Shelly Hendricks already had to make a great effort to communicate with others before face masks became a part of daily life.

Born with profound hearing loss, she was reliant on reading lips to understand what people were saying. Now that health officials are recommending that masks be worn in public to limit the transmission of coronavirus, she and other Minnesotans who are deaf or hard of hearing can't tell whether someone is speaking to them.

"It's really easy to feel left out in certain situations that other people take for granted," said Hendricks, a school nurse in Minneapolis. "That's part of why the mask thing becomes even more of an emotionally fraught situation for me. I already feel isolated at times. I already don't get information. And all of a sudden, here is another barrier."

Face masks have become a new obstacle for people with hearing loss — in Minnesota, that's estimated to be 20% of the population, according to the state Department of Human Services. A recent study highlighted by audiology publication the Hearing Review showed that a simple mask can reduce a voice by 3 to 4 decibels, while the N95 masks medical workers use can reduce it by close to 12 decibels.

It can pose a serious challenge for the elderly, who are both more likely to have hearing loss and to become severely sick from coronavirus. The hectic environment of hospitals, the noise of medical equipment and the tired condition of patients only make it harder to hear and process information, said Dr. Janet Hansen, an audiologist at Hennepin County Medical Center (HCMC).

"This adds an extra layer of difficulty not just where I work, but everywhere," Hansen said. "I think everybody in any medical environment is experiencing this right now."

Hendricks was frustrated that she had not seen any information from government agencies on what those with hearing loss should do while out in public, where she has already experienced several awkward situations.

At the grocery store, she was unable to speak with an employee wearing a mask who was directing people to checkout lines. At the park, she had to look to her son to learn what another person was saying to her. At the library's curbside book pickup, she did not know what an employee was trying to tell her, so the person shrugged and walked away.

The discomfort got to a point where she stopped wearing a mask, just as a way to signal that she relied on seeing another person's mouth to understand them.

"I have felt shame and embarrassment myself, because I feel like I'm a good citizen. I'm a public health nurse. I want to do the right thing," she said.

For someone who wears hearing aids, reads lips or uses American Sign Language, seeing the mouth is key, said Darlene Zangara, executive director of the Minnesota Commission of the Deaf, DeafBlind & Hard of Hearing.

"When you have a mask on, you can't lip read," said Zangara, who identifies as Deaf. "There's been no real adjustments made to help communicate unless they had personal experiences with people who are deaf or hard of hearing. So it's been very frustrating."

Finding solutions

Some creative alternatives are helping.

People are making masks with a clear plastic cover over the mouth. Others are wearing shirts with text explaining they are hard of hearing.

Hendricks designed and ordered 100 blue buttons with a message in bold type: "I have a hearing loss. I can't read minds. I can read lips. I can read." She has given away several and begun wearing them — this time with a mask on.

Zangara recommended that people use more expressive forms of communication, such as gesturing or writing notes on a piece of paper. She hopes more masks with the clear plastic over the mouth are soon available for purchase.

At hospitals and clinics, nurses and doctors are more accustomed to dealing with patients who are hard of hearing, Hansen said. They can raise their voices or give patients portable amplifiers. Hospitals including HCMC and Abbott Northwestern also use in-person and video interpreters.

"You almost can see the relief on the patient's face," said Hansen, who uses interpreters regularly in her practice. "I prefer to have a real person with me ... but in the current time, having someone on video where my patient has full access to the sound and seeing their face has been really helpful."

Hendricks hoped that by wearing her buttons she is able to raise awareness of an issue that, like the virus, won't go away anytime soon.

"This isn't about making people feel sorry for me, it's not about shaming anybody," she said. "It's just trying to bring light to a situation."

Miguel Otárola • 612-673-4753