During a television interview on September 18, everyone heard President Biden say “the pandemic is over.” Healthcare workers want this to be true as much as anyone else, but is it?
After 2 and a half years, we have certainly come a long way. First, we learned about how to best care for patients with COVID-19. Then, we developed multiple therapeutics to treat the infection. And perhaps most importantly, we have administered more than 12 billion COVID-19 vaccinations worldwide to prevent serious disease and death.
Many elements of normal, pre-pandemic life have returned. In grocery stores, masks are off and toilet paper is back on the shelves. Many office workers have returned to their cubicles, though much of our nation’s work remains virtual. But, particularly in hospitals, this virus is still ubiquitous. In my hospital, we are still admitting patients with COVID-19 as well as covering for staff affected by the virus, and masks continue to be regular fixtures on the faces of healthcare workers and patients. Increasingly, the community and the hospital feel like two different worlds.
As we have watched the rest of the world adapt to the pandemic and slowly reopen, many healthcare workers have wondered when it will be our turn. When will things finally “return to normal?”
There is room for optimism: the currently circulating Omicron variants do not have the same proportion of severe outcomes as earlier variants. Our COVID-19 community levels have teetered at the border of medium and high for the past 5 months, rather than cycling through surges as before. Many of our current COVID-19-positive patients are primarily admitted for non-COVID-19 diagnoses and are found incidentally to have COVID-19 infection on admission. Our community guidance on masking has relaxed, and many of our behaviors outside of work have returned to a pre-pandemic “normal.” Given my general health, I rarely wear a mask when out in the community. I may get COVID-19 again, but I also assess that my risk of severe outcomes is low and my access to appropriate therapeutics to further reduce the risk of severe illness is high. I am comfortable making these decisions for myself and my family.
We are currently at the precipice of another significant step toward normalcy with the latest officially sanctioned guidance from the CDC: “When SARS-CoV-2 Community Transmission levels are not high, healthcare facilities could choose not to require universal source control.” It is not the strongest or most directive statement the CDC has ever released, and the discussions about how best to interpret and make use of this guidance are ongoing.
Masks remain a fraught aspect of our pandemic response. They are a clear and visible barrier between healthcare workers and our patients — in both the positive and the negative sense. Masks are a vital piece of healthcare worker personal protective equipment. They help to protect our most vulnerable patients from any miasma we may be harboring and spreading before becoming symptomatic. They help to protect us from inadvertent patient coughs and sneezes. I have lost count of the number of personal exposures to contagious, pre-symptomatic patients I have withstood without becoming infected, thanks to simple surgical masks. The negative aspects of masks as a barrier are simultaneously apparent in my work and in my life. As physicians, we are struggling to appear empathic and kind with only the top halves of our faces while breaking bad news. Patients with hearing impairments are now struggling to participate in their own care. Visitors cannot kiss their loved ones, maybe for the last time, without breaking rules.
The University of Michigan Hospitals have made a statement that they will not be considering changes in policy for universal masking in patient care activities, and I am steadfastly supportive. Though they may be fewer in proportion, we are still seeing severe outcomes related to COVID-19, just as we always have with influenza, respiratory syncytial virus (RSV), or any of the other seemingly “minor” viral illnesses that decompensate our most tenuously compensated patients. In our hospital system, where our most vulnerable are gathered closely together, the chance of causing a serious infection through a preventable exposure cannot be ignored. In fact, given what we have learned over the course of the pandemic, there is reason to posit that masks may become a new “standard precaution” during respiratory virus seasons going forward, given the significant decreases in healthcare-acquired influenza or RSV while universal masking has been in place.
We are all eager to ditch the masks, but I won’t be tossing my mask away completely any time soon. I am not comfortable making the same decisions for my patients that I would make for myself. They don’t have a choice about being ill enough to require hospital admission, dialysis, or infusion therapy — and they are at our mercy for care.
Just as we dutifully perform “time outs” before procedures, and use maximal barrier precautions when placing central lines, I would encourage us to continue masking when caring for patients, at least for the time being. I will be, and will continue to work on, smiling with my eyes.