Universal Masking in Health Care Settings
Authors: Lara Z. Jirmanus, Eiryn Griest Schwartzmann, J.D. Davids, Margaret Morganroth Gullette, Colin Killick
Journal: Annals of Internal Medicine (2023)

LettersDecember 2023Universal Masking in Health Care SettingsFREELara Z. Jirmanus, MD, MPH, Eiryn Griest Schwartzmann, CHES, J.D. Davids, Margaret Morganroth Gullette, PhD, Colin Killick, MPPLara Z. Jirmanus, MD, MPHHarvard Medical School, Cambridge, Massachusetts, Eiryn Griest Schwartzmann, CHESCOVID Safe Campus, Columbia, Maryland, J.D. DavidsStrategies for High Impact and Long COVID Justice, Brooklyn, New York, Margaret Morganroth Gullette, PhDWomen's Studies Research Center, Brandeis University, Newton, Massachusetts, Colin Killick, MPPDisability Policy Consortium, Boston, MassachusettsAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L23-0350 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR: A fundamental responsibility of health facilities is to ensure the safety of all patients and employees. Shenoy and colleagues (1) contend that because COVID-19 has “transitioned to a more stable phase,” masking requirements in health care have only “incremental benefits.” The 26% of U.S. adults with disabilities and the 17% who are older than 65 years (2) who account for nearly 90% of deaths from COVID-19 would likely disagree. Furthermore, everyone is potentially at risk for long COVID-19, which affects 15.5% of U.S. residents (3).Since 2020, COVID-19 has stably remained the third leading cause of death in the United States (4). Although vaccines and treatments decrease mortality, a substantial proportion of patients are still at risk for severe illness or death from COVID-19.The benefits of universal masking to prevent nosocomial COVID-19 far outweigh the costs. COVID-19 is airborne, and most transmission is from asymptomatic or presymptomatic persons (5); therefore, standard respiratory precautions are insufficient to prevent transmission, particularly among patients in shared waiting areas. As disability advocates, we found the authors' assertion that unmasking would offer net benefit to patients who are hard-of-hearing and who have limited English proficiency to be disingenuous and ableist. These patients are at higher risk for serious illness from COVID-19 and have the right to safe and accessible health care.Nobody should have to expose themselves to COVID-19 to receive health care. Universal masking is more effective than 1-way masking, infants and young children cannot wear masks, and patients cannot remain masked during surgery. When institutions downplay the risk for disease while removing protections against it, patients are denied true informed consent, violating their autonomy.Unless patients can trust that their health facility is safe, serving them effectively is impossible. The most vulnerable patients often require the most frequent medical care, which places them disproportionately at risk for nosocomial COVID-19 exposure. Even when COVID-19 prevalence is low (which is increasingly difficult to estimate because of decreased polymerase chain reaction testing), people visiting health care settings are among the most likely to be infected.Thus, data on community transmission cannot guarantee that a vulnerable patient will not encounter a COVID-19–positive patient and experience a life-threatening or disabling outcome. Our organizations include many patients who will forgo necessary health care because of reasonable concern about serious health repercussions should they be exposed to COVID-19. Health systems should apply the precautionary principle, center the needs of the most vulnerable, and aim first to do no harm.References1. Shenoy ES, Babcock HM, Brust KB, et al. Universal masking in health care settings: a pandemic strategy whose time has come and gone, for now [Editorial]. Ann Intern Med. 2023;176:859-861. [PMID: 37068281] doi:10.7326/M23-0793 LinkGoogle Scholar2. Administration for Community Living. 2021 Profile of Older Americans. U.S. Department of Health and Human Services; 2022. Google Scholar3. Centers for Disease Control and Prevention. Long COVID: Household Pulse Survey. 21 February 2023. Accessed at www.cdc.gov/nchs/covid19/pulse/long-covid.htm on 6 March 2023. Google Scholar4. Ortaliza J, Amin K, Cox C. COVID-19 leading cause of death ranking. Peterson-KFF Health System Tracker. 10 November 2022. Accessed at www.healthsystemtracker.org/brief/covid-19-leading-cause-of-death-ranking on 25 November 2022. Google Scholar5. Johansson MA, Quandelacy TM, Kada S, et al. SARS-CoV-2 transmission from people without COVID-19 symptoms. JAMA Netw Open. 2021;4:e2035057. [PMID: 33410879] doi:10.1001/jamanetworkopen.2020.35057 CrossrefMedlineGoogle Scholar Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: Lara Z. Jirmanus, MD, MPH; Eiryn Griest Schwartzmann, CHES; J.D. Davids; Margaret Morganroth Gullette, PhD; Colin Killick, MPPAffiliations: Harvard Medical School, Cambridge, MassachusettsCOVID Safe Campus, Columbia, MarylandStrategies for High Impact and Long COVID Justice, Brooklyn, New YorkWomen's Studies Research Center, Brandeis University, Newton, MassachusettsDisability Policy Consortium, Boston, MassachusettsDisclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L23-0350. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoUniversal Masking in Health Care Settings: A Pandemic Strategy Whose Time Has Come and Gone, For Now Erica S. Shenoy , Hilary M. Babcock , Karen B. Brust , Michael S. Calderwood , Shira Doron , Anurag N. Malani , Sharon B. Wright , and Westyn Branch-Elliman Universal Masking in Health Care Settings Erica S. Shenoy , Shira Doron , Westyn Branch-Elliman Universal Masking in Health Care Settings Steven E. Reznick Universal Masking in Health Care Settings Tyler S. Brown , Amir M. Mohareb , Regina C. LaRocque Metrics December 2023Volume 176, Issue 12KeywordsCOVID-19Health careHealth care policyHospital medicineInfection controlInfectious disease epidemiologyInfectious diseasesPathogensPrevention, policy, and public health ePublished: 19 December 2023 Issue Published: December 2023 Copyright & PermissionsCopyright © 2023 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...