The Case for Keeping Masks Mandatory in Health Care

It’s been said that a smile is worth a thousand words. But in today’s world, the smiles of healthcare workers abandoning their masks on social media are chilling to those whose access to safe healthcare is thus denied. The removal of mask requirements in many healthcare institutions is causing infections with immediate and long term consequences due to the continued presence of the virus.

The number of reported cases has been going up and down over time, and it is depending on the level of reported tests. Sewage testing correlates, and is indicating that the number of actual cases is much higher. A variety of new and more contagious variants is spreading, and with them, the loss of the limited immunity that might have been gained. Sustained high levels of infection are causing accumulating long COVID. 

Removing mask requirements is not based on scientific data or real-world experience. Overwhelming evidence, ranging from experimental to real-world observations, shows that well fitted respirators effectively prevent airborne infections, and not only COVID-19. Whatever the reason for hospital acquired infections, the direct experience with infections and deaths of family members undermines public trust in the medical and health professions. 

When people go to the hospital, they expect to get better, not worse. Abandonment of mask mandates has unsurprisingly led to a rise in hospital-acquired infections, and outbreaks. About one in five to ten people who catch COVID-19 in a hospital after having come there for some completely other reason, end up dying. The normal rate of deaths is only two or three percent. This is fully preventable, and entirely attributable to policies of the institutions which allow diseases to spread unchecked.

Hospitals, medical practices, and clinics are places where patients can’t always wear masks to protect themselves, due to certain circumstances, such as young children, babies, people with disabilities, people under anesthesia or unconscious, and those with severe respiratory problems. This means that providers need to use the highest level of source control and personal protective equipment. Additionally, using elevated levels of air filtering, including directed filtered air flows, can help reduce the persistence of airborne particles not just in patient exam and treatment rooms, but in reception areas, waiting rooms, cafeterias, and restrooms. Therefore, comprehensive prevention strategies are needed.

Infection control is essential according to the Centers for Medicare & Medicaid Services (CMS) and accreditation agencies. Hospitals and healthcare staff have an ethical and professional responsibility to keep their patients safe from harm, including infections. When people seek medical care, they put their trust in healthcare staff and hospitals to provide the best possible treatment and care. Infection control is not only a matter of professional duty, but also a legal obligation. 

Medical ethics emphasizes patient autonomy, beneficence, non-maleficence, and justice. Justice means that all must have their rights equally respected and have one’s health protected as a right for all, including the most vulnerable. The principle of non-maleficence (first: do no harm) is particularly relevant. The duty to prevent harm includes preventing the transmission of infectious diseases. Beneficence requires promoting the well-being of patients and their outcomes. Finally, patient autonomy implies a right to receive care in a safe and clean environment.

Failure to prevent infections is a breach of trust. Patients are not blind to a lack of accountability and responsibility. Infections often lead to negative health outcomes, longer hospital stays, increased healthcare costs, a risk of disability or even death—and community distrust. Without proper infection control, people have been choosing to avoid medical care, forgoing critical diagnostics and therapies, or turning to alternative practitioners.

Vulnerable individuals have the right to equal access to healthcare facilities—as stated in the Americans with Disabilities Act (ADA) and other laws. This right is violated by healthcare workers who refuse their accommodation by not wearing masks or not taking other infection control measures creating a precarious situation for those at risk of severe illness or death.

Outbreaks of infectious diseases in hospitals can have devastating consequences, not only for the healthcare system, but also for patients, healthcare workers, and their families. When healthcare staff are infected, it decreases the capacity of healthcare organizations to provide adequate care, creating a spiral of detriment to the quality of care for all individuals, regardless of their diagnoses.

Italy, which was one of the countries hit hardest by the pandemic at its onset, now is wisely maintaining mask mandates in healthcare settings. Continuing to require masks (especially N95 respirator masks) helps to reduce the spread of this virus particularly by those who may be asymptomatic or pre-symptomatic. It also provides a visible sign to the public that the situation is being taken seriously and steps are being taken to keep everyone safe.

At a time when health and medical staff and patients alike are weary from the pandemic, it’s important for healthcare institutions to set an example for safety and mask-wearing. In infection control “an ounce of prevention is worth a pound of cure.” Let’s make sure our healthcare institutions prioritize the measures that will keep us all safe.