Masking is Essential for Safety in Hospitals

We all want to put COVID behind us and get on with our lives and put aside all our fears and the constant disruption of our normal life.

Nevertheless, COVID is still here, causing severe disease, death, and long COVID. 

COVID did not kill me in 2021 because a nurse in my PCP’s office urged me to go to the hospital, my daughter arranged the ambulance, and the staff at Brigham & Women’s knew exactly what to do. Those wonderful professionals exemplified competence and compassion. So I can attest that they do understand how to deal with an airborne disease.

Why then did Mass General Brigham (MGB) decide to end essential protections that would help protect against infection? MGB announced that, with the end of the public health emergency mandates, it is ending universal masking from May 12, 2023 in all of its facilities, including Salem Hospital. In addition, they had at first decreed that patients could not “... ask staff members to wear a mask because our policies no longer require it. Our system is adhering to current public health recommendations.”  

The Massachusetts Coalition for Health Equity (MCHE) condemned these callous and dangerous policies because hospitals should be a place of refuge and safety, not a potential focus of infection that vulnerable people fear and shun.

At a press briefing on Tuesday, May 9, Dr. Robert Goldstein, Commissioner of the Department of Public Health said, 

“We will continue to prioritize prevention using everything we know as we adapt to living with COVID-19...We are rescinding the statewide order that all providers and visitors in healthcare settings must wear masks.” 

Reacting to this policy, the Massachusetts Coalition for Health Equity expressed dismay. 

“Dr. Goldstein and DPH have essentially abandoned immunocompromised, vulnerable, and elderly residents of the Commonwealth, and told them “You are on your own.” Hospitals such as the Mass General Brigham group are telling patients they are not allowed to ask caregivers to mask in a flagrant violation of the Americans with Disabilities Act which guarantees patients access to safe, accessible healthcare.  This year 4,436 persons have contracted COVID while in hospital, according to data provided by the U.S. Department of Health & Human Services and hospital acquired COVID has a mortality rate of 5-10%.”

The hard-won experience of dealing with airborne infections, including COVID, has established the value of a layered approach to preventing infection. Vaccination, isolation, ventilation, and gathering outdoors all help to reduce transmission. The use of respirators (high-quality masks such as N95) by everyone reduces transmission. 

Titles II and III of the Americans with Disabilities Act (ADA) provide that state and local governments and places of public and private accommodation, including doctor’s offices, must make reasonable modifications to policies, practices, and procedures to comply with the needs of a person with a disability. For a person whose disability makes them more vulnerable to severe, disabling, or deadly COVID infection, expecting staff members to wear masks seems like a reasonable accommodation. Universal masking in health care settings benefits everyone by reducing the transmission of COVID.  See the ADA overview and training from the People's CDC.

COVID is with us and ready at any time to cause sickness and death. 

The pandemic is still raging: COVID is the 4th leading cause of death in the U.S., and millions of people in the U.S. have long COVID, a variety of symptoms that can limit normal activity. COVID is airborne, transmitted through invisible aerosols (tiny droplets), and 40% of COVID infections are without symptoms. Thus universal masking and pre-procedure testing are essential layers of protection in healthcare settings, especially for immunocompromised, disabled, high-risk children, elderly, and chronically ill people. 

Those of us who are especially vulnerable to severe disease and death from COVID infection depend on our social and medical systems to help keep us safe, or accept severe restrictions in order to protect ourselves. In fact, failing to maintain basic safeguards makes everyone vulnerable. Our healthcare system should continue surveillance including free at-home testing for individuals and measures of community transmission such as wastewater testing, continue free access to vaccination, and support universal respirator masking in all parts of a hospital or clinic.  
    
Infection control professionals

“...propose an updated standard for universal precautions in healthcare settings: permanently including universal masking in routine patient-care interactions. Such a practice prioritizes safety for patients, healthcare providers (HCPs), and visitors.”

Progress report

Many advocacy groups as well as the Chairs of the Joint Committee on Elder Affairs have advocated to retain masking and other infection control measures, with positive results.

We applaud the advocates for demanding their rights and their recognition of the realities of controlling airborne infectious diseases.     

UPDATE, REPORT:

We have a new report of internal advice to MGH staff that places additional barriers on patients' rights to a safe encounter and a reasonable accommodation. Thus, while removing the "don't ask" statement to patients, the policy is being continued internally.  This policy creates a barrier to a patient who wishes to practice what we might call "safe medicine."

While individual doctors express willingness to mask, we are concerned about exposure in waiting rooms and other contexts where other patients and staff may not mask.

What if a patient or visitor expresses discomfort with an employee not wearing a mask?

Remain respectful and empathetic in your response. You can tell them that our policies no longer 
require staff members to wear a mask. Our system is adhering to current recommendations. If patients and visitors have additional questions, they can contact the site-specific Patient and Family Relations Office—email on May 11 from MGH to hospital staff, header details withheld by the recipient out of fear of retaliation.

Reporting in the Boston Globe fails to do fact-checking, as these letters to the editor note. Statements from the Department of Public Health are not accurate. The burden falls on the most vulnerable. We need to demand better from the medical institutions and the public health people.

Jerry Halberstadt, Coordinator of the Stop Bullying Coalition, is elderly, disabled, and has recovered from COVID.