California health care providers’ retreat from COVID masking is shameful

When the California Department of Public Health last month lifted mask mandates in health care settings, it didn’t even cross my mind as a physician and CEO of Roots Community Health Center to drop masks in clinics I oversee in the East Bay and San Jose.

The absence of a public health order never determined health care facility policy before, so I was shocked that several health systems dropped masks the moment they stopped being required. I did not need to be mandated to do the right thing for patients and staff at the onset of the pandemic, and the removal of a mandate did not erase my duty to protect and advocate for essential frontline workers and marginalized community members.

With the swift unmasking, I was not surprised by the COVID outbreak within about two weeks at Kaiser Permanente’s Santa Rosa Hospital and the facility’s quick return to masking. We should all be dismayed that staff and patients were allowed to be sickened despite the availability of masks to prevent the unnecessary harm.

Organized medicine’s retreat from masking is shameful. It is not data driven, and there is no experiential evidence to support the decision to de-mask. That is why hospital-issued statements fail to cite science for their policy changes. Instead, faceless committees issue platitudes about being in a “new phase” and reference available treatments.

But they paper over the very problem they are creating: In what universe is it ethically appropriate for health care institutions to infect their own patients with SARS-CoV-2 when masking so effectively reduces its spread?

It appears that physicians and hospital administrators are conflating giving a patient COVID in a health care setting with the patient catching COVID on their own in the community. Amid the dropping of precautions in most other settings, I’ve heard repeatedly from vulnerable individuals that the hospital was the one and final place they could feel safe. But this is no longer true. Now, many hospitalized patients must be prepared to fight a new infection on top of whatever necessitated their hospitalization in the first place, simply because their care team “opted” to unmask.

I, for one, could not forgive myself if I sickened a patient who entrusted me with their care.

Early in the pandemic, we were all haunted by headlines of PPE shortages leading to health care worker deaths and skilled nursing facility outbreaks. We responded to this problem with proper PPE. Yes, we’ve come a long way since then. But our amazing vaccines do not halt transmission. And having treatment for an infection has never been an excuse to inflict that infection upon a patient.

Facilities that have accepted the risk of infecting their patients should be required to quantify and justify that risk and report on it in an ongoing fashion. They should detail to the public and stakeholders the incidence and infection mortality rate of COVID acquired in their facilities and the clinical outcomes and prognoses following a SARS-COV-2 outbreak in their facilities.

If removing masks is sound policy, the data will speak for itself. But care facilities that unmask staff and visitors must collect and report this data. Failing to do so compounds their unreasoned abandonment of a tool repeatedly shown to prevent the spread of SARS-COV-2.

Health care providers must incorporate new knowledge into practice. When HIV initially spread, we recognized the need for gloves and safe sharps disposal. These practices quickly became standards. The subsequent development of HIV treatments did not cause us to abandon these preventative measures.

As we continue to grapple with a widespread, mutating, airborne pandemic, universal masking should become the new infection-control standard. Anything less puts everyone in harm’s way.

Dr. Noha Aboelata is founding CEO of Roots Community Health Center, which serves the East and South Bay and works to eliminate health disparities and improve the well-being of marginalized communities.