Strategic Masking to Protect Patients from All Respiratory Viral Infections

[Jm954]

This topic is often raised on this forum and this paper makes the case for continued masking in hospitals.

Brief synopsis here

"Discontinuing masking outside of health care contexts is understandable. Immunity acquired by means of vaccination and infections, combined with the widespread availability of rapid diagnostics and effective treatments, has dramatically reduced the morbidity and mortality associated with SARS-CoV-2.

Most SARS-CoV-2 infections are now no more burdensome than the infections caused by influenza and other respiratory viruses that most people have long tolerated without feeling compelled to mask.

There are two reasons, however, why this framing has limited application to health care facilities.

Firstly, hospitalized patients are different from nonhospitalized populations. Hospitals, by definition, aggregate some of the most vulnerable people in society when they are at heightened vulnerability (i.e., when they have an acute illness).

Vaccines and treatments for SARS-CoV-2 have reduced the morbidity and mortality associated with SARS-CoV-2 infections for the majority of the population, but there remain important subgroups that continue to be at elevated risk for severe disease and death, including older adults, people who have immunocompromising conditions, and people who have severe coexisting conditions, such as chronic lung disease or heart disease.

Members of these groups constitute a large portion of hospitalized patients at any given time; many of them also make frequent visits to outpatient health care facilities."

Full read here: nejm.org/doi/full/10.1056/N...

Jackie

[bennevisplace]

Thanks Jackie. Although this is a US perspective, most of it applies to the UK too.

It shouldn't require exhaustive studies to establish that pre- or asymptomatic hospital staff and visitors would transmit respiratory viruses to vulnerable hospital patients; more so "presentee" staff who were allowed to come to work despite feeling unwell. But it defies belief to read that Even during the height of the pandemic, some health care systems reported that 50% of staff diagnosed with SARS-CoV-2 worked while symptomatic.

It seems to me that 99 percent of the debate over masking has been about whether or not; discussion - even in this esteemed journal - has not progressed to what kind of masks are appropriate in a given setting.

[Psmithuk in reply to bennevisplace]

….and the masks they do use in hospital give very little protection to either the patient or the nurse/doctor.

Chrisx

[Katie-LMHC-Artist in reply to bennevisplace]

I have two oncologists. The cancer hospital has everyone wear a mask. At my local oncologist's office, it is by choice. My local oncologist shared a study from India and stated that the surgical masks do not protect against Covid. The only mask that was effective was the N95 which is difficult to keep on for a length of time. The masks do help with exposure to other illnesses, including the flu. My local oncologist wears a mask to help with my comfort level when I come in to see him. My takeaway is that we have to figure out what works for each of us. I wear a mask when I go shopping and to all doctor appointments. I sit apart from others when in a doctor's office. Recently I went into a quick mart for an item and knowing I was the only one in the store besides the cashier, I dd not wear a mask. I think it is a balancing act to know when to wear a mask for protection. In the beginning of the pandemic, I designed my own masks, having an art background. I still wear my personal design masks. I also bought some surgical masks with tie-dye designs on them. We have to continue to be are own advocates!

[bennevisplace in reply to Katie-LMHC-Artist]

I agree that we have to find what best works for each of us. My best friend has been the FFP2, the European equivalent of the N95. These days the people I do see wearing masks, who are in a tiny minority, tend to be wearing one of those. My guess is that, like me, they are clinically vulnerable and have figured out what best works for them by way of personal protection.

Three years into the pandemic, several overseas trips, big family events, and neither my wife nor I have had Covid. There is a large slice of luck in this, but also informed judgement and a well-fitting FFP2. If I can wear one for 10 hours straight, why can't a health worker manage a few hours with a N95?

[annmcgowan]

Hi thanks for the post Jackie very interesting.

During my recent hospital outpatient visits no one was masking including the staff.

When I had Covid earlier this and had to spend some time in A&E I was isolated, unfortunately many of the staff were unmasked. After informing them I had Covid they choose to remain unmasked which confused me!!!

Based on my experiences I think it would be difficult to persuade staff or patients to return to masking. Once the government made it a choice the masks were off.

Sorry to sound so negative, I agree masking in necessary in certain situations. The problem would be persuading the hospital staff of that.

Take care

Ann

[CycleWonder]

I wear a mask into any medical building. I try not to stay inside very long if others are in the vicinity are not wearing masks. I often choose to wait outside if this can be accommodated.

I politely ask any medical staff member to wear a mask when working with me. The one time someone refused, I left the facility and cancelled my appointment.

[SurviveOr in reply to CycleWonder]

For me - especially staff in an oncology or pulmonary hospital - leaving it to individual staff members as to whether they want to wear a mask or not is , unconscionable ...

... it also show quite a lack of connection as to what the "heck" they're doing ...

... feeling unsafe walking into a hospital because individually "the staff decides the protocols" is nutz.

[bayside64 in reply to CycleWonder]

Good for you!

[Jm954 Administrator]

On my recent visit to the Haematology Clinic/Day Unit every member of staff wore a mask and the majority of the patients too. Good to see as some very vulnerable people there.

[Big_Dee]

Hello Jm954

👏👏 Right on!

[lexie]

I go to a top rated US hospital for my primary care provider who is an internist. I always mask and distance. At my recent biannual visit a few weeks ago the doctor came in to the examining room with a blue surgical mask but allowed it to slip down below her nose several times, leaving it there for a minute or two before pulling it back up. This is the kind of behavior that you saw at grocery stores by the general public during the height of covid. This is the doctor who was gone during the entire pandemic leaving her PA to see me for nearly 3 years. I suppose the hospital systems are lucky to hang on to those they can get to come back. I needed some referrals and refills so now that I have them I am searching for a new doctor.

[Smakwater]

A bit of humor to add. I remember the skepticism prior to covid when I was avoiding gatherings and events as my neutrophil counts were down. Then when covid arrived, the same people were hiding from me, avoiding on another, and staying up wind. A good friend even wrote me a note stating "now we know what you were going through".

For Real - Most of the time we like each others company and do not want to be alone or hiding the smiles behind a mask.

Certain environments and circumstance define the need for sure. Often we do not have the awareness until we are the circumstance.

JM