A coalition of health groups is urging the Healey administration to maintain universal masking in health care settings when the federal and state public health emergencies for COVID-19 lift on May 11.
The Centers for Disease Control and Prevention last fall eased its guidelines for masks in health care settings, saying they were not necessary in areas where COVID-19 transmission was not high. But Massachusetts was among several states that maintained universal masking.
Now, with community levels listed as low across the state — and across roughly 90 percent of the country — Massachusetts health officials have acknowledged to hospital administrators and others that they are planning to lift that rule in May. The plan has triggered an outpouring of concern from health groups focused on equity and protection for people who are vulnerable to serious complications from infection, such as the elderly, those with compromised immune systems, people with severe breathing problems, and other health conditions.
“The decision has been made behind closed doors without any input by people most impacted,” said Dr. Lara Jirmanus, a primary care physician and instructor at Harvard Medical School who cofounded the Massachusetts Coalition for Health Equity.
Members of the coalition met with health officials from the Healey administration late last week, imploring them to maintain the mask rule in health settings, Jirmanus said.
A spokesperson for the state’s Executive Office of Health and Human Services, in response to questions from the Globe, released a statement that said its decision aligned with CDC guidance and federal requirements based on transmission rates and was made following “extensive conversations with health care experts.” It said the state health department will continue to carefully track COVID-19 cases in Massachusetts and adjust as circumstances change.
The spokesperson noted that infection control leaders at several of the state’s largest hospital systems have repeatedly asked the state health department to end its mandate even in advance of May 11. The spokesperson said that sentiment has also been expressed by several other people, including infectious disease physicians and providers.
While reported new infections have fallen dramatically since the winter, state data indicate an average of eight people continue to die each day from COVID. Coalition members note that state data on new COVID infections are likely an undercount because many people are not reporting the results of their at-home tests. And even when COVID transmission is low, health care settings remain the most likely places for high-risk people to encounter a COVID positive person, coalition members said.
Jirmanus relies on her elderly parents, who have chronic health conditions, for child care. If masks are removed in health care settings, she said she would feel unsafe taking her 16-month-old daughter in for necessary care because she is too young to mask and could pass COVID to Jirmanus’s elderly parents.
“I anticipate that I will forgo all preventive care and all but the high-risk/trauma emergency care until my child can reliably wear a well-fitting mask,” said Jirmanus, who also has a toddler.
Elaine Hagopian, a 90-year-old Greater Boston resident who has chronic heart and breathing problems, said she would also think twice about going to the hospital. She said she still severely restricts social engagements and wears a mask in the elevator of her building.
“I would be concerned about having to go to the hospital,” Hagopian said. “You go to solve one problem and you might get another problem.”
Some states that had maintained masking in health care settings, such as California, New York, Oregon, and Washington, recently lifted those requirements. Yet other jurisdictions, such as Los Angeles County, have maintained mask rules.
Universal masking is more effective than one-way masking, especially when a masked person is surrounded by many unmasked people, some studies have found. With new deaths and COVID infections still reported daily, health care administrators are sorting through data, even carefully monitoring new COVID variants, to try to determine how they will approach the state’s lifting of the mask rule.
“While most of the general population has been out and about, there are certainly people who have been very cautious not going out because they are immunosuppressed, and we want them to be safe coming into a health care environment,” said Dr. Richard Ellison, hospital epidemiologist at UMass Memorial Medical Center, the largest health care provider in Central Massachusetts.
When Massachusetts lifts its mask mandate for health care settings, the state health department will require each facility to have an infection control and prevention framework in place, which may include mask requirements.
Ellison said UMass has not yet decided how it will approach the issue after May 11.
“As we think about what we will do this spring, we are also trying to think about whether we will start having people wear masks again in the fall with flu, RSV, and COVID season,” Ellison said.
“This is a time for us to be cautious. When we compare things to where we were in January and February, the number of cases have dropped off markedly, and we just hope the trend continues,” he said. “We are not to the point yet to say the pandemic is over. We are hoping it’s in the last legs, but we can’t say yet the pandemic is past us.”
Patricia Noga, vice president of clinical affairs for the Massachusetts Health and Hospital Association, said in a statement that administrators at each health care system are constructing their own masking policies, with input from infectious disease leaders, feedback from frontline workers, consideration for the needs of their patient population, and monitoring of local public health trends.
“They will be prepared to adapt their approach should any of those variables change over the course of time,” she said. “We ask community members to remain aware of their local healthcare facilities’ policies once this transition begins on May 11.”
Dr. Ted Calianos, president of the Massachusetts Medical Society, said in a statement that Massachusetts today is better equipped to prevent a spike in COVID transmission because of treatments, testing, and vaccines that can be quickly deployed.
“If we return to a state of increased transmission and our public health experts report metrics that signal an increase of disease and risk in the community, we would advise all people who gather as part of a group indoors, including at health care facilities, to strongly consider masking for the protection of themselves and others,” he said.
“We hope that those who choose to continue to mask in any setting are supported and that those who enter health care facilities that elect to require masking after May 11 will respectfully adhere to those policies.”
Due to an editing error, an earlier version of this story misstated the name of a CDC measure used to track COVID’s impact on communities. It is known as the COVID-19 Community level.