As healthcare workers, patients, parents and caregivers, we urge the Massachusetts Department of Public Health, local boards of health and healthcare organizations, including hospitals, clinics, physician and dentist offices, nursing homes, and home health care services to continue to require masking in all healthcare settings, and to provide masks (ideally N95 respirators) for everyone in those settings. As states move to end mask requirements in healthcare settings, we note this is dangerous and unethical. Furthermore, CDC guidance​ from September 2022 to permit patients and staff at health institutions to remove masks when “Community Transmission Levels” are not “high,” is based on flawed data.

Removing masks in healthcare is dangerous:

In 2022, a year when leaders have suggested the pandemic was under control, over 250,000 people in the US died from COVID-19, and COVID-19 has been the 3rd leading US cause of death since the beginning of the pandemic. As of February 2023, over 450 people in the US​ continue to die daily of COVID-19. And the threat looms of multiple new variants, which are highly transmissible and have mutations that can already evade existing vaccines and treatments​.

Clinics and hospitals are sites for COVID-19 patient care, so even when transmission rates are low, they will remain among the most likely locations to encounter people infected with COVID-19 (as well as people who are vulnerable to severe disease or death from COVID-19). Contagion in healthcare settings is already a problem even in well-equipped US academic medical centers. In January 2022, over 3,000 people weekly were infected with COVID-19 in US hospitals, including 4,734 in just one day, according to an analysis of federal data. Removing masks in healthcare puts both patients and healthcare workers at risk, which could place even more strain on the healthcare system amidst severe staffing shortages.

Removing masks in healthcare is unethical:

Failing to require masks in healthcare settings violates the medical ethical principles of nonmaleficence and autonomy. Patients come to clinics and hospitals to improve their health. Healthcare providers have an ethical responsibility to DO NO HARM and ensure that they do not expose them to COVID-19.

Universal masking with N95 respirators and high quality masks is more effective than one-way masking at preventing COVID-19 infection. The recommendation embodies the widely-recognized healthcare principle of universal precautions. COVID-19 is an airborne pathogen, meaning it spreads in the air when infected people breathe, speak, cough or sneeze. Universal precautions for airborne pathogens include universal masking with high-filtration N95 or better respirators. Respirators and high-quality masks protect the wearer and those around them by decreasing the burden of COVID-19 virus in the air. Because approximately 40% of COVID cases are asymptomatic, and many people may be infectious before they develop symptoms, it is utterly inadequate to require masks only for symptomatic people. Children and babies who cannot or may not wear masks and people in clinical situations that do not permit mask-wearing (such as post operative units) need others to protect them by wearing masks. Without universal masking precautions in healthcare, vulnerable people face substantial risk of being exposed in waiting rooms or clinical settings against their will, violating their autonomy, and deterring many from seeking much-needed care.

Vaccines alone are insufficient to prevent COVID-19 spread. Although vaccines lower the risk of hospitalization and death, even fully vaccinated and boosted people can die from COVID-19, especially older adults and people who are immunocompromised. Vaccinated and boosted people can also develop Long COVID, which may affect as many as one in five people after COVID-19 infection. Long COVID is keeping as many as 4 million people in the US out of work. Masking is essential, along with vaccines, ventilation, and other measures, to prevent COVID-related disability and death.

CDC Policy to remove masks in healthcare is based on flawed data

The CDC’s new policy relies on the Community Transmission Levels map, which grossly underestimates COVID-19 infection rates. Back in September 2021 the CDC estimated that only 1 in 4 COVID-19 cases were reported. But a spring 2022 study suggested that infections in New York City were underestimated by a factor of 30, and modelers from the Institute for Health Metrics and Evaluation (IHME) have stated that only 4–5% of infections are reported. This is because far fewer people are testing for COVID-19 as much required routine testing has ended, federal funding for COVID-19 testing has diminished, and most rapid tests are not reported. Further, most low-wage workers don’t have paid sick time, and many are incentivized or compelled to go to work with COVID-19, or to avoid testing.

In conclusion, we urge public health officials and healthcare organizations to keep our communities safer from COVID-19, by requiring and providing high-quality masks for all. The healthcare system should be a place of healing, where the risk of acquiring infections is minimized. As stewards of public health, we urge you to act in the best interests of the most vulnerable among us.