Doctors, not government, should make mask rules in health care
Medical professionals are experts at keeping patients safe from infection. That is why Governor Maura Healey’s administration is making the right decision by rescinding the state mask mandate in health care settings with Thursday’s end of the federal and state COVID-19 state of emergency. This will let hospitals make their own policies going forward. While opponents have real fears about hospital-based virus transmission, health care providers are well-equipped to decide when and where to impose mask requirements.
When COVID-19 was spreading virulently without vaccines or treatments, mask mandates were necessary to keep patients and caregivers safe. But while COVID still poses a serious health threat and people are still dying, society has more tools to handle it now. There are effective tests, vaccines, and treatments, and many people have natural immunity. Mortality rates have declined. Rates of COVID transmission in Massachusetts are low. Many people have returned to schools, offices, and daily activities without masks. Massachusetts is the last state with a universal health care mask mandate.
It makes little sense for the state to require masks for every person visiting a physical therapist, dentist, or pediatrician.
Shira Doron, chief infection control officer for Tufts Medicine, said hospitals have fewer patients hospitalized with COVID today than at any point since March 2020, and there will not be a better time to lift the mask mandate. “The question becomes if it isn’t right now, are we OK with [masking] forever?” she said. There are trade-offs involved: Doron said masks impede communication and connection between patients and providers and harm employee morale.
Experts from Mass General Brigham, Beth Israel Lahey Health, Tufts Medicine, and the VA Healthcare System in Boston wrote in an April 2023 commentary in the Annals of Internal Medicine that in the pandemic’s current stage, universal masking in health care marginally reduces the risk of virus transmission but at a high cost. It impedes communication, particularly for those whose primary language is not English or who are hard of hearing, and requires more cognitive effort by patients and providers. “Masks obscure facial expression; contribute to feelings of isolation; and negatively impact human connection, trust, and perception of empathy,” the physicians wrote.
Importantly, the end of the state mask mandate does not mean the end of masks. Any individual choosing to mask should be supported, and there is evidence that one-way masking with a high-quality, well-fitting mask is highly protective against illness.
And health care facilities have a responsibility to keep patients safe. The Department of Public Health, in May 5 guidance, said health care facilities must maintain evidence-based infection prevention and control policies. This includes improving ventilation, holding vaccine clinics, and imposing mask requirements in specific units or facilitywide, particularly during times of high virus transmission. The department directed health care facilities to make masks available to staff, patients, and visitors. DPH still recommends masking for patients with respiratory illness and for health care providers caring for COVID patients.
Massachusetts Public Health Commissioner Robert Goldstein said the decision to lift the mandate is aligned with Centers for Disease Control and Prevention guidance and federal requirements, was made following conversations with health care experts, and can change with circumstances.
The Boston Globe reported that many of the largest hospital systems will drop universal masking including Mass General Brigham, Boston Medical Center, Tufts Medicine, Beth Israel Lahey Health, and UMass Memorial Health. But the policies are nuanced. UMass Memorial Health will require caregivers to mask when seeing patients in emergency departments, oncology clinics, and transplant units. Boston Medical Center will require masks for COVID-positive patients, their visitors, and staff caring for them, and for staff in operating rooms and caring for patients with cert ai ni mmunoc om promising conditions.
Critics of the move include some seniors and people with disabilities who worry about the impact onim mu no compromised people who seek medical care. More than 700 people signed a letter organized by the Massachusetts Coalition for Health Equity, a health policy advocacy group that has urged caution on relaxing COVID measures, supporting extending the mask mandate. The letter says people come to health care settings for COVID care, so there is risk of transmission, and failing to require masks violates the medical principal of “do no harm.” “Masking is essential, along with vaccines, ventilation, and other measures, to prevent COVID-related disability and death,” the letter states.
There are also questions that still need to be answered, like whether a patient can ask providers to mask. Colin Killick, executive director of the Disability Policy Consortium, suggested that if staff refuse to mask when requested by a person with a disability, that could invite a legal challenge under the Americans with Disabilities Act.
State Senator Pat Jehlen and state Representative Thomas Stanley, who cochair the Legislature’s Joint Committee on Elder Affairs, urged the state to keep a mandate in place until more people get COVID booster shots. Carlene Pavlos, executive director of the Massachusetts Public Health Association, suggested universal masking in health care settings should become permanent.
Yet for years before the pandemic, doctors managed contagious respiratory illnesses without universal masking. The World Health Organization and the federal government have said the state of emergency is over and COVID-19 should be treated like other respiratory illnesses. In that milieu, infection control decisions are best left to medical professionals.
Massachusetts is the last state with a universal health care mask mandate.