Dr Henderson recently co-authored an editorial in favor of keeping masks in health care settings while the pandemic wears on.23 The editorial outlines several points in support of masking in health care settings, including the relative lack of any respiratory infections when masking was prevalent in community and health care settings.24
The editorial also addresses presenteeism, which is when health care professionals come into work sick, knowingly or otherwise.23
“One of the reasons that COVID-19 was such a problem for society and for our country in particular, was that asymptomatic spread was underappreciated at the start,” Dr Henderson said. “Masks are highly effective as source control whether someone feels sick or not.”
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Before Dr Henderson’s editorial was published, an editorial by Shenoy et al had argued that universal masking in health care was no longer necessary.25 The authors wrote that masks were no longer needed due to low rates of SARS-CoV-2 infections, hospitalizations, and deaths. As noted previously, however, data on infections, hospitalizations, and deaths are limited.8-14
Shenoy et al also wrote that masks are no longer needed due to the availability of COVID-19 treatments.25 At present, there are 4 therapies approved or authorized to treat patients with COVID-19 in the US — remdesivir (Veklury), baricitinib (Olumiant), tocilizumab (Actemra), and nirmatrelvir/ritonavir (Paxlovid).26 However, these treatments are not appropriate for all patients with COVID-19, and accessing the treatments has proven difficult for some patients.26-28
Shenoy et al also cited relatively high levels of prior immunity from vaccines, infections, or both as a reason why universal masking is no longer needed in health care settings.25 However, research has suggested that prior SARS-CoV-2 infection does not provide lasting immunity.29-31 Studies have also suggested that COVID-19 vaccines do not provide lasting protection against COVID-19 or severe outcomes, especially as new SARS-CoV-2 variants continue to emerge.32-34
Multiple studies have suggested that the risk of breakthrough SARS-CoV-2 infections is particularly high in cancer patients, and cancer patients have a higher risk of poor COVID-19 outcomes, including death.35-42
Risk Mitigation for Patients With Cancer
Advocacy groups, such as Action for Care and Equity and COVID Advocacy Initiative, have been pushing for a return to universal masking in health care settings, but those calls have largely been ignored.
“Many people are acting as though there’s very little COVID-19 out there,” said Michael Hoerger, PhD, a clinical health psychologist and associate professor of psychology, psychiatry, and oncology at Tulane University in New Orleans, Louisiana.
“And it’s really not true, which is very challenging for somebody with a serious illness who is no longer getting much protection from others in the community and is largely having to fend for themselves with risk mitigation.”
Dr Hoerger was recently awarded a grant for a pilot project to help patients with cancer avoid COVID-19 in New Orleans. The strategy includes providing patients with educational resources about how to reduce the risk of transmission as well as giving them high-quality masks, air purifiers, and rapid tests.
“There is this prevailing dogma from the start of the pandemic that COVID-19 was mainly spread through droplets from coughs and sneezes and that people would get COVID-19 by touching contaminated surfaces,” Dr Hoerger said.
“People were told to wash their hands, wipe down surfaces, and use hand sanitizer. Now, it’s very clear that COVID-19 spreads predominantly through the air, and when people understand that, it really reshapes the types of precautions they should be using.”
“I think COVID-19 is likely to be a part of our lives for years and decades to come and may take its place alongside the other viruses that we worry about all the time in health care settings,” Dr Henderson said. “Hospitals must try to develop strategies that provide the safest possible environment and don’t compromise patient care.”
Disclosures: None of the interviewees have any relevant conflicts of interest.
References
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