Washington DC, USA- September 19: Protestors march outside the White House to call attention to … [+]
While Covid-19 rates have been increasing throughout much of the country, the message from many of our public health and political leaders has become one of minimizing and denial. This is happening nationwide, but some physicians at Boston’s preeminent hospitals are more often in the news.
We know that high-quality masks work to prevent infection. But Boston area hospitals (among others) dropped masking requirements on May 12. Massachusetts General Brigham went so far as to tell patients they can no longer ask staff members to mask. This has understandably caused an outcry among immunocompromised patients who fear seeking care due to their risk of infection. I wrote about this here and here.
I contacted Dr. Erica Shenoy, chief of infection control at MGB, to ask about their policies but received no answer to my questions. More recently, I attended a talk by Dr. Shira Doron, chief infection control officer for Tufts. Doron was Shenoy’s co-author, along with Beth Israel Lahey’s Sharon Wright, in writing an article against universal masking in the prominent Annals of Internal Medicine journal.
During the limited question-and-answer period, Doron explained, “My job is to prevent the transmission of disease within a healthcare system.” She went on to say she does not mask when out and about because “I am not trying to outrun the virus.” She added, “Maybe you can delay it a little bit, but we’re all going to get Covid again and again throughout our lifetime.”
Asked about hospital ventilation, she replied that there is no need to improve the ventilation as rooms have “many air exchangers and excellent filtration. And so it’s really the safest place you can be.”
I was able to ask, “I was taught, ‘First, do no harm.’ Yet many Boston hospitals have dropped masking, and patients complain that HCWs refuse to mask even when they are asked to. How do you suggest protecting vulnerable, immunocompromised patients when you suggest masking is unnecessary in health care settings?”
Doron never answered that question. She deflected, saying, “This is something that I think about all the time.” She said she spoke with a number of patients who said, “I want to see that face of my caretaker, my doctor, my nurse.” Similarly, healthcare workers said, “This [masking] is not the kind of connection that I want to have with patients.” However, she added that we may see masking in specific settings when cases spike.
Dr. Michael Oleson, an epidemiologist and consultant, asked, “Why is the Healthcare Infection Control Practices Advisory Committee (HICPAC) not pushing for mandatory respiratory protection in healthcare settings? There’s evidence that we’re going to be losing half of our healthcare workers due to burnout, sickness, and death in around five years.” Doron replied that she is not a member of HICPAC. She is, however, a member of the Massachusetts DPH Healthcare Associated Infections Technical Advisory Board, along with Shenoy and Wright, both of whom serve on HICPAC.
The final question was from a woman identified as Jocelyn, who asked, “Why are there any medical profession professionals anywhere starting to minimize Covid when the threat of being disabled by Covid with long Covid and the risks for so many other serious issues such as heart attack, strokes, cognitive issues, diabetes are so high?”
Doron replied that a lot of the news is scaremongering for clickbait. “If you look at some of the headlines, you would think that all of America is walking around with long Covid or organ damage. And that isn’t the case.” She added, “The rate of long Covid has gone down dramatically over the last three years,” and then concluded her talk with, “The vast majority of people who get Covid today are recovering completely and doing perfectly well.”
How dramatically, and how well? What does the data say? The long Covid-19 prevalence among all U.S. adults fell from 7.5% in June 2022 to 6% in June 2023, per the CDC. It notes, “approximately 1 in 10 adults with previous Covid-19 were experiencing long Covid at the end” of the June 2023 study period. Further, “Among people with long Covid, 79% report having limitations to their day-to-day activities and 27% characterize the limitations as significant.” This is not trivial and there appears to be no data to confirm a dramatic drop in long Covid.
Doron told the Washington Post, “Transmission is inevitable” and “Most people don’t need to know what virus they have and don’t need to be buying tests all the time.”
Doron filmed “I’ll Stay Home for Christmas” two years ago with Tufts. The most ironic line in this is:
“I’ll stay home for Christmas, a plan we have devised,
To show respect and help protect the immunocompromised.”
Tufts tells vulnerable patients that “One-way masking is protective,” so they “should feel safe” even if their healthcare worker refuses to mask. That does not match the reality patients report. A number of people on social media or testifying at the HICPAC meeting said they had contracted Covid-19 in hospital settings where they were the only ones masked.
What Kind Of Mask Do You Need?
Most people accept now that Covid-19 has airborne transmission and that good masks will help reduce your risk of infection.
There is ample evidence that N95 masks are better than surgical masks. Fitted N95s filter 95% of the viral particles, but even a loose-fitting N95 can filter 57% to 86% of the particles. KN95 or KF 94 masks also offer high protection and can be improved with a simple strap to help them fit more securely. Elastomeric half-mask respirators are equally effective to N95s and are reusable.
Surgical masks (aka “baggy blues”) are too loose fitting and only filter 47%–50% of particles. If you need to wear a surgical mask, you can make it much more protective with a mask brace to help it fit more tightly.
One-way masking, as these Boston hospitals suggest, is far from ideal. If you are in such a hospital, wear an N95. The risk varies with the type of activity, ventilation in the space, number of people, etc. Lisa Brosseau, Ph.D., CIDRAP consultant, estimated it would take about 1.25 hours of exposure for a person wearing a non-fit tested N95 to get infected from someone who is unmasked but contagious.
Stanford sociologist Pantea Javidan, J.D., Ph.D., also viewed Doron’s speech. Via email, she said, “Doron’s callous disregard for vulnerable patients based on anecdotes and personal preferences and denying the findings of long Covid research made this one of the most painful lectures I’ve ever attended.” She added, “Her comments [about outrunning the virus] were replete with fatalism and implicit mental health stigmatization, implying that mitigation is an irrational exercise in futility.”
Javidan also expressed concern that some medical leaders are “promoting policies that erode health & safety, which render self-protection increasingly difficult.” We’ve seen this with Drs. Ashish Jha, the White House Covid-19 Response Coordinator, and Mandy Cohen, the CDC director, for example. Both have stressed that “We are in a better place” than last year and minimizing the toll of long Covid.
As Javidan concluded, “These are not leadership qualities that generate good health outcomes.”