Healthcare workers are divided over whether unmasking in medical settings has merit

Days before the nation's Public Health Emergency ended last week, signaling the end of the emergency pandemic era, the Centers for Disease Control and Prevention (CDC) updated its masking recommendations for healthcare facilities. In the update, the CDC advised healthcare facilities to take a risk-based approach when it comes to universal masking in healthcare facilities.

However, aside from instances where healthcare workers are directly working with COVID-19 positive patients or a facility is grappling with a known outbreak, face masks will still no longer be required. The CDC does advise face masks to be considered when working with high-risk populations, but the public health agency does appear to be taking a case-by-case basis in terms of universal masking, depending on hospital admission levels as the CDC will longer track individual cases.

While many hospitals and healthcare facilities have been walking back on masking since March, the end of the Public Health Emergency was the final push for some facilities, including Kaiser Permanente, to follow suit and go away with universal masking entirely. In April, the California Dental Association stated it would no longer require dentists to wear masks unless they were performing a clinical procedure. Universal masking was long thought to be a pandemic change that stayed in clinical practice, but it's becoming more likely that doctors won't always be masked in healthcare facilities in our post Public Health Emergency (PHE) future.

In March, the California Nurses Association condemned California lifting its masking requirement in healthcare settings. "This is an attack on frontline health care workers, who will now face greater risk of Covid-19 infections, reinfections, and long Covid," Cathy Kennedy, a RN and president of California Nurses Association, said in a statement, describing a condition in which COVID symptoms linger for months or even years. "The more Covid infections someone has had, the more likely they are to develop long Covid. It's surreal that political leaders would put nurses, patients, and community members at greater risk of developing chronic conditions like heart disease, stroke risk, diabetes, pulmonary embolism, cognitive impairment, and long-term immune dysfunction."

But is that what healthcare professionals actually want? And is this putting certain patients at undue risk? Dr. Eric Topol, Director of the Scripps Research Translational Institute and a professor of molecular medicine, said he doesn't believe it's time to unmask just yet.

"I wear a mask in my clinic," Topol told Salon. "Obviously, it would be nice if we can avoid those, but right now, there are still viruses circulating and immunocompromised people [and] people who are of advanced age are vulnerable. I do think masks help and that we should be careful."

Topol added that despite the end of the country's public health emergency, COVID-19 is still circulating and can still do a lot of damage. Indeed, studies have shown that it can increase a person's risk of long-term brain problems and risk of getting diabetes. Research continues to show that a COVID-19 infection can have a lasting impact on a person's heart.

"I think we need to keep our guard up," Topol said, adding that medical workers often exhibited presenteeism, which is working despite feeling sick. "A lot of healthcare workers come to work and are not perfectly healthy and they may be COVID carriers. In my profession, the show must go on and you must see your patients even when you're not feeling well."

Topol referenced an editorial published in the Annals of Internal Medicine last week arguing that healthcare workers aren't ready to unmask. The editorial cited presenteeism as one of the main reasons why medical professionals should keep their masks on, and pointed to how the AIDS crisis ushered in an era of medical professionals wearing gloves. "During the early HIV/AIDS epidemic, some physicians said they simply could not—for a host of reasons—wear gloves even when situations were associated with likely exposure to blood or bloody body fluids," the authors stated. "Health care personnel have adjusted to this requirement, and glove use in such situations has now become the standard of care and is widely accepted as part of standard precautions."

The editorial came a month after a separate editorial published in April stated that masking had "come and gone, for now" in healthcare facilities. Monica Gandhi, an infectious disease doctor and professor of medicine at the University of California, San Francisco, was not an author of the editorial, but agrees that masking should end in healthcare settings. "Not only are masks not as effective as we had thought, as summarized in this systematic review article, but face masks on healthcare providers can cut down on patients' impressions of empathy and caring per a randomized trial," Gandhi said in an email.

Since the beginning of the pandemic, masks have been a source of debate. It wasn't long after the outbreak that face masks became politicized as well. For a while, even a year into the pandemic, scientific studies showed time and time again that masks — cloth, surgical, N95 masks, and sometimes a mix of two — were a key step in stopping the spread of COVID-19. However, as the coronavirus mutated, cloth masks alone became ineffective.

However, masks classified as N95 and KN95 (referring to their ability to filter a high percentage of airborne particles), have still been demonstrated to significantly reduce the risk of infection. In the review Gandhi pointed to, the authors stated that updated evidence suggested that masks are only associated with a small reduced risk for SARS-CoV-2 infection in community settings. Nonetheless, the benefits of N95s couldn't be ruled out.

For Thomas LaVeist, Dean of the School of Public Health at Tulane University, the trend of unmasking in healthcare settings is "an unfortunate thing."

"The masks serve many different purposes, it protects people against multiple viruses — not just COVID-19 — and I think we should continue to mask in healthcare settings and other settings," he said, adding that he was in Taiwan and noticed more masks being worn. "I do think it would be a good thing if culturally in the U.S., people would just wear masks as a precaution, if they were feeling under the weather or something."