Editor’s Note: Abdullah Shihipar is a writer and public health researcher at the People, Place and Health Collective at the Brown University School of Public Health. The views expressed in this commentary are the author’s own. Read more opinion on CNN.
When the Biden administration declared the end of the Covid-19 public health emergency this spring, the last mask mandate holdouts began to jettison the requirement. Unconscionably, this has included many hospitals and health care facilities.
There’s no question that masks are annoying and add to hospitals’ costs, but that in no way justifies adopting policies that could endanger the very populations health care centers are supposed to serve. Those at highest risk for severe disease and death from Covid also happen to be the ones who generally need to access health care the most.
And while Covid hospitalizations and deaths may be lower, hospitals could still be risky for many since they are places where sick people congregate – and those who come there often have no option of skipping care to protect themselves, lest their health deteriorate from something else.
Indeed, hospitals that are removing masking measures are applying the wrong lesson from combating Covid: Our success doesn’t mean we can get rid of all the measures that kept the vulnerable safe, but that we have identified new tools to use in maintaining health. Masks are one of them, and they don’t just help against Covid, but against other respiratory illnesses, such as the flu, for which immunocompromised groups are at high risk as well.
Hospital-acquired infections have long been a problem in the United States – according to the US Centers for Disease Control and Prevention, at least 1 in every 31 patients acquires at least one infection from a health care setting. This amounts to about 1.7 million infected patients and 98,000 deaths a year and results in at least $28.4 billion in additional health care costs.
We should be trying to reduce these numbers, not add to them. And, in other ways, hospitals are trying to do just that, such as by encouraging frequent handwashing, collecting data about infections and maintaining a hygienic facility. Handwashing, for instance, can prevent 50% of avoidable infections obtained during health care delivery, according to the World Health Organization.
Covid can also be a hospital-acquired infection – and when so, it can pose more of a threat than elsewhere. Scientists in the UK reported in the journal Frontiers in Immunology that between January 2020 and September 2021, the risk of death was 1.3 times higher for those who get Covid after arriving in the hospital rather than those who contracted it in the community, as this group had a high number of cancer and transplant patients.
Even after the rollout of vaccines, the risk from Covid has remained. A study during the Omicron wave in the UK showed that 5.4% of patients who got Covid in the hospital died because of the virus or because it contributed to their cause of death. This risk undoubtedly persists because vaccinations for certain cancer patients and other immunocompromised people can’t always create the same immunity that vaccines confer on others.
The numbers could have been even worse, since this data was mostly gathered at a time when masking and other precautions were in place. And while this demonstrates that masking can’t prevent all infections, things can get worse in their absense.
During the first Omicron wave, Brigham and Women’s Hospital in Boston reported an increase in hospital-acquired Covid cases. Though a mask mandate existed, the cases decreased dramatically after staff in the affected units were required to wear the more effective N95 masks and patients began being tested daily – with no new cases in each of the outbreak units after the changes were instituted.
Similarly, in the UK, a study found that the use of respirator masks during the Delta wave was associated with a 33% reduction in the likelihood of getting a hospital-acquired Covid infection and a 21% reduction during the Alpha wave. Given this, hospitals should provide free N95s for patients and staff to use.
With Covid being a leading cause of death in the United States last year (stats for 2023 are not yet available) and the vast majority of people who are dying being elderly, immunocompromised or otherwise high risk, having people wear masks in health care settings, in order to prevent even a handful of deaths, seems like a good and necessary tradeoff (tacitly acknowledged by the many hospitals that have been maintaining masking requirements in places with more vulnerable patients, such as emergency departments and cancer clinics).
No doubt there are people, particularly staff working long shifts, who find masks uncomfortable, especially after three years. The chief nursing officer at Nebraska Medicine, for example, told The Wall Street Journal that maintaining the mandate would not be “good for business,” given the pressure they received from patients to end the mandate after other facilities dropped theirs.
So, the People’s CDC, an advocacy group that aims to raise awareness and change policy around the pandemic, is pushing the Centers for Medicare and Medicaid Services to incorporate Covid into its Hospital-Acquired Condition Reduction Program, which curbs funding if hospitals fail to adequately maintain standards of prevention. This would help create an expectation of masking across hospitals.
Even after the pandemic recedes further, masks should continue to be encouraged, if not required, in medical settings. In the late 1800s, handwashing was adopted to prevent the spread of bacteria and viruses. After the AIDS crisis in the 1980s, health care workers started to wear gloves outside of the operating room to protect patients and providers. Covid has taught us we should now employ masks more widely.
No one wants to go to the hospital and come away with a new illness – so when we’re there, let’s mask up.