Masking Mistakes – Fall 2024 Edition
It is my pleasure to introduce this article by Joseph Marine, MD in response to mandatory masking policies in a number of California hospitals. There is simply no randomized evidence to support these policies, and they make little sense in 2024. I worry about the mental abilities of the public health officers who instituted these policies, and that their actions will further erode trust in public health.
Vinay Prasad
Masking Mistakes – Fall 2024 Edition
Recent news reports indicate that several counties in Northern California will reinstate mask mandates for health care facilities starting November 1 running through March/April. The criteria for starting and ending the mandates have not been reported. The State of Maryland reinstated a health care mask mandate last winter based on the state reaching a threshold of 10 RSV/flu/covid hospitalizations per 100,000 population. Where this threshold came from is a mystery.
Proponents of such mandates argue that masking is a minor inconvenience and may be effective for “source control” to reduce the risk of nosocomial spread of respiratory viruses. While this is a worthy goal, the latter hypothesis has never been proven. We do not even know the extent of the problem. In addition, proponents fail to consider the harms of forcing everyone to wear a covering over their face in all health care facilities. They should consider these seven:
Forced masking creates an inhospitable environment for workers, patients, and visitors alike. Seeing human faces is natural and necessary for human society to function. We communicate through facial expression. Hiding faces is isolating and dehumanizing.
Forced masking sends a false signal to the public that health care facilities are “dangerous”. This idea did tremendous harm in the first covid wave in 2020 when many patients with serious symptoms avoided hospitals.
Forced masking is demoralizing to many health care workers who now see it as ineffective. Being forced to comply with irrational requirements is a well-understood cause of moral injury and burnout.
Forced masking will exacerbate the health workforce crisis. Most people would rather not cover their face all day at work. Some of those with a choice, especially non-professional staff, will choose to work elsewhere.
Forced masking will undermine public confidence that health care decisions are based on science and reason. Most people believe that mask mandates are not. Forcing people to mask in health facilities sends a message that doctors and hospitals don’t know what they are doing and may erode confidence in other health recommendations.
Mask mandates make no distinction between potentially effective masks, such as N95’s and respirators, and any piece of cloth with ear loops, sending a message that it is all just for show.
Forced masking undermines medical-scientific progress. Those who would implement health interventions (particularly coercive ones) should conduct high-quality studies demonstrating their effectiveness. Mandates bypass this usual requirement.
With studies showing falling public confidence in doctors and health care, we cannot afford to continue legacy covid policies that the public sees as irrational and ineffective. It would be sensible for public health officials to throw in the towel on the face rags and focus on more important issues.
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Thank you for addressing yet one more ridiculous mandate foisted upon hapless healthcare workers.
I am a general surgeon so all to well familiar with masking during my 50 year career in operating rooms, ICU's, etc. I sat on the infection control committee for 30 years at a major teaching hospital.
The healthcare workers have no reasonable expectation of being protected from any infectious diseases not transmitted by respiratory means. They cannot expect protection of themselves without donning pressure fit tested masks. When we wear masks and protective in the operating room we protect primarily the surgical wound from droplet contamination with saliva and help to protect ourselves from blood and bodily fluid splash from our patients.
Healthcare workers who ill with coughing and a runny nose can stay home, however the patients come to see the doctors for their illnesses. A more sane use of relatively useless surgical mask wearing would be to request the the patients with cough and nasal discharge wear a mask before they see a maskless physician to protect the healthcare staff from saliva droplets. Also to copiously use hand sanitizer before they touch anything in the facility.
Masks interfere with verbal communication, an important component of the patient visit.
Now let's consider the erroneous virtue signaling of the healthcare workers who can be assumed to be healthy if they show up for work. This masking mandate scam is about healthcare executives and their conspiratorial medical leaders exerting control of and causing fear of the healthcare workers for employment if they dare to ignore a useless mask mandate. What next? A useless six foot separation of humans. Try that out during a surgical procedure.
My health care colleagues where I live tell me that our health facility mask mandates are widely ignored by the staff.