We Need Mandatory Masking in Healthcare, and We Need it Now

Healthcare facilities should set the tone when it comes to masking. They should help patients protect themselves from Covid and other threats. Instead they push droplet dogma and put lives at risk.

We are in year six of the Covid pandemic, and patients are still struggling to access safe healthcare. Hospitals removed mask mandates, didn’t bother upgrading their air quality or ventilation, and stopped requiring staff to test or isolate for Covid.

As a result, Covid aware patients have to take enormous steps to protect themselves in the one place they should have a reasonable expectation of safety.

We can’t ‘just stay home’ from the hospital. We can’t hire and fire staff who don’t treat us with respect. We are at their mercy, and they are letting us down.

This is the second article in my Masks in Healthcare series, and will focus exclusively on the patient experience. If you missed the first article, you can read it below:

A Plea to Maskless Healthcare Workers from Vulnerable Patients

Almost every patient who wears a respirator to access healthcare has a horror story about being treated badly for masking. There’s so much anti-mask sentiment that patients aren’t simply put at risk of Covid, they’re actually judged for taking precautions. The level of care they receive suffers.

When you enter a hospital or healthcare facility wearing an N95, you’re invariably greeted with eyerolls, sighs and questions like ‘Are you sick? Why are you masking?’

It’s exhausting. Sometimes the doctor will offer to put on a mask, but more often than not they will pressure you to remove yours. We’ve all heard the absurd statement ‘You won’t get Covid here!’ when sitting in a hospital.

Healthcare environments are one of the places we are most likely to get Covid, so why aren’t they taking more precautions? Why is the onus 100% on the patient to keep themselves infection free?

I don’t have the answer, but I suspect it’s likely a combination of unwillingness to spend the money needed to upgrade the air quality and provide high quality masks, combined with pandemic fatigue and a desire to return to ‘normal’.

We all want to believe that healthcare workers are above being sucked in by misinformation and disinformation, but the truth is some of the most dangerous Covid minimizers are doctors themselves. Anyone can be taken in by propaganda, especially if the messaging allows them to feel more comfortable. Safe. “Normal”.

Where does this leave patients? In a horrible place where they have to weigh the risk of being judged as anxious hypochondriacs for masking, or getting Covid if they go without personal protection. It’s a no win situation, and none of us should have to make that difficult choice.

In short, healthcare is no longer safe.

While researching this article I spoke with many patients, parents and caregivers about their experiences masking in healthcare. The responses were heartbreaking. It would be impossible to cover them all in one piece, but there were common themes that illustrate how difficult it is to obtain Covid safe care.

First things first, most patients reported that if a healthcare worker offered to put on a mask, they don’t feel comfortable saying ‘Yes’.

Why is this? Why are patients afraid to say ‘Yes’ when they want their healthcare worker to mask?

It’s because they feel like it’s a trap. A test designed to see how difficult, anxious or non compliant they might be. Patients recognize they’re already at risk of Covid due to unmasked people being in the room all day, and they don’t want to risk further reductions in care by admitting they want staff to mask.

It’s absurd that this is where we’ve ended up. Can you imagine if a doctor asked you if you wanted them to wash their hands before sticking you with a needle? Or wear gloves during surgery?

It’s equally ridiculous to ask a patient if they want you to wear a mask. You should already be wearing one. You should be protecting yourself and your patient. You should be following the science. You should not be placing the burden of infection control on those who’ve come to you for help.

Yet here we are, with more and more patients reporting less and less masking in healthcare facilities. The covenant of trust between doctor and patient is broken, because healthcare workers are abdicating their responsibility to ‘do no harm.’

Sadly the sighs, half hearted offers to wear a mask and/or mask mirroring with a floppy surgical mask are the best possible outcomes most patients can hope for.

Many stories I heard were far more devastating.

Patients spoke of having their mask forcibly removed. Of feeling like they had to remove their own mask in order to be taken seriously by their doctor. Of going to great lengths in advance of a hospital stay to ensure mask policies would be in effect, only to have them disregarded once they’re hospitalized. Of being put on psych holds because they’re judged to be ‘too anxious’ about Covid. Of having their very real physical symptoms diagnosed as ‘all in their head’ in part because of their mask.

Caregivers told stories of vulnerable loved ones who went into the hospital for a treatable condition and ended up dying of hospital acquired Covid. Of family members placed in a shared room with a Covid positive patient. Of healthcare workers who would wait until the caregiver left the room and then convince the patient to remove their mask. Of having to fight to get their vulnerable loved one tested for Covid. Of having a high risk patient left in a crowded hallway or curtained room with absolutely no airborne precautions.

