Yes, we do need to bring back masks in medical settings

Yes, we do need to bring back masks in medical settings

By Iris Gorfinkel

Iris Gorfinkel is a family physician and clinical researcher in Toronto.

“Take a seat. The wait to see the doctor is about an hour.” 
The waiting room is packed…few if any, are masked

Imagine you — or a vulnerable loved one — needs urgent medical care. If you’re lucky enough to have a family doctor, you head to their clinic. Like most, yours is housed in a building with low ceilings and little air filtration. You enter the waiting room where several patients sit shoulder-to-shoulder waiting.

You have no choice but to sit alongside people sneezing, coughing and blowing their noses. Few if any, patients and health care workers are wearing a mask. While grateful for the hand sanitizer on offer, you begin to wonder if that will be enough to prevent your picking up an infection you hadn’t anticipated.

It’s an all-too-familiar scenario. 

The most common reason people see a GP is to assess an upper respiratory infection. They most frequently start after inhaling infected droplets or aerosols or from having touched an infected surface.

An N95 or KN95 mask helps block transmission, whether it’s SARS CoV-2, influenza or a common cold virus like RSV. They’re not perfect, but they reduce viral transmission by 30 per cent. Yet in spite of their benefits, most health-care workers and patients no longer routinely mask, even during assessments requiring close contact with an increased risk

