Liv Grace experienced respiratory infections three times in a span of four months. Each infection occurred after visiting a healthcare provider in the Bay Area. Liv Grace, a 36-year-old writer who uses they/them pronouns, contracted respiratory syncytial virus (RSV) leading to pneumonia in December after being treated by a nurse wearing a surgical mask who mentioned her children were ill with the virus. In February, Liv Grace contracted Covid-19 after visiting a cancer center for an infusion. In April, just before another episode of Covid-19, they encountered a pale, coughing phlebotomist who drew blood. Liv Grace was born with a rare immune deficiency related to lupus and takes medication that weakens the cells responsible for producing antibodies. This combination makes their body vulnerable to pathogens and slow to recover from infections.
Due to their high risk, Liv Grace rarely ventures outside healthcare facilities since the pandemic began. However, hospitals, even when community rates are relatively low, are still prone to outbreaks of illnesses, including Covid-19.
As the potential for a wave of coronavirus infections looms over the fall and winter, only a few hospitals, primarily in New York, Massachusetts, and California, have reinstated mask mandates for patients and staff members. The majority of hospitals have not implemented these mandates, and very few require masks for visitors.
Several Bay Area counties recently mandated mask-wearing for staff members in healthcare facilities treating high-risk patients, effective from November 1. However, this order does not apply to facilities in Berkeley, including Alta Bates Summit Center, where Liv Grace received treatment.
Opinions among patients, healthcare workers, and public health experts regarding the implementation of masking mandates in hospitals are divided. Some experts argue that hospitals have an ethical obligation to protect patients from infections, regardless of the patients’ choices outside healthcare settings. Other experts suggest that hospitals should consider masking measures as respiratory infection rates rise.
While the Centers for Disease Control and Prevention (CDC) recommend that hospitals consider masking when respiratory infection levels increase, the guidelines do not specify specific benchmarks, allowing each hospital to determine its own criteria. Ideally, every patient arriving at an emergency room or urgent care should be provided with a mask and asked to wear it regardless of symptoms.
However, hospitals also face challenges due to the opposition against masking in many parts of the population. This can lead to patients with Covid-19 sharing spaces with high-risk individuals, such as older adults or pregnant women.
Some hospitals, like City of Hope, a cancer treatment center in Los Angeles, have maintained universal masking for immunocompromised patients. But many prestigious hospital systems do not require masks, even in their cancer centers.
The National Nurses United union has called for stronger protections, including the use of N95 respirators, to safeguard healthcare workers, patients, and visitors. A recent study found that more cancer patients died from Covid-19 during the Omicron surge compared to the first winter wave, partly due to a lack of precautions.
While some hospitals have implemented partial masking in units with high-risk patients, experts argue that high-risk individuals are scattered throughout the hospitals and may be exposed in various areas.
Hospitals are continually evaluating their masking policies based on factors such as respiratory illness rates, admissions, and community prevalence of Covid-19 and other respiratory infections.
The CDC’s infection control guidelines are currently being revised by an advisory committee. However, critics have raised concerns about the committee’s lack of expertise diversity and its decision-making process. The need for N95 or similar respirators to block virus particles effectively indoors has been highlighted.
The repeated infections have had a significant impact on Liv Grace’s health, resulting in more migraines and seizures. They now feel scared to seek care even when necessary. Before the pandemic, hospitals were less dangerous since staff members often wore masks, and waiting rooms and elevators were typically less contagious in the late fall or winter.