Opinion: Why hospitals should keep mandatory masking

Masks unequivocally mitigate the spread of airborne pathogens. When the havoc being wreaked by COVID is still rampant, it is dumbfounding why universal mandatory masking would be removed in health-care settings — especially acute-care hospitals filled with the vulnerable sick, the immunocompromised, and those with significant pre-existing illness.

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Why now? All other public-health measures have disappeared. Immunity has waned in the general population, who are suffering from severe vaccination fatigue. We are still learning of potentially severely detrimental systemic ramifications of repeated COVID infections and the impacts and rates of long COVID. In Alberta, hospitalizations have currently plateaued, at an unacceptably high level of 450 patients, around five per cent of all acute beds.

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Hospital-acquired infections (HAIs) continue to occur, complicating and lengthening inpatient stays, or even resulting in death. Health-care workers have been encouraged to return to work, even if they’ve tested positive for COVID, as long as they don't have overt symptoms, thereby promoting asymptomatic spread.

In the U.K., currently 30 per cent of all hospitalized COVID-positive cases are acquired in the hospital (data is unavailable for Canada). HAIs have much worse outcomes than for the general public, given the vulnerability of already sick, immunocompromised, and post-operative patients. HAI mortality, previously as high as 39 per cent, continues to be around 10 per cent, according to leaked statistics from Australia. One in 10. Quite the Russian roulette.

The human rights commissioner of B.C. has equated the removal of hospital mask mandates as contrary to human rights for high-risk patients. If hospitals want us to trust this new policy, the statistics must be transparent. How many COVID HAIs have happened monthly since the start of the pandemic, and what is the trend? How about deaths? Show us the modelling and assumptions that indicate removing universal masking will not result in a jump of both of these embarrassing statistics.

Wearing a mask in a hospital is nothing new. The entire operating room staff is masked every day. Oncology staff mask frequently to protect the severely immunosuppressed. N95 masking is required for patients with airborne transmitted diseases such as TB.

The replacement policies recommended don't make sense. Suggesting that people "assess their own risk" is akin to suggesting a police officer decide when to wear a bulletproof vest. Proclaiming that someone should wear a mask after they already have symptoms demonstrates an ignorance about asymptomatic spread, causing 50 per cent of new infections, and would be like telling a woman to start getting yearly mammograms only after her breast cancer has metastasized.

Some have suggested that masks have contributed to health-care worker "burnout." The root causes of this state of emotional, mental, or physical exhaustion precipitated by prolonged or repeated stress, include being overwhelmed by sick patients, dealing with poor outcomes, fighting nonsensical politics that consume administrative decisions, and a multitude of emotionally hurtful issues having to do with injustice to caretakers. The continued uncertainty, inconsistency, and misdirection of COVID safety protocols in health-care environments may actually worsen health-care worker burnout.

Health-care workers just want to be safe. We want to avoid getting and transmitting disabling post-COVID complications. Without protection and support from our leaders, health-care workers will follow the only healthy routes left to us when the trauma of being neglected and ignored are experienced: longer breaks, tighter boundaries, retire early, and escape to find healthier working environments. A staffing crisis is no time to be causing more acute illness, more long-term disability, and more questions about our professional futures.

The politicization of masks and the social stigma now attached to them is one of the many negative consequences of the COVID-19 pandemic.Transmission of common respiratory viruses essentially disappeared when universal masking was instituted. Common sense, and decades of science, show that we prevent viral transmission if the respiratory system is mechanically protected from viral entry or exit. Now, more than ever, it is not just prudent but the moral and ethical responsibility of health-care workers to protect ourselves, our colleagues, our vulnerable patients, and the very health-care system we treasure so.

Sanjiv K. Gandhi is clinical professor of surgery, University of British Columbia and former head, pediatric cardiothoracic surgery, British Columbia Children's Hospital

Cameron Morhaliek is an adult and child psychiatrist from Edmonton, relocating to Powell River, B.C. as a result of the pandemic crisis and its exposed shortcomings in the Alberta mental health-care system.

Joe Vipond is an emergency doctor and clinical assistant professor at the University of Calgary and the co-founder of Masks4Canada and ProtectOurProvinceAB.

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