Hospital masking should be optional

Forcing family members & doctors to engage in the COVID19 forever war is anti-science & hurts patients

Warning: this post contains the word ‘shit’

Recently, I was walking into the hospital. Two security guards were sitting at the desk. One had a mask on his chin, the other, entirely unmasked. #1 elbowed #2, “Shit, there is a doctor here!”

#1 pulled up his mask hastily, and held out a box of cheap, plastic surgical masks towards me.

“No, don’t worry,” I told him, “I don’t care.”

#2 elbowed #1 in the ribs, hard.

“See, doctor don’t care. I told you!” he said, smiling. It was a beautiful smile.

Later, on my way out of the hospital, we struck up conversation.

“Boss says we have to make sure people wear masks, but it makes no sense. No one does it out there. I hate to do it in here.” he remarked.

With that: he confirmed my longtime belief that security guards have more common sense than hospital administrators. And the corollary: if you pick 20 random people off the street they could run the hospital better than the current admin (also true for Congress).

Arguments against continued hospital mask mandates

The strongest argument against continuing current policies is that they have no data to show they help. Pre-vaccine for covid, we had no cluster RCTs of hospitals to show universal masking policies (visitors, staff, docs, all floors) slow the spread of respiratory viruses, including sars-cov-2.

Post-vaccine, not only do we not have any evidence, the entire goal is disputable. It is likely that a trial conducted today would fail to demonstrate a reduction in spread of virus among all people hospitalized and among all workers. Why?

• Compliance is poor, and falling by the day

• People interact extensively outside of hospitals (PS some people think this is a bug of a trial, NO! wrong. You have to prove your intervention works in the backdrop of real life, not a farcical world where people only interact in hospitals.)

• The mask being passed out cannot stop spread of viruses when people spend time together in the same room, breathing the same air, which tends to happen in medicine.

• Sero-prevalance rises by the day no matter what we do, and fewer people are susceptible to severe disease

Meanwhile, a trial would show harms. Mandatory masking dehumanizes patients, who are already objectified and dehumanized. It prevents intimacy. It is hell on earth for people hard of hearing. I have seen people asked to wear a mask who are having dyspnea. Women giving birth. That is a great harm.

And, the corollary to this argument is that: allowing administrators to impose, by fiat, policies that do not have good evidence is why medicine has become…. for lack of a better word… shitty. Annual, computer module training has no data it improves outcomes, and makes our jobs… shitty. Boards recertification has no good data it helps patients, and makes our jobs… you guessed it… shitty. Endless paperwork, burnout seminars on weekends, training for a slew of pop-culture maladies, etc. etc…. shitty.

Administrators are making medicine so shitty that staff are withdrawing in droves. They have a bigger crisis than making staff wear flimsy surgical masks— their crisis is having any staff at all.

What about immunocompromised people?

A perennial objection to my proscription is it will harm immunocompromised people. First, the definition of immunocompromised has abused recently. An 19 year old marathon runner with exercise induced asthma told me he was immunocompromised. Because of bronchospasm on mile 22, at 7 min pace. That’s not quite it.

Of course, there are wards where patients are vulnerable. BMT for instance. Let’s remember what my policy is. Masks optional, but people are free to do what they wish. So on these wards, people can choose to wear n95s in the hall, or in their room, based on preferences.

I also want to reiterate that we don’t have data for these populations either, so I propose a 3 arm RCT here. One arm: masks optional; Second arm: patient can request anyone who comes in their room mask; Third arm; masks mandatory. Cluster RCT. I will bet big bucks, it is… drumroll please… totally null.

The mask police

In team rooms, hallways, stairwells, lunchrooms, staff are taking off the mask. Everyone is afraid of the 1 or 2 people (per 1000) who will rat them out. The mask police. This contributes to a miserable tattle-tale culture at work, and yet another reason medicine is becoming… shitty.

A few people can’t process the recent Cochrane review on community masking, which I explained on my Substack Vinay Prasad’s Observations and Thoughts, and Youtube

And they have become devotees of Lord Fauci (version 2.0, the promask guy, not 1.0 the antimask guy), and police breaches with vigor. They make life unpleasant for others, but an optional policy would disarm them of their ability to tattle.

Patients are harmed

Recently, a colleague confided in me that he had to referee a fight between a patient’s wife and the nurse. The patient’s wife was unmasked in the room, and the nurse yelled at her and implied she wished death upon her husband.

This squabble happens and is silly. Of course, she wishes the best for her husband, and part of that means being able to communicate with him with all the richness and emotion of being a human. Worse, there is no evidence that her wearing a surgical mask, as she marinades in the same room for 6 hours helps anyone. With each breath, some air rushes outside the mask, and by hour 4, all the air in the room is mixed. How on earth could anyone believe this has value? Without any RCT data? And so much value it justifies scolding her?

It is an abdication of deep principles in medicine.

It is a small thing, but it matters.

Medicine is becoming shitty because of death by a thousand cuts. Universal masking policies are being set by incompetent administrators who care only about risk aversion from litigation. They are hellbent on making medicine a bureaucratic hell to mirror their own lives, but we cannot let them.

Medicine is about evidence, and reason, and is the most beautiful job on earth. As a wise man told me the only thing better is bring a professor of medicine, and trying to make it better.

So I stand in solidarity with my Security Guard friends. No more mandatory hospital masking. If you agree. If you are fed up with rules that have no justification. Click this link to sign the petition below and make your voice heard.