Parents had some of the most heartbreaking stories of all. Children forced to remove their masks for temperature checks or other tests that could easily be done an alternate way. Separated from their parents and told that masks weren’t necessary and their parent was ‘anxious.’ Long Covid symptoms dismissed and somatized. Kids sent to psychologists because their parents wear masks. Sick children having their physical issues completely ignored. Parents threatened with child protective services for masking their kids.

Kids can’t protect themselves, it’s up to the adults in the room to protect them. As someone who suffered from chronic illness as a child, I would have happily masked if it would have lessened my suffering. It’s good parenting to ensure your child is protected when in a healthcare facility, and it’s appalling that these parents are being judged and bullied for trying to keep their kids as safe as possible.

Image Description: A white N95 is seen against a pink background

A Tale of Two Maskers

We need mandatory masks in healthcare. The current situation isn’t sustainable. We’ve lost too many patients to hospital acquired Covid. Countless more have been further disabled by infections they caught while accessing care they couldn’t go without.

Whether you’re Covid aware or not, it’s nearly impossible to keep yourself safe in healthcare facilities that refuse to acknowledge that Covid is airborne. They should set the tone. They should lead by example. They should be following the science.

By refusing to mandate masks, they’re sending a message that the threat is over. That patients are safe. They’re embracing the mirage of ‘back to normal’ that governments have been shoving down our throats for years. It’s killing people.

Without masks in healthcare, patients are put in impossible situations. I want to share two competing stories to highlight why it’s so hard to access care right now. The first is my own story. I’m a high risk immunocompromised patient who’s Covid aware and takes as many precautions as possible to avoid infection.

The second is a family friend who doesn’t really pay attention to anything Covid related. They aren’t a minimizer, but they aren’t Covid aware either.

What do we have in common? We were both unnecessarily placed at risk in a hospital setting. Those tasked with keeping us safe failed to ‘do no harm’.

A Patient Wearing an N95 Walks Into the Room….

When I need the hospital, I go in as prepared as possible. I know that people won’t be masking, I know that I can’t control who comes into my personal space and what they might be sick with.

I wear a fitted N95 and eye protection. I take a CO2 monitor with me to check the air quality and how well the room I’m in is being ventilated. I have a face shield in my bag for close contact exams.

Generally speaking I’ve been lucky and most staff have worn a mask when they see that I’m wearing mine. I’ve had to deal with inappropriate comments about ‘anxiety’, being told to “take off my mask and show my pretty face” or lectured about how masks aren’t required anymore, but I’ve been able to avoid being treated by an unmasked healthcare worker.

Recently my luck ran out.

I had a full day of testing at a hospital that had a ‘mask respected’ policy. It said that masks were no longer mandatory but if a patient asked, the healthcare worker would mask.

I was greeted by a receptionist wearing a surgical mask and felt encouraged that was a sign of good things to come.

I sat in the waiting room where about half the patients were masked (albeit all in the hospital provided surgical masks and many wearing them below their nose or chin).

A healthcare worker came and called my name, and they weren’t wearing a mask. I bristled. I steeled myself for a difficult conversation. A fight.

To my surprise and appreciation, as soon as she saw my mask she said “I’m going to go put a mask on for you.”

Those are some of the best words a patient can hear in a healthcare setting. They tell us you care about our health and wellbeing. You respect our choice to try and avoid Covid. You don’t want to cause us harm.

The test went smoothly and I thanked her for masking. I had a few more tests where the interaction went exactly the same way. They weren’t masked but when they saw mine, they mask mirrored.

Obviously I would prefer if masking was the default, but in the absence of that I’m incredibly grateful for mask mirroring because it takes the weight off me. I don’t have to fight. I don’t have to beg. I don’t have to risk being judged for asking someone to mask. I don’t have to waste precious spoons.

I was pleased with how things were going, and then I got to the last test of the day. I walked into the exam room to see an unmasked technician. There was no offer to mask, instead they took one look at my respirator and scowled. A big, obvious and disdainful stare.

I felt my heart rate and blood pressure rise because I could tell this would be a fight. The test I needed involved the technician being up close to my face for an extended period of time. My chart notes that I’m immunocompromised and high risk and that everyone treating me needs to be wearing a mask.

Me: “Could you please put on a mask?”

Tech: “No I need to be able to breathe to do my job.”

Me: “I’m immunocompromised and very high risk. You can check the chart. Everyone who treats me needs to be wearing a mask.”

Tech: “I’m claustrophobic and I do not wear masks.”

Me: “This is a requirement I have before I let anyone touch me. I’m sorry you feel uncomfortable in a mask, I’m uncomfortable with being put in unsafe situations unnecessarily. Please wear the mask or find me someone who will.”

The tech huffed loudly and stormed off to find someone else. They returned with another technician who was wearing a mask. I thank them for masking and ask the other technician to leave the room.

Tech: “No. I’m not leaving. I’m going to do the computer part of the test.”

Me: “I’m not comfortable with you in the room. Please leave.”

