- Health Goodbye to the mask in transport: it only remains in health centers, residences and pharmacies… and can they force its use at work?
Is it still necessary to maintain the widespread use of masks in healthcare settings as a measure to combat the transmission of SARS-CoV-2? Would it be appropriate to remove the obligation or soften the measure? Is there evidence to support these decisions?
These are some of the questions that revolve around the debate on maintaining the mandatory use of masks in healthcare spaces at a time when different investigations are questioning yes, to this day, this measure continues to have an impact to contain the transmission of Covid.
The assessment of some experts on how to proceed, and more so given the decisions taken by other neighboring countries, such as Portugal and the United Kingdom, to ease this obligation, is majority in favor of removing it in sanitary spaces and maintaining it in those where They have always been necessary, such as in operating rooms or intensive care units. But there are also those who defend that its use should still be mandatory in order to protect the most vulnerable.
The basis on which this discussion is based are different recent investigations that raise unknowns about the current impact of the measure. One of them is a study carried out in the United Kingdom that concludes that the requirement to wear masks in hospitals “may have little impact” in the transmission of, Covid-19 during the wave of the omicron variant. This is an investigation whose conclusions have been presented at the European Congress of Clinical Microbiology and Infectious Diseases, which has been held in Copenhagen (Denmark).
In this study, conducted in a London hospital during the first ten months of omicron operation (December 2021 to September 2022), it is suggested that the benefit of mask use in isolation is likely to be modest. “Our study found no evidence that mandatory mask use by staff affects the hospital SARS-CoV-2 infection rate. with the omicron variant,” says Ben Patterson, co-author of the study.
Together with him, Aodhan Breathnach, also a co-author of the study, adds: “Many hospitals have maintained the use of the mask at a significant economic and environmental cost, despite the substantial barrier it poses to communication (…). We hope that this empirical evidence can help inform a rational and proportionate mask policy in health services”.
Another job that pays more firewood around this controversy is the one that has just been published in Annals of Internal Medicine. Taking into account the conclusions obtained, its authors defend that “it may be that the time has come to stop implementing policies that are not appropriate for an endemic pathogen when the expected benefits of such policies are low.” And they add: “Universal masking in health care is a policy whose time has come and gone…for now”.
What do the Spanish experts think?
For Raúl Ortiz de Lejarazu, professor of Microbiology and emeritus director of the National Influenza Center of Valladolid, The evidence shows that in Spanish hospitals “normality must be resumed”, eliminating the widespread use of masks and limiting it to those areas where it has always been mandatory to wear them. “In hospitals there have always been areas in which the use of masks has been mandatory (operating rooms, clean areas, intensive care units, anesthesia awakening units…). That should never change and it should be there before the pandemic, during the pandemic and after the pandemic.
Referring to the study presented during the European Congress of Clinical Microbiology and Infectious Diseases, Ortiz de Lejarazu has supported his conclusions: “In this study, a verification has been made for several months, almost a year, in which it has been seen that obviously no difference in number of infections between the areas of the hospital where the use of masks is no longer mandatory and the areas where it continues to be so because it always has been”.
Therefore, he launches the following reflection: “This is logical, because masks have played an important role when the incidence of the virus was very high; but when it is very low, the use of masks is practically of no importance because it is something that is not worn continuously and throughout the day we will have the opportunity, at home or in other places, to become infected”.
A falling incidence
For Antoni Trilla, senior consultant of the Preventive Medicine and Epidemiology Service of the Hospital Clínic de Barcelona and dean of the Faculty of Pharmacy of Barcelona, the debate on this issue comes at a good time, since the winter season is coming to an end and everything indicates that the incidence of SARS-CoV-2 will decrease in the coming weeks. Currently, according to data published by the Ministry of Health last Friday, the cumulative incidence at 14 days in people over 60 years of age was 70.45; the percentage of Covid beds, 1.73%; and that of Covid beds in the ICU, 1.31%.
Given this, Trilla also considers that it would be appropriate to continue maintaining the mandatory nature of masks in certain areas and sanitary areas thatconcentrate a high volume of vulnerable patients (transplants, intensive care units…), but considers it wise to consider its withdrawal in other settings where the risk is low. “In other areas of the hospital with fewer patients at risk, and also in pharmacies, I am in favor of studying withdraw its obligation and make a good recommendation whose use and under what circumstances is its use still potentially useful”.
Óscar Zurriaga, president of the Spanish Epidemiology Society (SEE), is one of those who defends maintaining the measure, but with a clear objective: protect the vulnerable patient. “Regardless of Covid, the maintenance of masks is an additional measure against this virus and other respiratory viruseswhich means that vulnerable people this measure can be favorableespecially taking into account that it is an area in which vulnerable people of all kinds move and in which different pathogens abound”.
For this reason, and thinking again of the vulnerable population, he asks to prevent the measure from may fall into disrepute, informing the patient well and knowing how to explain why it is maintained. “We have lost the opportunity to educate the population to know when the mask is necessary and when it is not; and we should not maintain the measure due to follow-onism, since we can end up discrediting it (…). We must teach that it should be used for its usefulness, not for followerism, and it is important that the patient knows when he should use it and in what contexts.”
What does Health say
The Ministry of Health, asked by this newspaper about whether it has determined when masks will cease to be mandatory in those spaces where they must still be worn, as the BOE continues to state, replies: “In Spain, the position is that You should try to use masks in health centers and servicesas a general ruleregardless of whether there is Covid or not, and from there exceptions can be made or particular situations can be assessed”.
To this, he adds: “In any case, in this matter, for decision-making, the Alert Panel is clear that The benefit for the patients must prevail.“.
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