- A group of medical experts say masks are no longer needed in healthcare settings to stop the spread of COVID-19.
- Given recent shifts in the pandemic, the experts argue that healthcare settings should treat the coronavirus that causes COVID-19 like other endemic respiratory pathogens.
- Masks can also impede communication with patients who are hard of hearing or who do not speak English as a first language.
- They argue health providers should stick with standard infection control now including requiring workers to wear a mask and eye protection when doing activities that could generate sprays to the face.
Universal masking in healthcare settings is no longer needed, a group of U.S. epidemiologists and infectious diseases experts proposed April 18 in a commentary published in the journal Annals of Internal Medicine.
These policies, which were enacted early in the pandemic to reduce illness and death associated with COVID-19, required staff, patients and visitors to wear face masks in hospitals and other healthcare facilities.
However, given recent shifts in the pandemic, the eight experts argue that healthcare settings should treat the coronavirus that causes COVID-19 like other endemic respiratory pathogens — using standard infection control practices.
These standard practices require healthcare workers to wear a mask and eye protection when doing activities that could generate sprays to the face. Staff should also use additional precautions when caring for patients with a suspected or confirmed respiratory infection.
In addition, those protocols require staff, patients and visitors with respiratory symptoms to wear a mask while in healthcare settings.
“With the arrival of effective vaccines and a large portion of the population who developed immunity from natural infection, transmission from individuals with asymptomatic infection is now less common than in the earlier stages of the pandemic,” commentary author Dr. Sharon Wright, chief infection prevention officer at Beth Israel Lahey Health in Boston, told Healthline.
When SARS-CoV-2 first emerged on the scene, it was a silent spreader — more than 50% or so of transmissions resulted from people without symptoms, some studies found.
In contrast, recent data — after the emergence of the Omicron variant — suggests that most transmissions now occur around or after the start of symptoms. Given the small number of studies, though, asymptomatic transmission is still a possibility, even among a population with a high level of immunity.
Wright points to other developments that have made COVID-19 easier to deal with in healthcare settings, including treatments for people with infection — such as the antiviral Paxlovid — and widely available clinic-based and at-home testing.
Wright and her colleagues argue that while maintaining universal masking in healthcare settings may marginally reduce the risk of transmission, masks could impede communication, especially for those whom English is not their preferred language and for people who are hard-of-hearing and rely on reading lips and other facial cues.
Masks also contribute to feelings of isolation and negatively impact interactions between doctors and patients, the authors wrote. Some research suggests that the use of masks may even increase the mental load for both patients and clinicians during clinical encounters.
“At this stage in the pandemic, masking is only one tool to reduce overall transmission and there should be a calculus weighing risks and benefits,” said Wright.
Other research suggests that mask policies may not have that much effect in the face of fast-spreading variants such as Omicron. For example, a recent preliminary study, not yet peer-reviewed, found that a mask policy at a hospital in London, United Kingdom, did little to slow the spread of the Omicron variant.
This study was not able to compare masking to non-masking in high-risk areas of the hospital, which continued with the masking policy. In addition, the policy required people to wear surgical masks, not respirators such as N95, KF94 and FFP2, which are more effective at protecting the wearer when worn correctly.
Many healthcare systems in Michigan have already ended universal masking requirements. California has also ended a statewide mask mandate for healthcare settings, and Massachusetts will end its next month.
While some applaud the shift toward treating the coronavirus as endemic, people with compromised immune systems, and others at high risk, say they now have to choose between getting the virus at the doctor’s office and avoiding necessary medical care.
In a letter last month, Disability Rights California called the end of California’s mask mandate “a step backward for health equity in California.”
When Massachusetts Gov. Maura Healey announced the end to the state’s mask mandate, disability and health equity groups — and hundreds of local medical professionals — signed a letter calling this move “dangerous and unethical.”
“Without universal masking precautions in healthcare, vulnerable people face substantial risk of being exposed in waiting rooms or clinical settings against their will, violating their autonomy, and deterring many from seeking much-needed care,” they wrote.
They asked public health officials and healthcare organizations to keep their mask policies in place to reduce the spread of the coronavirus.
Some healthcare facilities may decide to implement universal masking for staff interacting with high-risk patients, said Wright, such as solid organ transplant recipients, people undergoing cancer chemotherapy and others who are severely immunocompromised.
These patients are often encouraged to wear a mask or N95 respirator when not inside a specialized patient room designed to reduce their risk of exposure to fungi and other microbes, she said.
“However the strongest predictor for severe outcomes from COVID-19 is advanced age,” Wright added.
Dr. Stuart Ray, a professor of medicine at Johns Hopkins Medicine in Baltimore, agrees that it makes sense to end universal masking in healthcare settings.
“The landscape of risk has shifted,” he said, pointing to the high levels of immunity gained through vaccination and prior infection, and evidence showing that people can protect themselves by wearing a high-quality mask.
However, healthcare settings “have an ethical duty to protect people who are particularly vulnerable,” he said, “so it makes a lot of sense to wear masks when they can be worn without disrupting your work.”
Even without universal masking policies, healthcare workers can still choose to wear masks at work, something Ray said is especially important given the possibility of staff having an asymptomatic infection.
“I tend to wear a mask in most situations, simply because it’s safer for patients and it’s not a burden for me,” he said.
At times when masks may not be feasible — such as if they hinder communication or the patient can’t wear a mask due to a respiratory or other medical condition — Ray said there are other ways to lessen the infection risk.
“If we have a meeting with a family where the stakes are high and a misunderstanding is possible, we’ll try to do that in a place that’s well ventilated,” he said. “I may also take off my mask while I’m speaking.”
While the pandemic of COVID-19 is no longer making headlines, the disease is still around.
“I was just on the wards recently seeing people with moderate to severe COVID-19,” said Ray. “So it’s not like the coronavirus is gone.”
New variants also continue to pop up. Some — such as XBB.1.16, dubbed “Arcturus,” which is spreading in India and some U.S. states — are causing spikes in cases.
In addition, over 1,300 people died of COVID-19 during the previous week — an average of around 5,200 per month, the agency reports. COVID-19 remains a leading cause of death among people 19 years or younger, some of whom are too young to wear a mask.
While rates of hospitalizations and deaths have dropped dramatically since earlier in the pandemic, the risks of COVID-19 go beyond acute illness. Each coronavirus infection increases the risk of chronic health issues such as diabetes — in adults and children — and heart conditions.
In addition, people with long COVID can have problems for weeks, months or years after their initial infection, with tiredness, fatigue, heart palpitations, difficulty thinking and other symptoms.
With few mask-related policies in place, people will need to decide for themselves how much COVID-19-related risk they are comfortable with, and what steps to take.
“If a person is vulnerable [themselves], or they are caring for or living with people who are vulnerable, then wearing a mask may be the rational choice,” said Ray.
In general, respirators such as N95 masks are more effective than loose-fitting cloth or surgical masks.
To protect yourself and others in the community, you can also choose to wear a mask in shared indoor public spaces such as on public transit, or in grocery stores, doctor’s offices and other places.