Dr. Bow Tie
On Dropping Mask Mandates in Hospitals/Healthcare Facilities
On April 20th, one of the hospital systems in which I work decided to follow the examples of area offices, some other hospital systems, and/or states around the country and rescind mask mandates inside the hospital. Mask requirements have been a thing of the past for the general community for some time now, but more and more folks had been asking when they would be dropped in hospitals.
Earlier in April, I'd gone to Easter Vigil with my parents and had this exchange:
Pastor, sees my mask: "I hope everything’s alright?"
Me: "Yes, this is just preventive."
Elderly lady 1, masked: "That’s why I wear mine. And with him (*jerks thumb at husband*), I don’t want him to get it again, either. *Husband nods, she continues* You know, I spent 16 days in the hospital. 1st 3 days were critical."
Pastor: "Do you remember those days?"
Elderly Lady 1: "Nope."
Elderly Lady 2: "It was 5 weeks for me!"
Middle-aged man (unmasked): "Heck, even I don’t want it again!"
That conversation was a reminder of why I still mask, and why it is important. So on 4/20 (and 4/21 when the other hospital system dropped its mandate), when some folks on those hospital wards apparently sang songs and took pictures of themselves throwing masks away, I was disappointed. Let me explain further.
I tweeted, frustrated, about the mask drop, and of course some folks immediately responded with "you can still wear yours." Obviously, no one is forbidding the wearing of masks, and I will still wear one for patient encounters until COVID-19 (immediate infection and its potential long-term sequelae) are less potentially dangerous and/or transmissible, because I won't always know who is more susceptible or immunocompromised. Will that be forever? I hope not, but I do not know. I know that it is for now.
Mask mandates were not dropped for people who test positive for COVID-19 or are within their 10-day isolation period, or if a unit has an outbreak. But both inside and outside the hospital, testing is WAY down, unless someone has obvious respiratory symptoms or reports recent exposure. We know asymptomatic transmission happens, but it is too inconvenient (cognitively and economically) to actually think about. However, as someone pointed out, if a unit has an outbreak it's too late.
Some people did ask, and no - no hospital is dropping pre-2020 universal precautions (gloves when necessary, hand-washing and other sanitary practices that were previously-known barriers to transmission of infection), and the gown/glove/N95/bouffant cap precautions for COVID-19 patients will likely still be in place, though I fear that the inconvenience will lead to less adherence.
Folks replied to my Tweet and a TikTok video I made with anecdotes of their departments facing staff call-outs due to COVID and other illnesses. At least one hospital in the Bay Area in California had actually previously stopped their mask mandate and had to reinstate it due to rising transmission and cases. In all honesty, I am sure some places will not reinstate when transmission rises, so I'm happy the Bay Area hospital did...but do we have to wait for that? Prevention is still preferable to treatment.
So why are these policies going into effect now? Well, transmission does appear to be down, but is it really? The CDC has their politically whitewashed "Community Levels" which look better than the initial maps of community-based transmission, but do not tell the whole story since they only use PCR positives instead of wastewater or logged home tests (and yet we are still seeing, nationwide, >1,000 people die of COVID each week in recent weeks). Importantly, "Community Levels" never applied to healthcare settings. We see more folks, immunocompromised or not, at their most vulnerable than often seen in the outside world. While there is still a relatively new virus, with greater potential consequences than others, floating around, it remains helpful to utilize an easy layer of additional protection in places where people seek treatment and healthcare.
It also needs acknowledged that some of this political and/or peer pressure. Masks were unnecessarily politicized since the beginning of the pandemic, despite growing favorable evidence, but a poorly summarized Cochrane Review (that had to be walked back by Cochrane because the lead investigator misrepresented its findings) and grifting pundits have led patients to bully and mock healthcare workers for masking, and healthcare facilities cave in to that.
As much as some want to claim otherwise, masks work. I have discussed before about certain oncologists from UCSF and other doctors who have embraced the fame they found in spreading disinformation and courting anti-vaxxers, who engaged in what my fellow scientific communicators refer to as "methodolatry" regarding randomized-controlled trials, insisting that any other form of evidence was insufficient. While RCTs are considered the gold standard for certain research, there is life beyond that ideal and we have many studies showing that masks do help prevent spread. Hell, in the real world, some of us still have not been infected* with COVID-19 because of masks, and I don't plan to change that. I'll include them below.
*Knock on wood*
Honestly, with all of this, what bothers me the most is the relief and joy people have expressed, when it is not that the pandemic is over (because it is not, as I pointed out) - we are just ignoring it more. It is not 2020-21 any more, but we still have >1000 COVID deaths per week. People are acting like masks were some torturous burden (with few exceptions of people with serious facial conditions) rather than a mild inconvenience that one can get used to. I find it hard not to roll my eyes, similar to when people complained about "lockdowns" which never really happened in this country. As a friend of mine put it, "so 'dumb Americany.'"
The disinformation and disregard for public (and preventative) health since 2020 has left me with a constant simmering anger that threatens to boil over more easily than ever. Moments like this are not apocalyptic, but they don’t have to be to present a danger, and it is frustrating that we have not learned from the last three years.
I’ll still mask in the hospital and in crowds, because it costs little to do so. Trolls like to mock and tell me "you can't just live in fear!" The irony is that it's usually them who are struggling with fear - a fear of change. The world will never be what it was in 2019. Some fundamental things have to change, even as we go out, have fun, and live our lives. Masks are part of what helps that - it’s not living in fear, it’s living in safety.
Masks Reinstated in the Kaiser Permanente Santa Rosa Medical Center: https://archive.ph/2023.04.21-000823/https://www.sfchronicle.com/health/article/kaiser-mask-rules-covid-outbreak-17909316.php
The Cochrane Review fact check: https://www.factcheck.org/2023/03/scicheck-what-the-cochrane-review-says-about-masks-for-covid-19-and-what-it-doesnt/