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.”

Continue Reading

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.


1. Hollowell A. More hospitals, health systems begin to walk back mask mandates. Becker’s Hospital Review. Updated May 1, 2023. Accessed August 24, 2023.

2. Kaiser Santa Rosa reintroduces masking requirements after hospital COVID-19 outbreak. ABC 7 News. Published April 21, 2023. Accessed August 24, 2023.

3. Rosenfield M. Boston hospital brings back mask requirement in unit affected by COVID cluster. NBC Boston. Published June 27, 2023. Accessed August 24, 2023.

4. What to expect at Seattle Children’s during COVID-19. Seattle Children’s Hospital. Accessed August 24, 2023.

5. Masking. Mass General Brigham. Accessed August 24, 2023.

6. Mitchell C. I’m worried about going to hospitals without a mask. CommonWealth Magazine. Published May 11, 2023. Accessed August 24, 2023. 

7. Taylor M. Mass General Brigham criticized over masking policy. Becker’s Hospital Review. Published May 17, 2023. Accessed August 24, 2023. 

8. Weekly review, signing off. COVID19 Data Tracker Weekly Review. US Centers for Disease Control and Prevention. Published May 12, 2023. Accessed August 24, 2023.

9. Wastewater Surveillance. COVID19 Data Tracker. US Centers for Disease Control and Prevention. Accessed August 24, 2023.

10. Talbot T, Hayden M, Yokoe D, et al. Asymptomatic screening for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) as an infection prevention measure in healthcare facilities: Challenges and considerations. Infection Control & Hospital Epidemiology. 2023; 44(1),2-7. doi:10.1017/ice.2022.295

11. Healthcare organizations change recommendations on preprocedural COVID-19 testing for asymptomatic patients. American College of Surgeons. January 24, 2023. Accessed August 24, 2023.

12. Staver A. Emergency rooms move away from universal COVID testing as staffing shortages continue. The Columbus Dispatch. Updated January 13, 2022. Accessed August 24, 2023.

13. Stainton LH. Last COVID-19 mandate falls with Murphy order. NJ Spotlight News. Published April 5, 2023. Accessed August 24, 2023.

14. Deaths by select demographic and geographic characteristics. COVID-19 Death Data and Resources. National Center for Health Statistics. US Centers for Disease Control and Prevention. Accessed August 24, 2023.

15. Li Y, Liang M, Gao L, et al. Face masks to prevent transmission of COVID-19: A systematic review and meta-analysis. Am J Infect Control. 2021;49(7):900-906. doi:10.1016/j.ajic.2020.12.007

16. Brooks JT, Butler JC. Effectiveness of mask wearing to control community spread of SARS-CoV-2. JAMA. 2021;325(10):998-999. doi:10.1001/jama.2021.1505

17. Collins AP, Service BC, Gupta S, et al. N95 respirator and surgical mask effectiveness against respiratory viral illnesses in the healthcare setting: A systematic review and meta-analysis. J Am Coll Emerg Physicians Open. 2021;2(5):e12582. doi:10.1002/emp2.12582

18. Andrejko KL, Pry JM, Myers JF, et al. Effectiveness of face mask or respirator use in indoor public settings for prevention of SARS-CoV-2 infection — California, February–December 2021. MMWR Morb Mortal Wkly Rep. 2022;71:212–216. doi:http://dx.doi.org/10.15585/mmwr.mm7106e1

19. Abaluck J, Kwong LH, Styczynski A, et al. Impact of community masking on COVID-19: A cluster-randomized trial in Bangladesh. Science. 2022;375(6577):eabi9069. doi:10.1126/science.abi9069

20. Chou R, Dana T. Major update: Masks for prevention of SARS-CoV-2 in health care and community settings—Final update of a living, rapid review. Ann Intern Med. 2023;176:827-835. doi:10.7326/M23-0570

21. Jefferson T, Dooley L, Ferroni E, et al. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database Syst Rev. 2023;1(1):CD006207. doi:10.1002/14651858.CD006207.pub6

 22. Statement on ‘Physical interventions to interrupt or reduce the spread of respiratory viruses’ review. Cochrane.org. Published March 10, 2023. Accessed August 24, 2023.

