In the summer of 2023, I was called to the emergency room to admit a patient in her 70s who was lightheaded after working in her garden. After a close examination, history, and physical, I determined she was dehydrated, and, given her age, I chose to send her to the medical floor for gentle IV fluids overnight. The following day, she developed joint and muscle aches, and then experienced chills and rigors – indicators of a likely viral infection.
She tested positive for COVID-19. A few days later, I, too, tested positive for COVID, which kept me away from my hospital in Pennsylvania for six days. Not long after I returned from being sick, we intubated two patients with COVID, the harbinger for the fall and early winter to come. By December, concerning upticks of COVID and respiratory syncytial virus (RSV) are evident in wastewater across the nation.1 Respiratory disease season has arrived.
On December 14, 2023, the Centers for Disease Control and Prevention (CDC) issued an official Health Alert Network Health Advisory to advise health care providers of low vaccination rates against influenza, COVID-19, and RSV. The advisory recommends that providers should administer vaccinations now to eligible patients, recommend antiviral medications as needed and appropriate, and counsel patients on preventative measures like “coughs/sneezes, staying at home when sick, improving ventilation at home or work, and washing hands to protect themselves and others against respiratory diseases.”
Masking is not mentioned in the introduction. It is included as the final of five recommendations for health care providers, where it says patients can wear “a well-fitting mask if a patient chooses to wear a mask” as a preventative measure. Nowhere is it recommended that health care providers themselves don a respirator. Yet, the masking of health care providers with a respirator like an N-95 is an important tool we can use to protect our patients and ourselves.
In recent months, like many clinicians, I did not consistently wear a surgical mask, much less an N-95 respiratory mask, for every emergency room patient that I evaluated. I only wore a mask for patients with upper respiratory symptoms, or when I myself had respiratory symptoms. The hospital did not require masking.
For me, these late summer COVID patients and my own bout of illness, were loud reminders that masking during the respiratory disease season in health care settings is warranted.
Masking is an effective measure to reduce the transmission of COVID-19. 2,3 Within a clinical setting, hospital-acquired respiratory infections cause significant morbidity and mortality.4 Over the course of the pandemic, we also refined our understanding of asymptomatic and presymptomatic case transmission.5 Extrapolating from these studies, one can infer that masking can play an important role in reducing respiratory infection spread within health centers as well, particularly among vulnerable patients with higher susceptibility to infection.
Nationwide, there is understandable fatigue around masking. In a clinical setting, there is also burnout and trauma from three years of pandemic care. There is a kind of anxiety that comes over the health care team when we again start to intubate and ventilate COVID patients. Some may be flashing back to the horrors of that not-so-distant past.
Perhaps this fatigue and trauma are why so few health care providers are masking up, even as we see cases of respiratory illness in our own clinics and hospitals, illnesses whose spread can be reduced with respirators.
Masking can be cumbersome and uncomfortable over the long hours of a shift. Masks or respirators can disrupt communication with patients, blocking our facial cues and reducing effective understanding when there are language barriers. But the benefits outweigh the risks. Our job is to protect and improve the health of our patients, and masking -- at least during the respiratory disease season, during waves of airborne infectious diseases, if not year-round, and when working with our high-risk patients – is our duty. Returning to pre-pandemic protocols is irresponsible, with our improved understanding of asymptomatic and presymptomatic spread of diseases, plus ongoing COVID, RSV, and influenza transmission.
Of course, masking is not the only preventative step we need to take. As the CDC’s Health Alert emphasizes, immunization against COVID, influenza, and RSV is strikingly low, and we need to do everything we can to promote vaccination. (See Resources for some downloadable and customizable materials to use with patients.)
Only 17% of the US population got the 2022 bivalent vaccine. Yet, that 17% saw 60% effectiveness against urgent care and emergency department visits and 65% effectiveness against hospitalization – a stunning reduction in severe disease.6 Those who are eligible should get the updated COVID vaccine, the flu shot, and the RSV immunization, to support the vulnerable around us, and help providers stay safe and well.
COVID is no longer top-of-mind, but the lessons we learned shouldn’t be forgotten. Masking is a simple step which, along with other preventative measures like vaccination, must be promoted within the health care setting to protect health care workers and vulnerable populations.
Resources:
Migrant Clinicians Network recently updated our COVID Hub to help you find the resources you need. The Hub is available at: https://www.migrantclinician.org/explore-issues-migrant-health/covid-19.html or use our navigation bar and select “Explore” and then “COVID-19.” Here is a preview of three of the eight sections:
- Vaccine Resources: This section includes updated resources and printable handouts in English and Spanish to educate about and encourage vaccination. Many of these resources, like our “Yo me la puse” vaccination posters, are relevant for other vaccinations beyond COVID, and are available as an editable template.
- Population-Specific Resources: This section rounds up numerous farmworker-specific resources from agencies like the CDC, National Council for Occupational Safety and Health, and National Center for Farmworker Health.
- Respirators and Masks: This section includes MCN’s fact sheet, “Protecting Ourselves and Others with Respirators and Masks,” in English, Spanish, and Haitian Creole, and numerous other downloadable resources in English and Spanish.
References
1 WastewaterSCAN Dashboard. Overview for National. Available at: https://data.wastewaterscan.org/ Data retrieved 12/14/23.
2 Mahase E. Covid-19: Lockdowns and masks helped reduce transmission, expert group finds. BMJ. 2023;382:1959. Published 2023 Aug 24. doi:10.1136/bmj.p1959
3 Boulos L, Curran JA, Gallant A, et al. Effectiveness of face masks for reducing transmission of SARS-CoV-2: a rapid systematic review. Philos Trans A Math Phys Eng Sci. 2023;381(2257):20230133. doi:10.1098/rsta.2023.0133
4 Chow EJ, Mermel LA. Hospital-Acquired Respiratory Viral Infections: Incidence, Morbidity, and Mortality in Pediatric and Adult Patients. Open Forum Infect Dis. 2017;4(1):ofx006. Published 2017 Feb 3. doi:10.1093/ofid/ofx0065 https://pubmed.ncbi.nlm.nih.gov/37603866/
5 Chow EJ, Lynch JB, Zerr DM, et al. Lessons From the COVID-19 Pandemic: Updating Our Approach to Masking in Health Care Facilities. Ann Intern Med. 2023;176(9):1266-1268. doi:10.7326/M23-1230
6 Jetelina K. Your Local Epidemiologist. Your ACIP Cliff Notes. Published 12 September 2023. Available at: https://yourlocalepidemiologist.substack.com/p/your-acip-cliff-notes?utm_source=%2Fsearch%2Fbivalent&utm_medium=reader2
