Should Patients Be Required to Wear Masks at Hospitals During COVID-19 Pandemic?

By Carolyn Crist

May 26, 2020

NEW YORK (Reuters Health) - As hospitals reopen, they should consider mandating patients to wear masks during the COVID-19 pandemic, two doctors say.

Frontline medical workers are wearing personal protective gear as they care for patients who have tested positive for the coronavirus, and now everyone who goes to a hospital for a service should wear one, the authors write in a letter to the editor in Anesthesiology.

"Protecting both patients and healthcare workers from contracting COVID-19 is critical as we restart performing non-urgent surgery and other non-COVID medical services," said co-author Dr. Lee Fleisher of the University of Pennsylvania Perelman School of Medicine in Philadelphia.

"Like many hospitals nationwide, we are testing patients for the risk of COVID-19 before they come in for surgery. However, the test is not 100% sensitive," he told Reuters Health by email. "As we start to care for more patients on-site, we believe it's critical to implement extra precautions to help maintain a healthy and safe environment.

Dr. Fleisher and Dr. Renyu Liu at the University of Pennsylvania note that more than 9,000 healthcare workers in the U.S. have contracted COVID-19 at hospitals, and dozens have died. Staff in the emergency departments, wards and intensive-care units have taken extra steps to protect themselves, and non-coronavirus patients and non-medical staff should now do the same, the authors argue.

Patients shouldn't delay care for urgent or emergency medical conditions out of fear of contracting COVID-19, they write. For those with severe health conditions, the hospital is still the safest place to go, they say, and strict mask policies will help patients and providers alike feel more comfortable about being at the hospital.

"As the number of patients starts to increase in hospitals nationwide, it's imperative that we implement policies that help to minimize the risk," Dr. Fleisher said. "These safety measures should help to reduce anxiety among patients."

In a graphic, Dr. Fleisher and Dr. Liu illustrate how different types of mask scenarios protect people. Ultimately, the highest protection occurs when someone who can transmit the virus wears a mask, they write. Although wearing a mask doesn't necessarily protect someone from contracting the virus, a universal mask policy prevents people from spreading it.

Since the SARS-CoV-2 virus, which causes COVID-19, can be spread through respiratory droplets by people who don't have symptoms and may not know they have the virus, everyone should wear masks to prevent someone else from becoming infected, the authors argue.

"Recognize that everyone wearing masks will help protect yourself, your colleagues, your patients, and family members accompanying the patient," Dr. Fleisher said. "It is a simple, potentially life-saving policy."

Dr. Fleisher and Dr. Liu recommend a policy that requires everyone entering a hospital to wear a mask, and it shouldn't be removed unless necessary for drinking, eating or a particular medical procedure. The policy should include doctors, staff, administrators, patients and patients' family members. A dedicated hospital entrance should have trained personnel who check temperatures, ensure that people wear masks, and offer a surgical mask to anyone who needs one when they enter the hospital.

The hospital where Dr. Fleisher and Dr. Liu work has implemented this policy, and patients are also tested for COVID-19 about 48 hours before a surgery. Patients will still wear a mask, even if they test negative, to protect doctors, hospital staff and other patients. They've started a formal study on the new policy.

"I think universal masking in hospitals would contribute to reducing transmission and protecting patients and healthcare workers against COVID-19 infections in hospitals," said Dr. Benjamin Cowling of the University of Hong Kong School of Public Health.

Dr. Cowling, who wasn't involved with the new paper, published research in April about surgical face masks and how they reduce the transmission of virus particles spread through respiratory droplets.

"This is a rational argument in support of patients wearing masks," he told Reuters Health by email. "It's to protect themselves but also to protect other patients and healthcare workers if patients have unrecognized and undiagnosed COVID-19."

SOURCE: Anesthesiology, online May 14, 2020.


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