A plea to maskless health-care workers from vulnerable patients

I am the definition of a “high-risk” patient: I am immunocompromised, I don’t mount a proper response to vaccination, and I have heart issues. In the past, I’ve been hospitalized for catching a cold.

Whenever I’m in the hospital – which is often – I wear an N99 respirator. I masked prior to the pandemic, during cold and flu season or in high-risk environments like the emergency department.

Before the pandemic, health-care workers would intuitively put on a mask when they saw mine, a process referred to as “mask mirroring.” They recognized the risk that any infection posed to me and took steps to try to keep me safe.

During the first year of the pandemic, it was relatively easy to stay safe in health-care settings. There were strict mask mandates in place and virtual care reduced the number of people visiting the hospital.

But as we rushed “back to normal,” I noticed a perceptible shift in health-care workers’ approach to masking: They very clearly didn’t want to do it anymore.

Even in hospitals that had active mandates, I would encounter staff wearing their mask below their noses or chins, and they would sigh and huff if I asked them to wear their mask properly.

One time I was in the elevator when a woman in scrubs got on. She was wearing a hospital badge. She was clearly an employee and therefore governed by the mandates the hospital had in place. Her mask was in her hand.

I politely asked her to wear it and told her I was immunocompromised. She rolled her eyes, held the mask in front of her face without actually putting it on. She leaned across me to hit the button, even though there was another set of buttons on the opposite side of the elevator. This felt like a deliberate attempt to violate my personal space and ensure I knew just how unhappy she was that I asked her to mask.

As time went on and more people bought into the comfortable lie that COVID was over, it became harder to access safe medical care. Fewer and fewer staff were complying with mandates; eventually mandates were dropped altogether in favour of “mask-friendly” policies.

“We respect the choice of all patients to wear a mask if they see fit. Hospital staff will decide whether or not a mask is required based on a number of factors. They will not tolerate any violence or abusive behaviour.”

Effectively, “we’re not going to mask anymore but if you really want to, we won’t stop you.” Stating that masks will be “respected” infers there is something inherently wrong with masking – that people who do it are to be tolerated and, perhaps, pitied. It is the exact wrong message to send in a hospital.

Despite having well-documented risk factors in my medical chart, since mandates have been dropped, I have been accused of being “anxious,” “scared of COVID,” “difficult” and told I should “stop worrying so much.”

Seeking medical care has been absolutely exhausting; I feel like I have to steel myself for each and every interaction as though I were going into battle, having to navigate risk. It’s not just the risk of COVID, it’s any hospital-acquired infection. The pushback against mandates has caused an overall reduction in infection control. I’ve had staff try to insert an IV without washing their hands and then get angry with me for requesting they stop.

I don’t understand how we’ve ended up in a place where it’s considered weak to want to protect ourselves and others from deadly and disabling viruses, but it is where we’ve ended up.

On one of my recent trips to the ED, I had an infuriating interaction with a doctor.

Doctor: Looks at my N99. “You seem anxious about COVID.”

Me: “Not anxious, realistic. Please check my chart. Colds have put me in hospital.”

Doctor: Checks chart. “Oh sorry, you should definitely keep masking. Do you want me to wear one?”

Please stop doing this to patients. While I’m grateful the doctor dropped the “anxiety” remark quickly and checked my chart, the comment on my mask should never have been made. The doctor should have been masking, too. If doctors absolutely cannot or will not mask for themselves, they should mask-mirror when they see a masked patient.

This idea that only the vulnerable need to worry is causing a tremendous amount of harm. I was “lucky” in that my chart clearly states that I am vulnerable so the doctor didn’t push back. But what about people with less obvious medical circumstances? What about those who are healthy themselves but are caring for a vulnerable person?

The only difference between me and everyone else is that I know I’m vulnerable

By the time the doctor had made the comment, checked my chart and offered to mask, we had been in close proximity for seven minutes. That’s more than enough time to infect a patient.

We must be cognizant of the fact that many patients don’t feel comfortable questioning a doctor given the imbalance of power. While some patients may want you to put on a mask, once you’ve accused patients of having “anxiety,” they’re going to shut down. They won’t ask. They won’t risk deterioration of care.

If masks remind people of the pandemic, that should be a good thing.

Many vulnerable patients are also unable to mask for a number of reasons. They may be nauseous, need oxygen, in the midst of a dental emergency, have tracheostomies or sensory issues. The list of people in a hospital who may be unable to mask is long and they have to rely on others to mask to help protect them.

I am not a doctor. I can’t treat myself. I can “just stay home” from almost any public setting, but I can’t avoid the hospital.

I’m not the only patient like this. We are all making huge personal sacrifices to keep safe in a world that has deemed us expendable. We’re exhausted, angry, scared and frustrated. Yet, despite how badly we’ve been treated and how much we’ve had to sacrifice, the place we go to get better is the place most likely to give us a deadly and disabling virus.

Hospitals are where the sickest people are – and where the strongest bugs thrive.

Mandatory masking would prevent a great many nosocomial – or hospital-acquired – infections and save lives.

If you’re a health-care worker who sees a patient in a mask, put one on for them. Don’t make them ask. Don’t psychologize them. Don’t betray the trust they’ve shown you. They’ve put their lives in your hands. Don’t take that for granted, it’s not an easy thing for many of us to do.

When I posted on Twitter/X asking patients if they had delayed or avoided care due to lack of masking and asking health-care workers why they did or didn’t mask, the responses I received were overwhelming.

There were more than a thousand replies from people who were either avoiding care or had been infected in a health-care setting. There were doctors saying they are not concerned with getting sick and their patients can “mask if they want.” These responses demonstrated a clear need for masking policies in hospitals.

There were heartbreaking stories of health-care workers trying to protect themselves and their patients, only to be told by administrators and superiors that they weren’t allowed because masks remind people of the pandemic.

I am sensitive to people who have gone through trauma, but we are still in a pandemic. If masks remind people of the pandemic, that should be a good thing. People need to know the pandemic is not over and that by not masking, they are taking serious risks with their health.

If your trauma is so severe that you can’t mask for a vulnerable patient – or worse, you lash out at a patient for masking – then you need to carefully assess whether you should be in a patient-facing role.

The author dedicates this article to disability advocate and Long-COVID patient Tinu, who passed away on Sept. 26, 2024. #ForTinu