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Transcript

0:25

Hey, everyone, and welcome back for another Deep Dive. Today, we're tackling a topic that I think is on a lot of people's minds lately. Yeah. Masks in medical settings, and specifically why some experts are calling for them to come back. We're looking at an opinion piece by Dr. Iris Gorfinkel. She's a family physician, A and D, a clinical researcher. Oh, wow. So she's coming at this from both sides, and she makes a really compelling case for more masking. It is interesting how this is bubbling back up again. Right. It's a hot button issue, for sure. Yeah. Haven't we talked enough about masks in the last few years? You would think so, right? You would think. But I think what's interesting is that our listeners are smart. They're following this issue, and they're not just looking for those surface-level hot takes. They want to understand the nuances here. Exactly. So that's what we're going to do today. Yeah. Let's unpack this. We're going to unpack it. So let's start with... I think Dr. Gorfinkel does a really good job of sort of setting the stage. She really paints this picture of what the patient experience is like these days. Yeah, she does. It's very vivid. So picture this. You finally managed to get an appointment with your doctor. Right. After weeks of waiting. Oh, yeah. Months, maybe. Months even. It's so hard to get in to see anybody. It really is. So you're there and you walk in to the waiting room and he's packed. Oh, yeah. And everyone there, it seems like, is coughing or sniffling or both. It's definitely an anxiety producing experience. And I think she really captures this feeling that a lot of us are having. Where on the one hand, we're so relieved to finally be seeing a doctor. Yes. But then there's this other part of us that's like, should I be wearing a mask? Should I be worried? Right. And she even takes it a step further and talks about how some people are even feeling anxious about asking their doctors to wear a mask. Isn't that interesting? It's like... Which I just find so fascinating. It is fascinating. Why is that? Like, why do we... Why is it different with doctors? We ask our dentists... Yes.... and our hygienists, right? Yes. You're right there in their face. They have to. Yeah. But with the doctors, like, we don't want to. Right. It's like we're questioning their judgment or something. Yeah. And maybe it's part of that thing of like, you know, they're the ones with the medical degree. It's the power dynamic, maybe. Yeah. We're paying them for their expertise. And so, to kind of question their practices feels... Almost taboo. Yeah. A little bit taboo. Like, are we allowed to do that? Right. But then Gorfinkel brings up this other point, which I think is really important. And it's the fact that wait times are so long. Oh, yeah. That just compounds it. That when you finally get that appointment, you're so unlikely to do anything that could jeopardize, you know, getting seen. Right. You've waited months for this. Exactly. You need help now. You're not going to rock the boat. Exactly. She calls it a precious commodity. And I think that's really true these days. It feels very precious. It does. So you're kind of caught between a rock and a hard place. Yeah. So we've talked about how people are feeling, but I'm curious, what does the science actually say about the risk of going maskless in, you know, doctor's offices and hospitals and places like that? Right. Because it's not just about our comfort levels. Yeah. It's about protecting everybody. Exactly. And I think that's what we're going to get into next. Yeah. And especially those who are more vulnerable, you know, exactly, people with underlying health conditions. So let's get into that. What does the science actually tell us about how risky it is to go maskless these days? Yeah. Well, and Gorfinkel really digs into this. OK. She's really highlighting the science behind mask efficacy. OK. Talking about N95s, KN95s. So not just like a cloth mask. Right. Those are talking about the higher grade one. Exactly. Yeah. When worn correctly can really reduce viral transmission significantly. OK. So how much of a difference are we talking about? Right. So she's citing studies that show N95s can filter out up to 95% of airborne particles, which includes viruses. So that's a big deal. That's huge. It is huge. Now, obviously, no mask is perfect and how well it works depends on how well it fits your face if you're wearing it consistently. Right. All of that. But even a small percentage reduction in transmission can make a big difference, especially in a health care setting. Yeah. It's like that saying, right? An ounce of prevention is worth a pound of cure. Exactly. And this is another point she makes that I think is really important. She reminds us that, you know, we have vaccines now. Right. And they're really effective at preventing serious illness and hospitalization. Yes, instantly. Yes. But they don't completely eliminate transmission. Right. Especially with these newer variants that are circulating. Yeah. We've all heard those stories, right? Or even experienced it ourselves where, you know, somebody tests positive and they're like, but I was feeling fine. I didn't have any symptoms. Exactly. And they're fully vaccinated. Fully vaccinated. Right. It happens. And that's the tricky part, right? Because you don't know if you're contagious. You don't know. And that asymptomatic transmission is a big part of why this whole discussion is so complicated. So it sounds like what she's really getting at is this idea of shared responsibility. Absolutely. She makes a strong argument that we have a responsibility to protect each other. Yeah. Especially in places like hospitals and doctor's offices where people are already vulnerable. Right. It's not just about me and my risk tolerance. It's recognizing that my actions have an impact on other people. So if we accept that premise, that we have a responsibility to at least try to minimize risk in those settings, what does that look like, practically speaking? Does that mean everybody has to mask up all the time? Well, and that's the million dollar question, right? Yeah. And to her credit, Gorfinkel doesn't necessarily advocate for this one-size-fits-all approach. Okay. She suggests that masking policies should be more flexible and adaptable, taking into account people's individual circumstances and potential barriers. So give me an example. What would that look like? Sure. So let's say someone is hard of hearing and they rely on lip reading. Right. A traditional mask might not work for them. Right. Or in situations where a mask might make it really difficult to do a certain medical procedure or to communicate effectively. Right. We need to be able to make adjustments. So finding that balance again. Exactly. Between protecting everybody but also making sure that people's individual needs are met. And she also emphasizes that this isn't just about COVID. Right. Masking can protect against other respiratory viruses too. The flu RSV. Oh, especially this past year, right? Like RSV was huge. It was scary. Yeah. And those viruses can be really dangerous for young kids, older adults, people with compromised immune systems. So we've talked about, you know, how people are feeling about masks, the science behind them, this idea of shared responsibility. She also in her piece touches on long COVID. She does. Which is something that, you know, we're still learning about, but it's definitely a factor in this conversation. And it feels like every day we're learning more and more about how serious it can be. Yeah, we are. It's like it's a whole other layer to this. Right. That I don't think a lot of people were really aware of at the beginning. And even now, I think a lot of people are like, oh, I had COVID, I got over it. Right. They think it's a cold. Yeah. Two weeks later. You know, I'm fine. Exactly. And for some people it is. Right. But for others, it's not. So from your read, like, how does Gorfinkel bring this into the masking discussion? What's her take on how this all plays together? Well, I think for her, it just underscores the fact that we need to be cautious. Okay. You know, she cites some studies that suggest long COVID could affect people for three years or even longer after that initial infection. Three years? Yeah. Which is a really long time. It's not just like, oh, I got to take a couple of weeks off work. Exactly. It can have a real impact on your life, you know, and on your livelihood and everything. It really makes you rethink what it means to be over something. It does. It's not just about, oh, I tested negative, I'm good to go. Right. Like, what does that actually mean? Right. And I think, you know, we're talking about, you know, these long-term impacts that just reinforces the need for being proactive. Okay. Like, masking, especially in those health care settings, where you're just more likely to be exposed to something. You're already not feeling great, probably, if you're in that setting. Exactly. You're already vulnerable. So it's almost like, why would we not take that extra step? Right. And she even argues that, you know, protecting against long COVID, this is a public health priority. Wow. It's not just an individual concern. That's interesting. This has been such a great conversation. I feel like we've really gone in-depth on this. As we kind of pull back and look at the big picture, what are some key takeaways for our listeners? What do we really want them to walk away from this conversation with today? I think the biggest thing is information is power, right? We've unpacked all this stuff about, you know, how patients are feeling about masks, the science behind it, this idea of collective versus individual responsibility, the risks of long COVID. You know, we've covered a lot of ground. Yeah, we did. But knowing all of this, how will you approach your next doctor's appointment? Will you feel empowered to ask your doctor to wear a mask, if that's something that makes you feel more comfortable? Right. Or will you hesitate? It's about advocating for your health. Yeah, and be mindful of others too. Yeah, absolutely. Such a good point. I love that takeaway. I think for me, the big one is stay curious, keep asking questions, stay informed. Absolutely. I'll do the same. We'll see you next time for another Deep Dive.