Dr. Jeremy S. Faust, an emergency physician at Brigham and Women’s Hospital, called the change “terrible policy” and “a change that endangers the lives of people at risk” in an online essay published during the weekend.
“It is one thing to de-escalate pandemic mitigation in low-risk settings. Doing so in nursing homes is a hostile act toward a vulnerable population, given the current conditions on the ground,” he wrote. He noted that the new recommendations would allow universal masking to end in regions with “substantial” transmission. (The CDC categories are “high,” “substantial,” “moderate,” and “low.”)
Others noted that masking cannot continue indefinitely and said it makes sense to set parameters for when it will be lifted.
“Every other sector of society has changed” in its approach to the pandemic, said Dr. Erica S. Shenoy, associate chief of infection control at Massachusetts General Hospital. “But in health care we’re kind of frozen in time.” Of course, there’s good reason for that, given the vulnerability of patients, but at some point, health care providers will want to go back to pre-Covid policies, he said.
It won’t happen soon, however, experts agreed.
The guidelines will not take immediate effect in most of the country, including all of Massachusetts, Connecticut and Rhode Island, where transmission remains at the highest level.
And the CDC doesn’t have the last word: In Massachusetts, the state Department of Public Health requires patients, residents, staff, vendors and visitors to wear masks in all healthcare settings. These rules will remain in effect unless the state changes them; the department is currently reviewing the CDC recommendations.
“We’re in a strange place in the United States,” said Dr. Michael L. Barnett, a health services researcher at the Harvard TH Chan School of Public Health, who said he was “not too excited” about the CDC’s changes. “There is a lot of streaming going on. [But] there’s a sense at the highest levels of politics that we’ve just finished trying too hard.”
Barnett, who co-authored a study showing how vaccinating staff protects nursing home residents, added: “It makes even less sense to me to be permissive with nursing homes, which are the most vulnerable place of pandemic. You could make a better case for relaxing anywhere but nursing homes.”
In a statement, the CDC said the new guidance helps reduce the burden on the health care workforce, “and helps improve the quality of life of long-term care residents,” as well as reflecting the vaccine-induced immunity and infection in the population. and the availability of treatments. “Although SARS-CoV-2 has not disappeared, the situation is clearly different from last winter,” the statement said.
An advocate for the elderly noted that, if read carefully, the guidelines clearly provide protection for nursing home residents. Even in areas of lower transmission, the CDC still recommends masks during facility outbreaks and when caring for high-risk patients and those who are moderately to severely immunocompromised.
That would cover virtually all nursing home residents, said Paul Lanzikos, coordinator of Dignity Alliance Massachusetts, a volunteer organization that works to improve long-term care.
“The CDC is not really opening the doors. It’s saying ‘go slow,'” said Lanzikos, the former executive director of North Shore Elder Services.
But he warned that he would oppose any premature reduction of the “very basic and very easy preventive measure” of masking. “I don’t think there’s any question that we should continue to mask for the foreseeable future,” Lanzikos said.
Tara Gregorio, president of the Massachusetts Senior Care Association, a nursing home trade group, said nursing facilities “continue to follow robust infection prevention protocols.” They will work with the Department of Public Health, he said in an email, “to implement federal guidance in a way that continues to balance the safety and well-being of our residents with their overwhelming desire to see the faces of their loved ones again. dedicated caregivers and communicate more freely.”
Barnett acknowledged that people with hearing loss have a hard time understanding speech when they can’t see a person’s mouth. The solution, he said, is not to give up masks, but to switch to clear masks, which are available but underused. Faust also pointed to transparent masks as a better solution.
Julia R. Raifman, an assistant professor of health law, policy and management at Boston University’s School of Public Health, expressed concern about how the guidelines will play out in hospitals. “Hospitals are places that need to be safe,” he said, mentioning all vulnerable patients, from newborns to cancer patients. “In times of COVID, that requires doing everything possible to keep COVID out of the air.”
Raifman said he plans to ask the hospital where he receives care to continue universal masking despite the CDC’s recommendations and will seek care elsewhere if they don’t comply.
“All the data suggests that COVID remains a substantial problem. We’ve seen leaders from the top down intentionally shy away from it,” Raifman said. “There are short-term political gains in minimizing the damage of the pandemic.”
The Massachusetts Hospital and Health Association said its members are still reviewing the new guidelines, but stressed that masks are still being worn in healthcare settings, as required by the state Department of Public Health.
Patricia Noga, vice president of clinical affairs, said in a statement that “universal masking has helped keep healthcare organizations safe for both patients and caregivers during the worst of the crisis, and we recognize that the time will come to ‘adjust these policies based on careful consideration of COVID-19 trends and staff feedback.
“But it’s important for patients to understand that, starting today, you will still be asked to wear a face covering when you enter a healthcare facility.”
Shenoy, of Mass. General, said his hospital system had already launched its own review of its COVID-19 policies. “We’re not going to mask ourselves forever,” Shenoy said. With transmission continuing at a steady pace and a winter surge looming, expect masking requirements to continue for some time.
But as circumstances change, he said, “You want to tailor the intervention to the level of risk.” The CDC’s guidance provides “a framework for linking your interventions to the amount of virus in your community.”