Opinion | The Checkup with Dr. Wen: A Middle Ground on Masking in Healthcare Facilities

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Should hospitals and other healthcare settings maintain mask requirements, even if they have long been abandoned in virtually all other settings?

This is a very controversial issue. Some leading experts have argued that the disadvantages of hospital masking mandates outweigh the benefits, while others argue for changing the paradigm of medical care to support universal masking for the foreseeable future.

Last month, the Department of Veterans Affairs announced a new policy that, in my view, strikes a reasonable middle ground: Masks are no longer required in most clinical settings, but are still mandated in areas that serve patients at high risk. The latter category includes dialysis clinics, transplant and chemotherapy units, urgent care and emergency departments. The VA guidance is also clear that covid patients should still mask and that patients can request healthcare staff to mask for their protection.

I spoke with VA Health Undersecretary Shereef Elnahal to better understand how he and his team came to this compromise.

Elnahal told me he prioritized two key factors. The first was to protect the most vulnerable veterans, which is why the mandate remains in places that treat large numbers of high-risk patients.

The second was the preference of veterans. We received a lot of feedback from Veterans’ families and healthcare professionals as to why we were still requesting post-public health emergency masking in some settings, such as medical and surgical units for less serious health issues and outpatient care. The clear input he and other VA leaders received is that veterans and their families did not want continued universal masking across all settings.

Our most important obligation is to serve veterans the way they ask us to, Elnahal told me. The policy needed to take this into account, as well as input from experts, scientific evidence and evolving circumstances.

Indeed, we are in a very different stage of the pandemic than we were a few years ago, with far more tools to prevent and treat covid-19. The VA encourages its patients and employees to stay up to date with vaccines, and Elnahal noted that the department has a virtual trial-for-treatment program that offers Paxlovid prescriptions over telemedicine to ensure early treatment.

Basically, VA policy is a floor, not a ceiling. This means that local medical centers can add masking requirements if they see fit. For example, if there are outbreaks in a specific nursing home or hospital, that facility could add requirements beyond national guidance. And the policy could be revised in the future if, for example, a more worrying variant or a dangerous new pathogen raises alarms.

I asked Elnahal what has been the reception to the relaxing mask requirements so far. He told me that the vast majority of people, including veterans, assistants and employees, said the VA is striking the right balance.

I agree. Few public health policies will satisfy everyone, and it’s a Herculean task to find a happy medium on controversial topics like masking. I think the VA expresses the right values ​​in its decision making. It is clear that the majority of Americans do not support universal mask requirements, and that a substantial and vocal minority are vehemently opposed. On the other hand, healthcare facilities must safeguard their most vulnerable patients. Identifying which areas are frequented by high-risk patients and requiring masks in these settings, while removing mandates in others, strikes a reasonable compromise.

Meanwhile, healthcare facilities should clarify as does the VA that patients, family members and healthcare professionals have the right to require providers to wear masks while seeing them. No one should be dissuaded from getting cancer screenings, dental cleanings or other routine outpatient care for fear of contracting the coronavirus, and providers should respond to patient requests to mask up.

Finally, people concerned about infection risk should note that one-way masking—wearing a mask even if others around them aren’t—is highly protective for the wearer. Individuals wishing to avoid coronavirus and other respiratory viruses should wear a high-quality, well-fitting mask (N95, KN95, or KF94) at all times while in indoor public areas, including healthcare facilities.

And let’s not forget other preventative measures, including good hand hygiene, which reduce the transmission of not only the coronavirus but many other infectious pathogens as well.

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