May 16, 2023 - Health

Industry debates continued masking in health care settings

Illustration of a mask with an animated "no smoking" symbol over it, with the crossbar extending to different lengths, but never getting all the way across.

Illustration: Brendan Lynch/Axios

The deep divide over masks that was a hallmark of the pandemic is splitting the medical community, where many health workers and their patients, now free of mandates, are opting not to wear them.

Driving the news: The demise of CDC and state mask orders for medical settings has been welcomed by providers who worried about a loss of connection with patients, or communication challenges with those with hearing loss.

  • It's also welcome for those patients who found them uncomfortable and questioned their benefit amid waning community spread of COVID-19.
  • But for others, it marks the end of a critical line of defense against COVID — particularly for the most vulnerable patients — in one of the last places they could expect precautions.

What they're saying: "This is a time when a lot of hospitals, including, ironically, my own hospital, are making masks optional," said Tara Palmore, an epidemiologist at George Washington University Hospital in Washington, D.C. and co-author of a commentary published in the Annals of Internal Medicine Monday.

  • The concern is "the idea that we could inadvertently make patients sick by exposing them to our own illnesses," she said. "We can protect ourselves by wearing masks. We can also protect patients."
  • Health care workers' well-established history of coming to work sick further supports the continued use of masking, Palmore and others say.

Yes, but: A review also published Monday in the Annals of Internal Medicine found little to moderate benefit to masking in communal settings, and a similar risk for COVID-19 infection in routine medical settings for those wearing surgical masks and more snug N95 respirators.

  • Researchers couldn't rule out there might be some benefit to wearing N95 respirators.
  • A study, presented last month at the European Congress of Clinical Microbiology and Infectious Diseases in Copenhagen, found that hospital mask rules didn’t stop the spread of COVID in the absence of other precautions, meaning institutions could adopt "mask optional policies" without increasing risks to patients, the Los Angeles Times reported.

The big picture: The medical consensus still supports the use of high-quality masks to reduce the transmission of COVID and other infectious diseases.

  • "The long and short of it is: Masking is a good thing and we should use it as we need it," Tania Bubb, the president-elect for the Association for Professionals in Infection Control and Epidemiology, told Axios.
  • But APIC has not taken a position on whether health care settings that still have mask mandates should scrap them, she said, adding decisions should be based on the institution, patient population, geographic setting and risk for disease in that setting.
  • Community surveillance to help measure COVID transmission largely ended with the end of the public health emergency last week, making those assessments harder, she acknowledged. "I'm struggling with that in terms of how do we get that accurate picture," she said.

Between the lines: Masks use became highly politicized during the pandemic, and studies presented at times confusing conclusions of their effectiveness.

  • One review from the Cochrane Library caused an uproar in March with some commentators citing it as proof masks didn't work while experts and Cochrane officials disputed that interpretation as "misleading."
  • Another study, published in November, stirred controversy after suggesting medical masks may offer similar effectiveness as N95 respirators in protecting health care workers, Fierce Healthcare reported
  • "We just don't need another poorly designed and conducted study on this," said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota at the time.

Be smart: The idea of mask mandates going away in health facilities raises alarm bells for medically vulnerable patients still very much living with the reality of the pandemic, said Charonda Johnson, a veteran and strategic partnerships manager for COVID Survivors for Change, who suffers from long COVID. She also lost her father to the virus.

  • During a recent visit to a VA hospital for another bout with COVID, she was given a prescription to pick up at the hospital's pharmacy.
  • "I walk in and everyone was unmasked. I wanted to scream," she said. "Nobody's acting like there's anything different or like there's any risk. What kind of sense does that make?"

Go deeper: Listen to the Axios Today podcast, where host Niala Boodhoo and Tina Reed discuss the ongoing masking debate in health care settings.

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