The case for it, against it, and a big unanswered question
Thank you for this review. As a family doc in small examining rooms I’ve never stopped wearing an N95. It has never failed me (or failed to protect my patients).
As an older physician, married to an older dentist: I remember when we didn't wear gloves, and the huge push back when we started in the 1980's--"do you think I have AIDS??" My husband was always appalled that I didn't wear a mask with patients when they had respiratory illness. If we've learned anything, it's that universal precautions should be updated. We now understand airborne transmission: so update universal precautions. It should be simple, but there's so much vitriol and polarization. Thank you Katelyn, as always!
Immunocompromised and disabled people are literally everywhere, not just in hospitals or parts of hospitals.
I have never stopped- n95. My staff may wear surgical masks, but are required to wear PPE (n95, face shield) for all testing - we a lot in Peds. I would LOVE to show my face. My smile is one of my most memorable features I have been told, one of the reasons I love telemedicine is I can see my patients and visa versa.
My patients and families have always been required to mask w ANY respiratory symptoms but we stopped for well visits. We will have to reassess this. I know we will go back to requesting masks for that, but I hate being the first. We get flack from a mixed community.
I actually began wearing a mask in Nov 2019 when leaning in to examine patients. I just got tired of getting flu when kids coughed just as I was inspiring and leaning in. I know nobody recalls that. We have historically asked flu positive patients to mask when coming in with the diagnosis or heavy cough. Pre pandemic. I know nobody recalls this either.
Nobody, ever, in 3.5 years became ill inside my office from working or a visit. I plan on keeping it like that.
Masks for symptoms. Masks for all soon.
And BTW, we already have a local small Flu A outbreak by PCR. So welcome home flu. Again.
I welcome this. My kids and I are often the only in the masks in medical facilities, and I hate it.
My husband and I were both in the hospital with Covid in August. Me for respiratory failure (8 days) and him because he has AML and had a neutropenic fever (3 days). We likely caught it at the Cancer Center. We were among the very few patients and caregivers who wear masks religiously. None of the staff wear masks. I wear masks whenever I go into an indoor public place (KN95), such as picking up prescriptions or takeout. My husband only goes to medical appointments. August was the first month that the patients at the cancer center started coming down with COVID according to our doctor. I don't know if I'm more angry about it or more discouraged. That hospital stays and treaments cost about $40,000 for me and about the same for my husband.
Thank you so much for yet another timely and clear presentation. Your bottom line is an excellent take-home and worth repeating: “Infectious diseases violate the assumption of independence— what we do directly impacts those around us. A low-cost, minimally invasive intervention, like masking, is a great way to start protecting our community’s highest-risk individuals this fall and winter season.”
As a former healthcare risk manager, I appreciate this review. From a risk perspective, I never stopped wearing an N95 respirator. Dropping universal masking policies in health care settings only makes risky situations worse. Many people seeking healthcare are already vulnerable from pre-existing health conditions, disease, cancer, disabilities, or age, which places them at an increased risk of contracting Covid-19 and other potentially life-threatening illnesses. I spent years investigating system issues and adverse events, including deaths from hospital-acquired infections. I'm serious when I say hospitals are Petri dishes of infection. Every healthcare facility of which I am aware has seen an increase in staff and patient Covid infections since mask requirements were dropped. Hospitals aren't required to test for Covid, and since people can be asymptomatic, or shed virus before they become symptomatic, it's almost impossible to know who is sick. As a patient myself, it leaves me feeling vulnerable, wondering how many people who were exposed became infected, how many died or developed Long Covid as a result? Based on my work background, any mask is better than no mask, but especially N95's decrease aerosol transmission and the chance of becoming infected with a respiratory virus like Covid. It makes sense to wear them if you can. During my career, I also worked in the Operating Room - where masks are not optional and where wearing one never adversely affected us psychologically or impeded communication. Hopefully soon, hospitals and healthcare facilities will bring back good infection control policies that work to protect, not infect.
We had 4 COVID+ and 1 awaiting results on my unit (Women’s Health) over the weekend. I stopped wearing a mask, but I knew as soon as I started seeing COVID +, I would start again. I am now wearing my goggles and mask while in the hospital.
Heating, Ventilation, and Air Conditioning (HVAC) systems need to be set for a higher percentage of fresh air / makeup air.
"Masks work on individuals. We have limited evidence on whether they work to reduce population-level transmission."
I read this often, and it always gives me pause.
If masks work on individuals, how can they not reduce population-level transmission? For me, cognitive dissonance.
I think this may be a case where the more scientifically-minded understand what is being said. Or for all I know, maybe everyone else gets it but me.
But if my reaction is at all typical, I wonder: why continue to make the statement?
I don’t understand how after all this time people need to continually adjust their mask, especially doctors and other people in healthcare. The mask is simply not appropriate for their face. I don’t have to readjust the N95 and KN95 masks that I wear.
I worked in the dental field going into and through the Covid pandemic. I have since retired but have found all along there is almost no guidance or consideration given to dental office personnel. It was very frustrating during the pandemic as a manager of a large dental clinic to find info on how to protect my staff and patients. Dentistry is a highly aerosolized environment meaning when we work in a patients mouth our high speed hand pieces (drills) aerosolize saliva and send it out far and wide in microscopic droplets. I am hoping that at some point the CDC and CDPH will consider dentistry as essential healthcare workers and give the same advice and consideration as is given to hospitals, medical offices and long term care facilities.
Thank you for clearly stating an issue that gets lost in "personal freedoms" and "government overreaches". Preventing (or at least limiting) the spread of illness is a key facet of health care, and that is what masking should be about - and in hospitals, doctors' offices, nursing homes, and anywhere else that ill, potentially ill, and/or high risk people congregate, that should be the key determinant. I was not comfortable in a mask - but I found masks that were effective and, if not comfortable, at least less uncomfortable.
I understand that they can be hard to breath in, that people reach for their faces and inadvertently touch/move the mask - but I also remember when my dentist was at the cutting edge of service provision when he, and his hygienists, began wearing masks because they were constantly getting breathed on, and then face shields to protect against bodily fluids, and then both - and as a patient, I appreciate their caution, as they are much less likely to contract, much less pass on, illnesses that way.
Which, it seems to me, should be a key issue for health care providers at all levels - but that idea's been lost in the political noise.
I live in Marin County, and we've been lucky to have outstanding Public Health throughout the pandemic, a true partnership with the community.
I checked the Walgreen's website today, and there are no covid booster appointments for Marin. In order to get a shot, one must drive to the East Bay. I don't know if that means all covid booster appointments are already booked, or whether there's a shortage in the Bay Area? And only Pfizer is available; Moderna is nowhere to be found.
My elderly parents who live in another state had an easy time booking an appointment for a Moderna covid booster. I hear at CVS, overworked pharmacists are doing walkouts. Bumpy booster rollout, for sure. https://www.kctv5.com/2023/09/25/impossible-cvs-pharmacists-demand-more-staff-meet-demand-covid-vaccines-prescriptions/
I am still waiting for Novavax. I really hope FDA updates us soon on timing - days, weeks or months?
Thank you for this review! As a NICU nurse I appreciate the steps taken to ensure the health and safety of all patients. Surprisingly we have not had a single infant test positive for COVID thus far!