New national guidelines released late Friday raise a thorny question: How much longer should patients, staff, and visitors at health care facilities continue wearing masks? When and how can such precautions ease?
The revised guidelines from the Centers for Disease Control and Prevention make mask requirements optional for health care facilities in regions where community transmission is not labeled “high” — currently just one-quarter of the country.
But the idea of lifting such requirements in hospitals and nursing homes, even as hundreds continue to die of COVID-19 each day, immediately sparked controversy.
Dr. Jeremy S. Faust, an emergency medicine physician at Brigham and Women’s Hospital, called the change “terrible policy” and “a life-threatening change for at-risk individuals” in an online essay published over the weekend.
“It’s one thing to de-escalate pandemic mitigation in low-risk settings. To do so in nursing homes is a hostile act towards a vulnerable population, given current ground conditions,” he wrote. He noted that the new recommendations would allow universal masking to end in regions with “substantial” transmission. (The CDC categories are “high,” “substantial,” “moderate,” and “low.”)
Others noted that masking cannot continue indefinitely and said it makes sense to set parameters for when to pull back.
“Every other sector of society has changed” in its approach to the pandemic, said Dr. Erica S. Shenoy, associate chief of infection control at Massachusetts General Hospital. “But in health care, we’re kind of frozen in time.” Of course there’s good reason for that, given the vulnerability of patients, but at some point, health care providers will want to move back toward pre-COVID policies, she said.
It won’t happen soon, though, experts agreed.
The guidelines will have no immediate effect in most of the country, including all of Massachusetts, Connecticut, and Rhode Island, where transmission remains at the highest level.
And the CDC doesn’t have the final word: In Massachusetts, the state Department of Public Health requires patients, residents, staff, vendors, and visitors to wear masks in all health care settings. Those rules will stay in effect unless the state changes them; the department is currently reviewing the CDC recommendations.
“We’re in a strange place in the US,” said Dr. Michael L. Barnett, a health services researcher at the Harvard T.H. Chan School of Public Health, who said he was “not too thrilled” with the CDC’s changes. “There’s lots of ongoing transmission. [But] there’s a sense at the highest levels of politics that we’re just kind of done with trying really hard.”
Barnett, who coauthored a study showing how vaccinating staff protects nursing home residents, added, “It makes even less sense to me to be permissive with nursing homes, which is the most vulnerable place in the pandemic. You could make a better case to relax anywhere except nursing homes.”
In a statement, the CDC said the new guidance helps reduce the burden on the health care workforce, “and helps to improve quality of life among long-term care residents,” as well as reflecting the vaccine and infection-induced immunity in the population and the availability of treatments. “Although SARS-CoV-2 has not disappeared, the situation is clearly different than it was last winter,” the statement said.
One advocate for the elderly noted that, if read closely, the guidelines clearly provide protection for nursing home residents. Even in lower transmission areas, the CDC still recommends masks during facility outbreaks and when caring for high-risk patients and those who are moderately to severely immunocompromised.
That would encompass virtually all nursing home residents, said Paul Lanzikos, coordinator of Dignity Alliance Massachusetts, an all-volunteer organization working to improve long-term care.
“The CDC’s really not opening the gates. It’s saying, ‘go slowly,’” said Lanzikos, the former executive director of North Shore Elder Services.
But he cautioned he would oppose any premature scaling back of the “very basic, very easy preventive measure” of masking. “I don’t think there’s any question we should be continuing masking for the foreseeable future,” Lanzikos said.
Tara Gregorio, president of the Massachusetts Senior Care Association, a nursing home trade group, affirmed that nursing facilities “continue to follow robust infection prevention protocols.” They will work with the Department of Public Health, she said in an e-mail, “to implement the federal guidance in a way that continues to balance the safety and well-being of our residents with their overwhelming desire to once again be able to see the faces of their dedicated caregivers and communicate more freely.”
Barnett acknowledged that people with hearing loss have difficulty understanding speech when they cannot see a person’s mouth. The solution, he said, is not to forgo masks, but to switch to transparent masks, which are available but underused. Faust also pointed to transparent masks as a better solution.
Julia R. Raifman, an assistant professor of health law, policy, and management at the Boston University School of Public Health, expressed concern about how the guidelines would play out at hospitals. “Hospitals are places that need to be safe,” she said, mentioning all the vulnerable patients from newborns to cancer patients. “In the time of COVID that requires doing what we can to keep COVID out of the air.”
Raifman said she plans to ask the hospital where she receives care to continue universal masking despite the CDC recommendations, and will seek care elsewhere if they don’t comply.
“All the data suggest that COVID remains a substantial problem. We’ve seen leaders from the top down purposefully turn away from it,” Raifman said. “There’s short-term political gain in downplaying the harms of the pandemic.”
The Massachusetts Health & Hospital Association said its members are still reviewing the new guidelines, but emphasized that masks are still worn in health care settings, as required by the state Department of Public Health.
Patricia Noga, vice president of clinical affairs, said in a statement that “universal masking has helped keep healthcare organizations safe for both patients and caregivers through the worst of the crisis, and we recognize that the time will come to adjust those policies based on careful consideration of COVID-19 trends and feedback from staff.
“But it’s important for patients to understand that as of today, you will still be required to wear a face covering when you enter a healthcare facility.”
Shenoy, of Mass. General, said her hospital system had already launched its own review of its COVID-19 policies. “We’re not going to be masking forever,” Shenoy said. With transmission continuing at a steady pace, and a winter surge looming, she expects masking requirements to continue for some time.
But as circumstances change, she said, “You want to tailor the intervention to the risk level.” The CDC guidance provides “a framework for tying your interventions to the amount of virus around in your community.”