In hospitals, viruses are everywhere. Masks are not. | ET REALITY


Liv Grace suffered respiratory infections three times over the course of four months. Each of them occurred after a visit to a medical provider in the Bay Area.

Max. Grace, 36, a writer who uses they/them pronouns, was infected with respiratory syncytial virus, which caused pneumonia, in December after they were treated by a nurse wearing a surgical mask and complained that her children They were sick with the virus.

Max. Grace contracted Covid after a visit to a cancer center for an infusion in February. And there was the pale, coughing phlebotomist who drew her blood in April, just before they contracted Covid again.

Max. Grace was born with a rare immune deficiency related to lupus and takes a medication that depletes the cells that produce antibodies. The combination renders the body unable to defend itself against pathogens or recover quickly from infections.

Since the pandemic began, Mx. Grace has rarely ventured anywhere other than healthcare facilities. But hospitals, by their nature, tend to be disease fociincluding Covid, even when community fees are relatively low.

“People like me, who are very high risk and very susceptible, are still going to get sick when we’re sitting in a virus soup,” Mx said. Grace said.

Faced with a possible wave of coronavirus infections this fall and winter, relatively few hospitals… mostly in NY, Massachusetts and California – have mask mandates restored for patients and staff members. The vast majority do not have them and almost none require them from visitors.

On Thursday, several Bay Area counties had announced mask mandates for staff at health care facilities that treat high-risk patients, including infusion centers, starting Nov. 1.

The order does not apply to facilities in Berkeley, including Alta Bates Summit Center, part of the Sutter Health network, where Mx. Grace was treated.

“We continue to monitor the impact of Covid-19 on our communities and work with state and local health departments to ensure any additional masking and public health requirements are incorporated into our policies,” a Sutter Health spokeswoman said in a statement.

Among patients, health care workers and public health experts, opinions are sharply divided on whether and when mask mandates should be instituted in hospitals.

Brigham and Women’s Hospital, which is part of the Mass General Brigham system, currently requires masks only in hospital settings. However, some of its own experts disagree with the policy.

Hospitals have an ethical obligation to prevent patients from becoming infected on-site, regardless of what they choose to do elsewhere, said Dr. Michael Klompas, an epidemiologist at Brigham and Women’s Hospital.

“That’s their prerogative,” he said of patients who are at risk outside of the health care setting. “But in our hospital, we must protect them.”

In August, Dr. Klompas and his colleagues published a paper showing that mask wearing and Covid screening at Brigham and Women’s also decreased flu and RSV infections. by about 50 percent.

The Centers for Disease Control and Prevention recommends that hospitals consider using masks when levels of respiratory infections increase, especially in urgent care and emergency rooms, or when treating high-risk patients.

But the guidelines do not specify what the benchmarks should be, leaving each hospital to choose its own criteria.

Ideally, every patient would be given a mask upon arrival at an emergency room or urgent care, and asked to wear it regardless of symptoms, said Saskia Popescu, an infection control expert at the University of Maryland. .

But hospitals must also take into account the backlash against mask-wearing in large sections of the population. “Now that we’re not in this emerging state with Covid, I think that’s going to be the most challenging thing, especially since masks have become so politicized,” he said.

As a result, in the emergency rooms of many hospitals, such as Banner-University Medical Center Tucson, Arizona, and Kaiser Permanente Sunnyside Medical Center, outside Portland, Oregon, Covid patients sit next to older adults, women pregnant women and people with conditions such as diabetes that put them at high risk if infected.

Very few hospitals that predominantly treat immunocompromised patients, such as City of Hope, a cancer treatment center in Los Angeles, have maintained universal mask use. But some of the country’s most prestigious hospital systems do not require masks even in their cancer centers, where severely immunocompromised patients like max. Grace to receive infusions.

“Just do what you want; that’s essentially what the CDC guidelines say, right now, in terms of universal mask use,” said Jane Thomason, senior industrial hygienist for National Nurses United, which represents nearly 225,000 nurses. registered.

The guidelines give hospitals “permission to prioritize profits over protecting nurses and patients,” Thomason said. The union has called for stronger protections, including the use of N95 respirators, to protect health care workers, patients and visitors.

A recent study found that more cancer patients They died of Covid during the Omicron wave than in the first winter wave, in part because the people around them had stopped taking precautions.

But partial masking (say, only in units with high-risk patients) can still endanger patientssaid Dr. Eric Chow, chief of communicable diseases at Public Health Seattle and King County, Washington state. High-risk people “are scattered throughout the hospital,” he said. “They’re not necessarily confined to a specific space.”

Until Thursday, hospitals in the Emory Healthcare system required staff members to wear masks only when interacting with hospitalized patients. It also now requires masks for staff members working in high-risk settings, such as cancer centers.

Emory’s Winship Cancer Center in Atlanta changed its policy “based on the increasing prevalence and hospitalizations of Covid-19 and other respiratory illnesses in the community,” Andrea Clement, the institute’s associate director of public relations, said in a statement.

Staff members are now required to wear masks anywhere they may encounter patients, including lobbies, elevators and stairwells. Masks are “recommended” for patients and visitors, but not required.

Mass General Brigham is evaluating new criteria for reintroducing mask wearing, such as the proportion of people in its emergency rooms with respiratory illnesses, admissions for such illnesses and wastewater data, said Dr. Erica Shenoy, chief of infection control. of the hospital system.

In June, Dr. Shenoy and her colleagues argument in the Annals of Internal Medicine that the time for universal mask-wearing had passed, in part because most interactions between patients and health care staff are brief.

In response to criticism from scientists, they later cited the results of a unpublished study showing that only 9 percent of people without symptoms carried infectious coronavirus.

“The fact is that Covid conditions have changed dramatically,” Dr. Shenoy said in an interview. “From a policy perspective, it’s important to have an open mind and be able to reflect and review our policies as we move forward.”

But several experts, including Dr. Klompas, said that stance underestimated the long-term effects of other respiratory infections, such as influenza and RSV.

Respiratory viruses can unmask or exacerbate chronic diseases of the heart, lungs or kidneys and trigger autoimmune diseases. “It’s much bigger than just infection,” Dr. Klompas said.

CDC infection control guidelines date back to 2007 and are being reviewed by an advisory committee. tthe process has been plagued with controversy: Critics fear the recommendations are too modest to protect patients and staff. (Dr. Shenoy is one of eight committee membersand co-author of the June editorial, Dr. Sharon Wright, is its co-chair).

In July, National Nurses United submitted a request to Dr. Mandy Cohen, director of the CDC, which was signed by hundreds of health care, virology and infection control experts, and dozens of unions and public health organizations.

The petition criticized the infection control committee for lacking diversity of expertise and considering its decision-making opaque. The committee did not appear to recognize how the coronavirus spreads indoors or the need for N95 or similar respirators that effectively block virus particles, according to the petition.

Advisers were scheduled to vote on the changes at a meeting in August, but postponed the vote until November. During a public comment period at an August meeting, several people, including Mx. Grace, expressed her dismay at the draft guidelineswhich according to them were inappropriate and endangered their lives.

The repeated infections have taken their toll on Mx. Grace, causing more frequent migraines and brain seizures and leaving them afraid to seek care even when they need it.

Before the pandemic, hospitals were less dangerous because staff members often wore masks and people in waiting rooms and elevators were likely to get sick only in late fall or winter, Mx said. Grace said.

“It was still scary,” Mx said. Grace said. But there was no “negative attitude about asking for more precautions.”

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