Healthcare Facilities Called Upon to Continue Masking

By Christopher Cheney

Healthcare facilities should continue to have masking policies despite the fact that the crisis phase of the coronavirus pandemic has passed, according to a new journal article.

Universal masking in healthcare facilities was adopted during the pandemic based on research that indicates masking could reduce the risk of respiratory viral transmission. Many healthcare organizations have lifted universal masking requirements since the end of the COVID-19 public health emergency earlier this year.

The new journal article, which was published this week in Annals of Internal Medicine, calls on healthcare facilities to continue masking requirements either universally or under specific circumstances. “In our view, the ongoing disease burden among persons at highest risk for severe COVID-19, the large proportion of transmission from asymptomatic and presymptomatic cases, uncertainty about the future course of the pandemic, and the effects of post-COVID-19 conditions merit integration of lessons learned from the pandemic into healthcare precautions and policies,” the new journal article’s co-authors wrote.

The new journal article’s co-authors agree with another journal article published in Annals of Internal Medicine in June that calls for healthcare facilities to adopt one of four approaches to masking:

  • Require masking in healthcare settings year-round
  • Require masking in targeted settings with high-risk patients such as transplant, oncology, and geriatric units
  • Require masking during specified months of the local respiratory viral season
  • Require masking when the community burden of respiratory viruses is at a critical threshold as determined by “appropriate metrics”

Healthcare facilities should not go back to limited masking policies that were in place before the pandemic, the new journal article’s co-authors wrote. “Our appreciation and understanding of both patient and healthcare system impacts associated with SARS-CoV-2 and other respiratory viruses have been reshaped as a result of the COVID-19 pandemic. We should be mindful of continuing areas of uncertainty while integrating the lessons learned into our hospital-based practices to prevent harm to vulnerable patients rather than reverting to suboptimal pre-pandemic behaviors.”

There are several reasons why healthcare facilities should continue masking, the lead author of the new journal article told HealthLeaders.

“First and foremost, COVID-19 continues to circulate in our communities and there continues to be uncertainty about the future course of the pandemic. This is especially true as new variants emerge. We also know that hospitalizations and deaths, while lower than at other periods during the pandemic, are still occurring and disproportionately impact people at higher risk for severe disease. This includes people who are older and people who have chronic conditions. No. 2, we are only beginning to learn more about post-COVID-19 conditions also known as long COVID. We know that people of all ages are at risk for post-COVID-19 conditions. Even people with asymptomatic or mild acute COVID-19 are at risk for post-COVID-19 conditions,” said Eric Chow, MD, MS, MPH, chief of Communicable Disease and Immunization for Public Health at Seattle and King County, clinical assistant professor of epidemiology at University of Washington, and clinical assistant professor of Medicine-Allergy and Infectious Disease at University of Washington Medicine.

Masking is also needed to safeguard healthcare workers, he said. “Masking protects healthcare workers. Many health systems are desperately trying to maintain their healthcare workforce capacity and implementing masking in healthcare facilities will help prevent infections and outbreaks among healthcare workers. This can help mitigate additional shortages of healthcare workers.”

Universal masking in hospitals may be the safest option, Chow said. “This is one of the approaches we have recommended in our article, and it avoids having a patchwork of policies within a hospital system. It also acknowledges that masking reduces the risk of infection not only in patient encounters but also between and among healthcare workers, which is another source of infection. Targeted masking policies are implemented in units where there are high-risk patients, but this is a less perfect approach because there are high-risk patients who are admitted to different parts of a hospital.”

Improving communication while masked is a consideration for healthcare providers, he said. “There is a need to provide safe care and to improve communication while wearing masks. Some approaches include discussing with individuals about their own preferred approach to improving communication. Healthcare providers can allow for extra time for patient encounters, choose a quiet location for patient encounters, and speak clearly and slow down their talking speed. Other approaches could include alternative forms of communication such as written communication or assistive technology to maximize understanding.”

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.