A recent study published in the Annals of Internal Medicine Journal advocated that it was not the (right) time to stop using masks in healthcare settings.

Study: For Patient Safety, It Is Not Time to Take Off Masks in Health Care Settings. Image Credit: GroundPicture/Shutterstock.com

Background

Hospitals must decide on de-escalating some mitigation strategies as the coronavirus disease 2019 (COVID-19) public health emergency is lifted. Decisions on tweaking institutional policies on infection control and prevention are complex and rely on various institutional and regional factors.

Masking in community settings has been contentious during the COVID-19 pandemic, partly due to the lack of quality evidence endorsing efficacy and mask-wearing politicization.

So far, most studies addressing the effectiveness of masks have methodological limitations, with suboptimal adherence to mask usage in almost all studies. It is difficult to demonstrate that masks work when mask usage is inconsistent.

The authors suggest that masking should continue during interactions between healthcare professionals and patients for patient safety despite the lack of clinical effectiveness trials.

Masks limit the spread of particles

Laboratory studies showed that facepiece respirators and surgical masks could effectively limit the spread of droplets and aerosols from people infected with coronaviruses and influenza.

Although masks are not 100% effective, they reduce the number of viral particles released while coughing or communicating and mitigate risks. Moreover, transmission from healthcare personnel to the patient and vice versa can occur even when both use masks, but it is not common.

Presenteeism compels the need for continued masking in healthcare settings because healthcare personnel continues working even when sick.

In several studies, up to two-thirds of healthcare professionals admitted working with respiratory symptoms. Presenteeism is well documented during respiratory viral outbreaks associated with healthcare.

Through interviews, the authors examined presenteeism in one of their hospitals during the COVID-19 pandemic.

More than 50% of the staff who preferred asymptomatic testing and were later SARS-CoV-2-positive acknowledged they had some COVID-19-related symptoms at testing, highlighting the problems of presenteeism. Nonetheless, transmission to patients did not occur despite the proximity while providing care.

Masking in healthcare settings

Individuals vaccinated for COVID-19 or influenza may develop mild symptoms that could be mistaken as non-infectious. Moreover, one-third of infections with SARS-CoV-2 Omicron are asymptomatic but could be severe and life-threatening if transmitted to susceptible individuals.

Hospitals with immunocompromised and elderly patients will face challenges when discontinuing measures.

The universal masking approach may not be the only option; other approaches can be applied according to the clinical setting. For example, masking in the season of respiratory viral infections, at the start of fall, and across wards with patients at risk of respiratory sequelae, among others.

Masks should continue to be examined in clinical settings for benefits and unforeseen outcomes, and the major limitations of masking, e.g., communication impedance, should be addressed by improving or redesigning masks.

Notwithstanding the pitfalls of masks, healthcare institutions have functioned well during the COVID-19 pandemic. Some argue that universal masking is not practical for patient care.

During the acquired immunodeficiency syndrome (AIDS) epidemic, physicians indicated they could not use gloves even when they were likely to be exposed.

Nonetheless, healthcare professionals have adjusted, and gloves are accepted as standard precautions and have become the standard of care.

Concluding remarks

It is noteworthy that masking reduced healthcare-related transmission of almost all respiratory viruses, not just SARS-CoV-2, in several institutions. Further, a recent survey of epidemiologists across the United States (US) suggested that most (97%) were not eager to remove masking in their facilities.

Although this sentiment may have changed over the past months, many experts support using masks to prevent the spread of respiratory viruses. Therefore, the authors advocate that masking should not be discontinued in healthcare settings for the safety of patients.