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Should hospitals and other health-care facilities maintain mask requirements, even though they have long been dropped in virtually all other settings?

This is a highly contentious issue. Some prominent experts have argued that the downsides of hospital mask mandates outweigh benefits, while others advocate changing the paradigm of medical care to sustain universal masking for the foreseeable future.

Last month, the Department of Veterans Affairs announced a new policy that, in my view, achieved a sensible middle ground: Masks are no longer required in most clinical settings but are still mandated in areas that serve high-risk patients. That latter category includes dialysis clinics, transplant and chemotherapy units, and urgent-care and emergency departments. The VA guidance is also clear that patients with covid should still wear masks and that patients can request health-care personnel to mask for their protection.

I spoke with VA Undersecretary for Health Shereef Elnahal to better understand how he and his team came to this compromise.

Elnahal told me he prioritized two key factors. The first was to protect the most vulnerable veterans, which is why the mandate remains in places that treat large numbers of high-risk patients.

The second was veteran preference. “We got a lot of feedback from veterans’ families and caregivers about why we were still requiring masking post-public health emergencies” in some settings, such as medical and surgical units for less severe health issues and outpatient care. The clear input that he and other VA leaders received was that veterans and their families did not want continued universal masking in all settings.

“Our most important obligation is to serve veterans in the way they ask us to,” Elnahal told me. Policy needs to take this into account, as well as the input of experts, scientific evidence and evolving circumstances.

Indeed, we are in a very different phase of the pandemic than we were a few years ago, with many more tools to prevent and treat covid-19. The VA encourages its patients and employees to be up-to-date with vaccines, and Elnahal noted that the department has a virtual “test to treat” program that offers telehealth Paxlovid prescriptions to ensure early treatment.

Crucially, the VA policy is a floor, not a ceiling. That means local medical centers can add masking requirements if they see fit. For example, if there are outbreaks in a specific nursing home or hospital, that facility could add requirements above and beyond the national guidelines. And the policy could be revised in the future if, say, a more concerning variant or a new dangerous pathogen raises alarms.

I asked Elnahal what the reception to relaxing mask requirements had been thus far. He told me the overwhelming majority of people, including veterans, caregivers and employees, have said the VA is striking the right balance.

I agree. Few public health policies will satisfy everyone, and it’s a herculean task to find a middle ground on contentious topics such as masking. I think the VA articulates the right values ​​in its decision-making. It’s clear that most Americans do not support universal mask requirements and that a vocal and substantial minority vehemently opposes them. On the other hand, health-care settings must safeguard their most vulnerable patients. Identifying which areas are frequented by high-risk patients and requiring masks in these settings, while removing mandates in others, strike a reasonable compromise.

Meanwhile, health-care facilities should make it clear — as the VA does — that patients, family members and caregivers have the right to request that providers wear masks while seeing them. No one should be deterred from getting cancer screenings, dental cleanings or other routine outpatient care for fear of contracting the coronavirus, and providers should be responsive to patient requests for masks.

Finally, people concerned about infection risk should keep in mind that one-way masking — that is, wearing a mask, even if others around them are not — is highly protective for the wearer. Individuals who wish to avoid the coronavirus and other respiratory viruses should consistently wear a well-fitting, high-quality mask (N95, KN95 or KF94) while in indoor public areas, including health-care settings.

And let’s not forget other preventive measures, including good hand hygiene, which reduces the transmission of not only the coronavirus but many other infectious pathogens, too.

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