Recently, many of the hospitals and clinics in and around Chicago, including my own, have elected to discontinue universal masking requirements, noting the lowest rates of COVID-19 in the last three years. This is being hailed as a sign of moving on from the COVID-19 pandemic. But is it really “moving on?” Or moving backward?
For the last three years, patients have received masked care. While hearing and speech impaired individuals definitely benefit from unmasked communication, the majority of patients have gotten better care because of those masks. There’s no doubt that universal masking blunted influenza and other respiratory virus spread in Chicago during the first two years of the pandemic, and the same has been true in health care.
Many people find masking annoying or uncomfortable and don’t worry much about catching a cold here and there. But hospitals and clinics are places where the sick congregate with the vulnerable, and masking is the least burdensome way to make that safer for everyone.
In the absence of universal masking, health care organizations are required to follow “transmission-based precautions” and “standard precautions” both of which have been around for decades. This strategy relies on everyone (patients, visitors and health care workers) to correctly self-identify when they have respiratory virus symptoms, test appropriately, isolate according to recommendations and wear a mask in the medical center. This was our main way of protecting patients from influenza, RSV, the common cold, tuberculosis, whooping cough and many other nasty infections before COVID-19 came along.
Now that we have COVID to worry about as well, the stakes are even higher if someone (patient, visitor, or health care worker) fails to realize that their allergy symptoms could actually be an infection. It also relies on people to report a recent COVID-19 exposure or high risk activity ( such as travel or attending a crowded indoor event) and voluntarily don a mask at the entrance even though they feel fine. Given the current attitude of many toward COVID-19 (to ignore it), is this really the right strategy for health care?
Pre-COVID-19, I recall sitting in pediatrics waiting rooms with my (then) young child trying to figure out which kids were there for “well child” visits and which ones were sick. The last thing I wanted to bring home was another cold, more missed days of school and the stress of arranging for emergency child care.
As a physician, I know that every patient going for surgery is told that the risks include infection but that these are rare and the staff do everything possible to minimize them. But what if your nurse in pre-op has a cold? Not even COVID-19. Just a cold. Not a big deal, right? Try coughing with a fresh abdominal wound.
Before COVID-19 we did not do everything we could to avoid your catching an infection in health care. We did everything we thought we could at the time. We know better now.
A universal source-control masking strategy is a harm reduction approach that asks everyone to wear at least low-quality masks to reduce the amount of COVID-19, tuberculosis, influenza, rhinovirus, adenovirus, metapneumovirus, measles, mumps, etc. in the air around them, whether they know they have infection or not.
It works much like the myriad other things we do in health care to protect you even if we may not know for sure that you need it, like hand washing, gloves, and cleaning rooms with bleach. We can’t easily tell when these things are needed and when we can safely skip them, so we do them for everyone, every time.
These kinds of interventions have reduced spread of multidrug-resistant organisms, decreased device related infections, and generally made health care safer, paving the way for more complex medical treatments and procedures. Without progress in infection prevention, many of the things we are able to do today (cancer treatments, transplants, complex surgeries) would not be possible because the risk of infection would be prohibitive.
Unmasking in health care in order to “give health care workers a break from masks” or “keep up with what others are doing” is like saying we are going to provide the best health care 2019 has to offer.
Yes, masks can be annoying and uncomfortable and there are definitely a few situations where we should ditch them for the sake of good communication. But they aren’t much different from gloves, electronic medical record best practice alerts, hand washing, bar code medication administration, fall precautions, medication reconciliation, or pharmacy verification — and you deserve every single one of them.
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ABOUT THE WRITER
Dr. Emily Landon is an associate professor of infectious diseases and the executive medical director of Infection Prevention and Control at the University of Chicago Medicine. In this piece, she speaks for herself and not on behalf of the university or the hospital.