Tech: “No. I’m doing my job.”

I’m somewhat ashamed to admit that at this point I gave up. I was exhausted, in pain and just wanted to go home. I had run out of spoons.

We did the test as quickly as possible, I thanked the masked technician for accommodating me, and prepared to leave. As I was walking out I looked at the unmasked technician, still sitting at the computer scowling at me, and I said the following:

“If you genuinely can’t wear a mask for five minutes to protect the sickest patients, you shouldn’t be working in healthcare. I will be filing a formal complaint.”

And I walked out.

It perhaps wasn’t the smartest choice I’ve ever made, but after five years of feeling like I’m playing Russian roulette with my life whenever I need medical care, I was fed up.

I wanted to make it clear to them that I didn’t agree with what they were doing and that I was going to follow up for the sake of all the patients who came after me. For all the readers who tell me every day they don’t feel comfortable asserting themselves when a healthcare worker refuses to mask.

For the patients who don’t know that they need a respirator to prevent Covid and who go in wearing a surgical mask only to be infected by healthcare workers like this one.

For everyone who’s had hospital acquired Covid or lost a loved one to it.

I know there’s a decent possibility that nothing will come from the formal complaint, but I’m going to do it anyways. I’m going to spend precious spoons on something that I shouldn’t have to do.

Masks in healthcare shouldn’t be controversial. They weren’t controversial before Covid. If you were wearing a mask and asked staff to wear one too… they just did it. It was never this hard.

Politicizing masks has resulted in tremendous harm befalling the most vulnerable among us. It’s started a tidal wave of reductions in infection control. Covid isn’t the only threat in a hospital setting. Many viral and bacterial infections can be prevented by wearing a mask, and patients like me can no longer rely on staff to do that one simple thing for us. We can no longer assume we will be safe.

Photo by Patty Brito on Unsplash

Image Description: A woman wearing blue scrubs holds up a pink stethoscope in the shape of a heart

The “I’m Sick of Being Sick” Surgical Masker

This is the story of the other type of masker. The one we’ve all seen in waiting rooms, wearing a loose surgical mask that we know isn’t providing them much protection at all.

I’ve got a close family friend who needed to go to the hospital for cancer screening. This person is not Covid cautious, they’re more of an ostrich. Not a minimizer but certainly not informed. They stopped masking as soon as mandates were dropped and repeatedly told me they were “sick of hearing about Covid.”

Then they got Covid. Three times. The last time took their sense of taste and smell. They began getting pesky colds and flus more often. In their own words, they were “sick of being sick.”

When they arrived at the hospital and saw the masks at the entrance, they put one on. They were so fed up with being sick all the time, that they reconsidered their stance on masking.

The staff treating them were maskless. They were told more than once they could remove their mask if they wanted. They refused and kept it on.

When they got home they messaged me to tell me that they masked the entire time and ‘good thing because so many people were coughing and wheezing and almost no one else was masked.’ They were proud of themselves for making a proactive decision to safeguard their health.

This person who had previously given in to peer pressure and given up masking, was willing to be the lone masker at the hospital and stand up to healthcare workers trying to get them to remove their mask.

Why? Because they had finally hit an inflection point where they realized that perhaps repeat Covid infections were not good for them and could be prevented by wearing a mask. At this moment in time, they were reachable. Their mind was open to change.

Unfortunately, hospitals and public health have utterly failed us so there was nothing to communicate to my friend that they needed a respirator. They saw that the hospital were providing surgical masks and naturally assumed those would be ‘good enough.’

A few days later, they got Covid. Rather than being upset that their healthcare workers let them down, or that the wrong type of mask was provided, they concluded that ‘masks don’t work’ and vowed never to wear them again.

It’s unfortunately a reasonable conclusion for them to make. They wore the mask the hospital provided. They see healthcare workers as the ‘experts’ so they assumed that if a surgical mask was not sufficient to prevent infection, they would be told and provided with something better.

They kept it on despite the pressure to remove it because they were sick and tired of being ‘sick and tired.’ Yet they still caught Covid. We know it’s not because masks don’t work but rather because a surgical mask is not sufficient protection when no one else is masking.

Unfortunately public health and governments have been unwilling to communicate this important message to people. Hospitals and healthcare workers aren’t doing it either. Everyone is so focused on going ‘back to normal’ that they’re ignoring basic science, and people are losing their health and/or their lives as a result.

Many folks are still wearing cloth or surgical masks to the hospital and then giving up on masking altogether when they inevitably get sick. Others are finally reconsidering wearing a mask (like my family friend) because they’re sick of being sick, but they wear the wrong type and then conclude that masks don’t work. We desperately need better education and respirators in healthcare.

There’s simply too much Covid out there, and the new variants are incredibly transmissible. When no one else is masking or taking precautions, you need superior personal protection such as an N95.

