, Schertz described how a friend struggled to communicate at a drugstore. Because the clerk was wearing a mask, the friend didn't understand the simple question of whether she was paying in cash or by credit.
"Just simple little things that, without a mask, we would have figured out very quickly what was needed from us. But with this mask on, we're guessing or we have to write it down," Schertz said. "We have no other way if we can't hear and we can't see the words being formed on the mouth. It's a huge challenge ... an added barrier, for sure."
The barriers in everyday communication are often intensified when deaf people seek medical care – a longtime issue that has led to significant health impacts in the community and has become even more complicated in a pandemic.
The disparities in health education and access to care have historically led to "inadequate assessment, limited access to treatment, insufficient follow-up and poorer outcomes," according to a 2013 article in the American Psychological Association's Spotlight on Disability Newsletter by Lawrence Pick, a professor at Gallaudet University in Washington, D.C.
Battling all these long-existing barriers is what led Anne McIntosh to create the Safe'N'Clear Communicator mask, the first medical mask approved by the Food and Drug Administration with a clear window over the mouth to facilitate better communication — something she said would improve patient care for everyone, not just those who are deaf or hard of hearing.
"Reading facial expressions is critical to interpreting communication more accurately," McIntosh said in an email. "There are studies that show communication breakdowns in the OR can lead to medical errors that lead to less than optimal outcomes for the patient."
While the push for more widespread use of clear face masks is ongoing, the reality is that deaf and hard of hearing people have had to rely on other resources to communicate effectively and access information.
Ashlea Hayes, a board member for National Black Deaf Advocates, has mostly been writing down messages to communicate — but even that isn't ideal for people whose primary language is ASL.
"It's never enough, because English is not our first language. Our first language is our visual communication, and that's how we get information. And that's how we understand the world around us. ... If you take that from us, we feel left out," Hayes said through an interpreter.
The process can take an emotional toll, as well.
"I kind of feel like I'm in this bubble alone. People can't see me or hear me," Hayes said. "I feel more isolated now than before, honestly."
Creating more accommodating spaces for the deaf and hard of hearing community is an "age-old question," Hayes said, but there can be helpful steps in the process. Her local Starbucks provides a roll of paper to write orders down on, and there's a screen that shows people's names when their coffee is ready. Adding live-captioning on platforms like Instagram has also been an improvement.
In Schertz’s hometown of Rochester, New York, which has a relatively high population of deaf and hard of hearing people, Schertz said having ASL interpreters in the hospital has always been critical. She adds that many in the community have also taken it upon themselves to let stores and pharmacies know that not everyone can understand their employees with masks on.
What it simply comes down to, Hayes and Schertz said, is for hearing people to understand that not everyone communicates the same way. How everyone experiences the new mask norms may not be the same, either.
"I would just hope that people would be more tolerant and maybe try to invest in a new mask that has a see-through portion where the mouth is," Hayes said. "That's not a complete solution, honestly. But at least it's something, and it's a helpful step to get where we need to be."