23. Palmore TN, Henderson DK. For patient safety, it is not time to take off masks in health care settings. Ann Intern Med. 2023;176(6):862-863. doi:10.7326/M23-1190

24. Lyu W, Wehby GL. Community use of face masks and COVID-19: Evidence from a natural experiment of state mandates in the US. Health Aff. 2020;39(8):1419-1425. doi:10.1377/hlthaff.2020.00818.

25. 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. Ann Intern Med. 2023;176(6):859-861. doi:10.7326/m23-0793

26. Know your treatment options for COVID-19. US Food and Drug Administration. Updated June 28, 2023. Accessed August 24, 2023. 

27. Owens C. It’s very difficult to get access to antiviral COVID treatments. Axios. Updated Jan 29, 2022. Accessed August 24, 2023. 

28. Huang P. Lifesaving COVID drugs are sitting unused on pharmacy shelves, HHS data shows. NPR. Published March 18, 2022. Accessed August 24, 2023. 

29. COVID-19 Forecasting Team. Past SARS-CoV-2 infection protection against re-infection: A systematic review and meta-analysis. Lancet. 2023;401(10379):833-842. doi:10.1016/S0140-6736(22)02465-5

30. Deng L, Li P, Zhang X, et al. Risk of SARS-CoV-2 reinfection: A systematic review and meta-analysis. Sci Rep. 2022;12(1):20763. doi:10.1038/s41598-022-24220-7

31. Nguyen NN, Nguyen YN, Hoang VT, Million M, Gautret P. SARS-CoV-2 reinfection and severity of the disease: A systematic review and meta-analysis. Viruses. 2023;15(4):967. doi:10.3390/v15040967

32. Toubasi AA, Al-Sayegh TN, Obaid YY, Al-Harasis SM, AlRyalat SAS. Efficacy and safety of COVID-19 vaccines: A network meta-analysis. J Evid Based Med. 2022;15(3):245-262. doi:10.1111/jebm.12492

33. Wu N, Joyal-Desmarais K, Ribeiro PAB, et al. Long-term effectiveness of COVID-19 vaccines against infections, hospitalisations, and mortality in adults: Findings from a rapid living systematic evidence synthesis and meta-analysis up to December, 2022. Lancet Respir Med. 2023;11(5):439-452. doi:10.1016/S2213-2600(23)00015-2

34. Ssentongo P, Ssentongo AE, Voleti N, et al. SARS-CoV-2 vaccine effectiveness against infection, symptomatic and severe COVID-19: A systematic review and meta-analysis. BMC Infect Dis. 2022;22,439. https://doi.org/10.1186/s12879-022-07418-y

35. Schieszer J. Risk of breakthrough COVID-19 higher for patients with cancer. Cancer Therapy Advisor. Published April 7, 2022. Accessed August 24, 2023. 

36. Schieszer J. Breakthrough COVID-19 in cancer patients more common during omicron wave. Cancer Therapy Advisor. Published April 21, 2022. Accessed August 24, 2023. 

37. Healy LM. Bivalent COVID-19 vaccine may not protect cancer patients from current variants. Cancer Therapy Advisor. Published February 15, 2023. Accessed August 24, 2023. 

38. Blevins Primeau AS. Cancer patients have higher risk of breakthrough COVID-19, poor outcomes. Cancer Therapy Advisor. Published January 9, 2023. Accessed August 24, 2023. 

39. Goodman J. Risk of death from COVID-19 “remains high” in vaccinated cancer patients. Cancer Therapy Advisor. Published February 16, 2022. Accessed August 24, 2023. 

40. Blevins Primeau AS. Associations between cancer and COVID-19 death “more substantial” in women. Cancer Therapy Advisor. Published May 2, 2023. Accessed August 24, 2023. 

41. Venkatesulu BP, Chandrasekar VT, Girdhar P, et al. A systematic review and meta-analysis of cancer patients affected by a novel coronavirus. JNCI Cancer Spectr. 2021;5(2):pkaa102. doi:10.1093/jncics/pkaa102

42. Nadkarni AR, Vijayakumaran SC, Gupta S, Divatia JV. Mortality in cancer patients with covid-19 who are admitted to an icu or who have severe COVID-19: A systematic review and meta-analysis. JCO Glob Oncol. 2021;7:1286-1305. doi: 10.1200/GO.21.00072