Discussing Pros, Cons of Universal Masking Post-COVID 19

Conference | <b>ID Week</b>

Pro: Health care professionals work around vulnerable patients, and in environments that might be contaminated by COVID-19. Con: Patients want to see their caregiver’s face.

To appreciate just how fast COVID-19 moves and mutates, the topic for a panel discussion at this year’s ID Week (going on now) is: “PPE in the Post-COVID World: Is Universal Masking the New Standard?” Monica Gandhi, MD, MPH, chairs that panel and recently told Infection Control Today®(ICT®) that the topic had been chosen before the Delta variant surfaced.

“That was a time when things were getting so much better,” Gandhi tells ICT®. “And it was a true question: ‘Do we need to universally mask in health care settings’? Then Delta hit and because of that the talk changed. All of our talks changed because we thought we were emerging from the pandemic when we designed this session.”

The Delta variant appears to be waning, so Gandhi says: “The question still stands: ‘When we get through this will universal masking be standard’?”

The answer in a nutshell is that universal masking will be the standard in health care settings for the foreseeable future, but not for the long-term, says Gandhi, a professor of medicine and associate division chief of the Division of HIV, Infectious Diseases, and Global Medicine at the University of San Francisco, and San Francisco General Hospital.

Universal masking in society in general will not happen in the United States for various reasons, says Gandhi. For one thing, the Centers for Disease Control and Prevention is considering easing masking guidance for indoor settings. For another, too many in the public would simply ignore such guidance. “I think that we have too many mixed feelings here, and it won’t be recommended universally,” Gandhi says.

There are several factors at play when considering universal masking at health care facilities, says Gandhi. The infection preventionist (IP) or other health care professionals work around vulnerable patients. In addition, they are also working in an environment that might be contaminated by COVID-19. “We all agreed that universal masking is necessary now,” says Gandhi. “And likely for quite a long time.”

However, the panel can’t agree on whether universal masking should be standard for all patient interactions forever. Both the patient and the caregiver would likely be vaccinated, and they’d possibly be sitting 6 feet away from each other quietly discussing a course of care. It’s the sort of private conversation that patients and primary care physicians have all the time.

Gandhi cites a famous randomized controlled study published in 2013 in BMC Family Practice that showed that patients weren’t as comfortable talking to practitioners wearing masks.

“There was a very clear, statistically significant difference that patients felt there was a lack of a loss of empathy in the interaction,” Gandhi says. “Primary medicine interaction that occurs in the outpatient setting, that’s a very strong connection. So, again, I don’t think we’re going to be universally masking in the future forever.”

If universal masking continues for a time in the post-COVID-19 world, then infection preventionists (IPs) will need to put that on their checklists. Gandhi says that IPs “are going to have a really important role in maintaining surgical masking … for at least six more months.”