Covid-19 and N95 Masks

22/03/2022

Marco Paolicelli

Covid-19 Confusion Grows as Hospitals Come Out Against N95 Masks

Since the start of the pandemic—when masks became a de rigueur protective accessory—there has been a clear hierarchy among them. N95s provide the greatest protection, followed by surgical masks, then cloth masks, and finally the loose and makeshift bandana. The tighter the fit, the better the protection—and N95s were the clear winners.

But all of that has been knocked sideways in recent weeks as, according to in-depth reporting by Politico, an increasing number of hospitals around the country are asking patients and visitors to remove their N95s and replace them with less-protective surgical masks that hospitals provide. The hospitals explain their concern is that N95s need to be fit-tested to work properly, and thus surgical masks are better for the public at large. They also argue that they are simply following guidelines from the U.S. Centers for Disease Control and Prevention (CDC), which do not require N95s in hospital settings and even refrain from recommending against cloth masks.

“It’s baffling,” Dr. Ezekiel Emanuel, a bioethicist at the University of Pennsylvania and a former COVID-19 adviser to the Biden Administration, told Politico. “This is something where the CDC has been on the wrong side for a long time.”

The CDC has actually been on no particular side, which is part of the problem, resisting calls from public health experts for over a year to call for N95s in hospital settings, Politico reports. Worse, patients and visitors who want to lodge complaints when asked to swap out their masks are forced to do so through any one of 50 state agencies overseen by the Centers for Medicare and Medicaid Services (CMS), a bureaucratic thicket most people don’t know how to hack through.

Many of the reports from the field are anecdotal, but their numbers are growing. Emanuel complains that his daughter was required to trade her N95 for a surgical mask during a recent visit to Massachusetts General Hospital. Northwestern Medicine in Chicago and Munson Healthcare in Traverse City, Mich., reportedly have similar rules in place—though in some cases visitors and patients are permitted to keep their N95s as long as they cover them with a surgical mask.

Some clarity may be coming soon. On March 18, representatives of the CMS and other federal officials met with Mia Ives-Rublee, a disability advocate with the liberal think tank Center for American Progress, to thrash out the issue. According to Ives-Rublee, the CMS plans to notify hospitals nationwide that patients and visitors should be allowed to wear their N95s if they prefer, and also plans to clarify rules that govern how the public can lodge complaints. From the beginning, masks have been a political flash point in the public’s response to the pandemic. The latest debate is just one more battle in the two-year war.

TODAY’S CORONAVIRUS OUTLOOK
More than 472.1 million people around the world had been diagnosed with COVID-19 as of 12 a.m. E.T. today, and nearly 6.1 million people have died. On March 21, there were more than 1.3 million new cases and 16,246 new deaths confirmed globally.

WHAT ELSE YOU SHOULD KNOW

The U.S. lacks the funds to purchase a fourth COVID-19 vaccine dose for all eligible Americans, reports the Washington Post. The Biden Administration is prepared to place orders for the shots, but the necessary money to pay for them remains locked up in a stalled $15 billion spending bill on Capitol Hill. Health officials have yet to agree on whether a fourth dose is needed, but the White House is worried that the Congressional funding fight could leave Americans unprotected if the additional shot is indeed deemed necessary.

King Harald of Norway, 85, has tested positive for COVID-19 and is experiencing what royal officials describe as “mild symptoms,” reports the Associated Press. Harald is the second sovereign to test positive in a month, following the infection of Queen Elizabeth II, of England, in February. The Norwegian King has already received three COVID-19 shots and is expected to take a break from his official duties for a few days, during which his son, Crown Prince Haakon, will take over.

New York City, once the epicenter of the pandemic, has seen COVID-19 cases rise 30% in the past week, reports amNY. The Omicron subvariant BA.2 is responsible for nearly half of the new cases, according to state health officials. In response to the bump in cases, Gov. Kathy Hochul once again urged New Yorkers to get booster shots. State data show that only 43.5% of New Yorkers who are eligible for boosters have actually received them.

Pfizer announced today that it has agreed to sell 4 million doses of its anti-viral COVID-19 pill Paxlovid to 95 low-income countries, reports the New York Times. The move, while welcome, can cover only a small fraction of the 4 billion residents of the 95 designated countries. Overall, Pfizer has said it can manufacture 120 million treatment courses of Paxlovid this year, most of which have already been claimed by wealthier nations.

People who were diagnosed with COVID-19 in the past year have a 40% greater chance of developing diabetes than people who weren’t infected, according to a new study in the Lancet. The mechanism responsible for the connection is unclear. Researchers speculate that the virus might somehow trigger the body to increase its level of blood sugar, though just how this would happen is unclear. It’s also possible that the diabetes is a result simply of weight gain and inactivity among people who have come down with COVID-19.

Politico

U.S. health officials seek Covid-19 hospital safety complaints following POLITICO report

America’s hospital regulator wants patients to report facilities that request they remove their masks.

By RACHAEL LEVY

03/19/2022 02:29 PM EDT

U.S. health officials are discussing how to ensure Americans file Covid-19 safety complaints after POLITICO reported that some hospitals ask patients to remove their N95 masks, among the best respiratory protection available, according to three people familiar with the conversations.

Federal officials are concerned that many patients aren’t aware of how to report hospital safety issues to regulators, a process that takes place through state agencies, said two of the people familiar, including one inside the Biden administration.

Mia Ives-Rublee, a disability advocate who spoke with federal officials on Friday, also confirmed the administration’s thinking.

The Centers for Medicare and Medicaid Services plans to notify hospitals that patients should be allowed to wear their N95s when entering, said Ives-Rublee, who works at the Center for American Progress, a liberal think tank. CMS also wants to ensure patients know where to lodge complaints if a facility requests someone remove their mask or doesn’t follow Centers for Disease Control and Prevention guidance. Next week, CMS plans to discuss the matter with state survey agencies, which consider complaints about health care facilities, two of the people familiar said.

The agency moves follow POLITICO’s report on Wednesday, which found that hospitals around the country ask patients to replace their N95s with less protective surgical masks. The hospitals that require patients to swap their N95s said they are enforcing quality control and following CDC guidelines, though the CDC doesn’t say patients must do so.

The CDC didn’t immediately respond to a request for comment. CMS declined to comment.

Ives-Rublee, who has pushed the CDC to require high-quality masks, particularly in health care settings, told POLITICO she participated in a meeting on Friday during which an agency official said they don’t recommend broad use of N95s because people wear them incorrectly.

Health care workers often undergo fit-testing to ensure a N95 seals properly, but research shows that a N95 doesn’t need to be fit-tested to provide superior protection to a surgical mask. While once in short supply, N95s are now widely available. The federal government earlier this year started providing free N95s for the public through pharmacies.

Hospital staff and visitors often wear surgical masks — in accordance with CDC guidelines – but public health experts fear that such masks put people at higher risk of catching Covid. A recent POLITICO analysis found a record number of hospitalized patients were infected with Covid during the Omicron wave. Michael Osterholm, an infectious disease expert who advises the Biden administration, earlier told POLITICO that he had “no doubt” sub-par masks contributed to the transmission.

Though public health experts have urged the Biden administration for over a year to recommend N95s for all, the CDC has not done so. The agency and the White House have argued that even in hospitals, surgical masks provide sufficient protection in many situations, despite the CDC’s research showing that N95s provide much better protection. The agency also says the public can wear cloth masks, which it found are the least effective in stopping Covid transmission.