Public health should be getting that message out to the people. They should be telling them how to protect themselves and others. How to choose a respirator, fit test it and don and doff it properly.

Healthcare workers should be doing the same. They should be modelling the behaviour necessary to curb the spread of Covid. They should be wearing N95s at all times. They should encourage patients to do the same. They should stop telling patients it’s ‘ok’ to remove their mask.

My family friend was someone who was reachable. Their frustration over being sick so often meant they were open to stepping up their personal protection and mitigations.

The healthcare system failed them, and now it’s unlikely they will ever be amenable to changing again.

If you have someone reachable in your life, someone who wants to be sick less but doesn’t have the information they need to protect themselves, I’ve got the perfect article for you! My piece on respirators includes everything you need to know to maximize your odds of avoiding Covid and other airborne diseases.

We’re Witnessing the Fall of Public Health… and Your Best Tool is a Mask

Photo by Matthew Waring on Unsplash

Image Description: A mural painted on a grey wall of a healthcare worker in a blue gown and white respirator.

We Are Failing Our Most Vulnerable

At the end of the day, any healthcare worker who won’t mask for their patients is abdicating their responsibility to ‘do no harm.’

Patients have the right to expect they will be protected in a healthcare setting. Can we prevent 100% of hospital acquired Covid infections? Maybe not. But we have a duty to try and prevent as many as possible.

We know how to do it. We know that air filtration and ventilation, combined with consistent mask use, will drastically cut Covid infections. We can keep patients and staff healthy while modelling the kind of behaviour necessary to end the pandemic once and for all.

Patients should not be put at risk any longer. They shouldn’t have to weigh the risk of getting healthcare against the risk of getting Covid. They shouldn’t be treated as expendable.

Tinu Abayomi-Paul, a disability and Covid cautious advocate who died in September, perhaps said it best:

“Those of us at high risk aren’t abstract people you’ve never met. We’re people you know and love, and we might die because you won’t wear a mask.”

Tinu had Long Covid and cancer, and fought tirelessly for her own safety and the safety of all vulnerable patients. She never gave up advocating for masks in healthcare, even when healthcare workers consistently refused to mask for her.

She deserved to be protected, and her preventable death is a tragedy that has played out far too many times.

Patients are dying and becoming disabled in record numbers because healthcare workers and facilities won’t do more to manage Covid.

We’re hardly even tracking these deaths and disabilities. We barely have line of sight on Covid deaths, let alone how many people are catching Covid in hospitals.

Then there are the people who are staying home from necessary healthcare because they know they won’t be protected. Who’s advocating for them?

If someone dies alone at home because they didn’t feel safe going to the hospital, that should count as a death related to Covid. But no one is paying attention. No one cares. They will blame the person who died for making the wrong choice, instead of blaming the institutions who’ve forced us to make these horrible choices in the first place.

I can’t possibly go through every patient story I’ve received, but what I can tell you is the same themes repeat over and over. Patients do not feel safe. They don’t feel respected. They don’t feel like their lives matter.

They’re genuinely scared to access healthcare. They know they’re risking Covid or other hospital acquired infections, psychological profiling which could impact their future care, or both. As a result, far too many are going without the care they need.

We’re already letting a devastating multi system vascular virus spread unchecked throughout our population. People are becoming disabled at record rates, and we don’t have the means to care for all of them. Should we really look the other way while people go without needed medical care due to risks that could easily be mitigated?

Of course we shouldn’t. Every person who loses more of their baseline should be considered a tragedy. Every person who passes away as a result of unsafe medical care is a preventable death. Every person who goes misdiagnosed or undiagnosed because they were labelled as having ‘Covid anxiety’ is a glaring example of systemic healthcare failures.

We need to do better. We know how to do better. We can save so many lives and preserve the dignity of patients in the process.

If you’re working in healthcare, please wear a mask. Ideally a respirator. If you see a patient masking, put one on yourself. Don’t ask them if they ‘want you to’. Don’t tell them they can remove their mask. Don’t question why they’re trying to protect themselves.

Show them you understand the science and the threat that hospital acquired infections pose. Show them you value your health and the health of your patients. Show them that you care about keeping patients safe.

To hospital administrators and those in government and public health, upgrade the air quality in hospitals. Provide free respirators to staff and patients. Start educating the public on the fact that Covid is still here, still deadly and still airborne.

If people understood how to protect themselves and why they should avoid repeat infections, I’m confident more would make the effort. But they need to be informed.

Let’s start there. Let’s start in healthcare settings as that’s where people should have the best understanding of a viral threat. Let’s lead by example and start reducing infections. Let’s save lives.

Do you mask in healthcare settings? What kind of a mask do you wear? Have you had your care impacted because you’ve asked staff to mask?

Let’s share our stories and spread the word about patient safety, airborne infection control and the need to mandate masks in healthcare.