As holidays approach, advocates call for a return to universal masking in health care settings

A Boston Medical Center nurse demonstrates how she dons her N95 mask inside the ICU in October 2020. Advocates are calling on the state to require universal masking in health care settings ahead of respiratory infections this winter.Jessica Rinaldi/Globe Staff

Anticipating a surge of COVID-19 and other respiratory infections this winter, a group of doctors and activists on Monday called on the state to require universal masking in health care settings.

In a virtual news conference, the Massachusetts Coalition for Health Equity also demanded free access to COVID-19 testing and high-quality masks, public education about the risks of long COVID, and protections enabling disabled people to insist that their caregivers wear masks.

When the federal Public Health Emergency for COVID-19 ended on May 12, the state lifted its requirement for masking in health care settings. Hospital systems then eased or eliminated their masking requirements.

Some have since restored mask mandates. In September, the Cambridge Health Alliance reinstated its mask mandate for patients, staff, and visitors in any place where patient care is delivered. UMass Memorial Health is requiring masks for employees when they interact with patients in isolation, such as ICU, cancer, or transplant patients.

But the state’s largest hospital system, Mass General Brigham, will not require masks until, for two consecutive weeks, more than 2.85 percent of patients coming to emergency rooms or outpatient facilities in the region have respiratory illnesses. Then, health care staff will be required to wear masks when directly interacting with patients. An MGB spokesman said Monday that the rate was 1.68 percent last week.

The coalition, which advocates for the health and well-being of marginalized populations, including the elderly and those with disabilities, is urging the Department of Public Health to require that patients, staff, and providers wear masks in hospitals, doctors’ offices, mental health clinics, and dental offices. They also want all patients to be screened for COVID-19 before procedures.

A Department of Public Health spokesperson said that, when the public health emergency ended, the department asked all hospitals to develop “plans for when and how to reinstitute mitigation measures for respiratory viruses, including masks,” and some have adopted new policies in response to the rise in cases. The state has also required all health care workers to receive flu and COVID vaccines annually unless they have an exemption. Hospitals are also required to provide masks to anyone who requests one at a clinical visit.

But Dr. Lara Jirmanus, a primary care doctor and member of the coalition, said universal masking was the best way to protect people this winter.

“COVID is airborne, meaning that it spreads through the air like smoke,” she said. “You can even become infected by someone after they’ve left the room.” More than half of COVID-19 cases are transmitted by people who have no symptoms, she added, “which means people can infect each other without knowing it. And then that is a major reason why it is helpful for people, especially during periods of high transmission, for everybody to be masked to protect everyone.”

Dr. David Alpern, a Northampton physician and a coalition member, pointed out that COVID-19 symptoms are “often indistinguishable from the common cold.” As a result, “Health care staff who may go to work with symptoms become potential spreaders.”

“The absence of the N95 masks in health care settings inevitably leads to increased COVID transmission, which by the way, can contribute to our worsening health care workforce crisis,” Alpern added.

Dr. Theodore Pak, MD, an infectious disease fellow at Mass General Brigham who was a guest speaker at the news conference, said that patients commonly acquire COVID-19 in the hospital, but these cases rarely come to light in the United States because there are no systems to track them. In other countries, like the United Kingdom, “we have seen tens of thousands of patients — we’re talking about rates of like one in seven patients during the waves of COVID — getting their COVID while they’re in the hospital,” he said.

Colin Killick, executive director of the Disability Policy Consortium, said that many people with disabilities need to visit health care settings often, “and every one of those visits becomes a roll of the dice.”

He compared masking to wearing gloves, a practice that continues in all health care settings.

“I can’t understand why we don’t just continue using a basic, simple intervention that results in patients being safer and saved lives,” he said.

Jirmanus said that the Cambridge Health Alliance, where she works, gives patients the option of asking their health care team to wear masks. Other health institutions, she said, require patients who make such requests to provide documentation that they have a disability or condition that makes them vulnerable. “That can be very intimidating for people. I’ve seen people not be able to provide that documentation. … The question is, why are we even doing this?”

Jayda Jones, a disability rights advocate, said that people who are disabled, immunocompromised, or chronically ill are being discouraged from asking providers to wear masks or have been denied such accommodations. “This leads to some people with disabilities delaying or foregoing medical care and treatment,” Jones said.

Rapid tests for COVID-19 are becoming increasingly available. The Department of Public Health has shipped 870,000 COVID-19 tests to approved programs, such as nursing homes, congregate care facilities, and local boards of health. The Boston Public Health Commission is also distributing 10,000 free rapid tests at community centers and health centers around the city. And anyone can order four free tests from the federal government on COVIDTests.gov. Households that ordered this fall can order four more tests, and those that have not can submit two orders for a total of eight tests.

Asked to comment on the coalition’s demands, Patricia Noga, vice president of clinical affairs for the Massachusetts Health and Hospital Association, provided a statement saying: “Nothing is more important to our healthcare facilities than providing safe, equitable, and high-quality care to everyone who steps in their doors. They are adhering to all DPH guidance as the winter approaches, while placing a strong emphasis on the expertise of their own infectious disease experts, frontline caregivers, and patients. We commend community advocates for making their voices heard on these important issues.”