Discussing Pros, Cons of Universal Masking Post-COVID 19

To appreciate just how fast COVID-19 moves and mutates, the topic for a panel discussion at this year’s IDWeek 2021 was “PPE in the Post-COVID World: Is Universal Masking the New Standard?” Monica Gandhi, MD, MPH, chaired that panel and recently told Infection Control Today^® (ICT^®) that the topic had been chosen before the Delta variant of COVID-19 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.” (IDWeek 2021 was held from September 29 to October 3.)

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

Monica Gandhi, MD, MPH

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

Universal masking in society will not happen in the United States for various reasons, said Gandhi. For one, the CDC 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 said.

There are several factors at play when considering universal masking in health care facilities, said Gandhi. Infection preventionists (IPs) or other health care professionals work around vulnerable patients. They are also working in environments that might be contaminated by COVID-19. “We all agreed that universal masking is necessary now, and likely for quite a long time,” said Gandhi.

However, the panel couldn’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 possibly be sitting 6 feet away from each other quietly discussing a course of care. It’s the sort of conversation that patients and primary care physicians often have.

Gandhi cited a famous randomized controlled study published in 2013 in BMC Family Practice that showed patients weren’t as comfortable talking to practitioners wearing masks.¹

“There was a very clear, statistically significant difference that patients felt there was a loss of empathy in the interaction,” Gandhi said. “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 IPs will need to put that on their checklists. Gandhi said IPs “are going to have a really important role in maintaining surgical masking…for at least 6 more months.”

Reference:

1. Wong CKM, Yip BHK, Mercer S, et al. Effect of facemasks on empathy and relational continuity: a randomised controlled trial in primary care. BMC Fam Pract. 2013;14:200. doi:10.1186/1471-2296-14-200