Universal Masking in Health Care No Longer Seems Appropriate

Maintaining masking may offer marginal benefit in terms of reducing transmission, but impedes communication

By Elana Gotkine HealthDay Reporter

MONDAY, April 17, 2023 (HealthDay News) — Masking policies are an important infection prevention strategy, which played a role early in the COVID-19 pandemic, but universal masking in health care settings is no longer appropriate, according to an ideas and opinions piece published online April 18 in the Annals of Internal Medicine.

Noting that despite the evolution of the COVID-19 pandemic and transition to endemicity, widespread masking requirements continue in health care settings, Erica S. Shenoy, M.D., Ph.D., from Harvard Medical School in Boston, reviewed the utility of universal masking in this setting and the potential downsides of maintaining such policies.

The authors note that the implementation of masking along with other strategies to limit transmission was supported by public health guidelines and health care epidemiology experts and was appropriate during the early pandemic response given the limited knowledge and lack of preventive and therapeutic options. However, the burden of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been mitigated over time, and an imminent end to the public health emergency has been announced. Consequently, many pandemic interventions have been deimplemented, with masking requirements in health care settings a notable exception. Maintaining masking may have marginal benefit in terms of reducing the risk for transmission, but these benefits need to be weighed against costs, including impeded communication, increased cognitive load due to the increase in listening effort required, and obscuring of facial expression, which may negatively impact human connection, trust, and perception of empathy.

“We have achieved major advancements in the prevention and management of SARS-CoV-2 since the pathogen was initially identified in 2019,” the authors write. “In recognition of these achievements, the time has come to deimplement policies that are not appropriate for an endemic pathogen when the expected benefits of such policies are low.”