Doctors’ new coronavirus threat: Patients who refuse to wear masks

Some Americans’ decision not to wear a mask in public has become a political act, the latest demonstration of how misinformation complicates the American response to the Covid-19 pandemic.

As states reopen, enforcing new mask requirements in public spaces has sparked conflict: A Target employee in California his arm broken after attempting to remove two customers who refused to wear masks. In Flint, Michigan, a security guard was at a Family Dollar store shot dead after a dispute with a dissatisfied customer about wearing a face mask.

These kinds of confrontations are now also taking place in medical clinics and hospitals, which endangers health workers.

A Florida urologist, who asked for anonymity because he was afraid of losing his job, tells Vox that his first patient on May 13 refused to wear a mask. The doctor works in a private clinic, which recently introduced a policy that all patients should wear a mask in the building to minimize the transmission of the virus. The patient was given a mask at the reception, but refused to put it on.

“The nurse asked him to put on his mask if he wanted to be seen,” said the urologist. “He became verbally aggressive with her and said he had the right not to wear a mask and that we denied his constitutional rights.” The clinic manager was called upon to speak to the patient and explained that the mask should protect both him and the medical staff. “He kept refusing, so the administration asked him to leave.”

At that point, the patient called 911 to complain that he was not receiving medical care. “We are a private property, not an emergency room,” said the urologist. “We don’t have to treat him and he didn’t have an acute emergency. I think he just didn’t understand his rights very well. ‘

The coordinator refused to send an agent to the scene, but the clinic then called the police. “He walked out of the building before the police showed up.” The mask, the urologist says, “not just for his safety. It is for the safety of the people around him. ”

It is difficult to estimate how widespread a mask refusal is, and it is probably unusual. A recent HuffPost / YouGov poll found that most Americans say they usually or always wear masks when they are in public and around others.

But medical professionals interviewed by Vox in three states suggest that health workers are sometimes endangered by people who refuse to wear masks in healthcare facilities. This rejection of a public health measure only adds to the threats to primary health care workers, who are at higher risk of Covid-19 infection, especially in the United States. persistent shortage of protective equipmentsuch as masks, gloves and surgical gowns.

What we know about the benefits of wearing masks

Part of the potential confusion about wearing masks stems from changing recommendations from health authorities. The US surgeon general arrived in February Americans said stop buying masks because they allegedly wouldn’t protect users from infection and because health professionals needed them first. However, in early April, the CDC changed its guidelines to recommend that people cover their faces in “public environments where other social distance measures are difficult to maintain.”

Like the CDC NPR told, Recent research have shown that the virus is often spread when people are pre-symptomatic and asymptomatic. As much as 31 percent of people with Covid-19 may be asymptomatic and people may be infected two to 14 days before developing symptoms. Exactly because you may not know who has become infected on a busy sidewalk, in a hospital or in a doctor’s office, other people’s masks protect you, and your mask protects them.

SARS-CoV-2, the new coronavirus, is very small and surgical and homemade masks are not as effective as the N95 masks worn by health professionals to filter the virus. (A study shows the type of fabric used changes the effectiveness of homemade masks, with T-shirt fabric performing the best materials tested.) Still, researchers say they still seem to reduce the transmissibility of the virus by reducing the transmission of infected drops.

For this reason, a growing number doctors, scientists, and public health experts are now calling for universal masking in public indoor areas and crowded outdoor areas. A recent study, not yet peer reviewed, analyzed data from Hong Kong, where almost universal masking was voluntarily adopted very early in the pandemic. It suggests that the transmission of coronavirus can decrease by up to 75 percent when using surgical masks. And other studies suggest that if the use of masks were universal, it would control transmission even better than a strict lockdown. Especially when the US reopens, masks will be crucial tools to help control public transmission.

A secret service agent wears a face mask as President Donald Trump and Alex Azar, Secretary of Health and Human Services, walk to Washington One on the South Lawn of the White House in Washington, DC on May 14, 2020.
Drew Angerer / Getty Images

It doesn’t help that Trump and Pence don’t wear masks in public

However, this evidence-based message has been politicized in the US, with some on the right refusing masks and becoming a symbol on the right for personal liberties.

A poll published May 7 by the Associated Press-NORC Center for Public Affairs Research suggests that 76 percent of Democrats wear masks when they leave home, compared to 59 percent of Republicans.

The gap is also evident in the top Republican leadership. Even as two White House assistants tested positive for Covid-19 – including one of the personal servants of President Trump and Katie Miller, the vice president’s press secretary – the President recently told advisers wearing a mask would “ridicule” him.

Vice President Mike Pence followed Trump’s lead and recently declined to wear a mask on a tour of the Mayo Clinic, a medical center in Rochester, Minnesota. Pence was the only person not wearing face cover during the tour, a violation of the clinic policy as well as federal guidelines.

After Pence’s tour, Fox News’ Laura Ingraham doubled the number of rejection masks, saying, “Social control over large populations is achieved through fear and intimidation and suppression of free thinking.” Republican state representative Nino Vitale is required by the Ohio health department to wear a mask, but has so far declined. “We are all created in the image and likeness of God. That image is most often seen by our face, ” he wrote on Facebook,

Part of the problem, explains Saskia Popescu, an infectious disease epidemiologist, is the early mixed message about masks that has created room for doubt in the public understanding of the benefits of masks. “Every time there is uncertainty, there is an opportunity to use it for politicization – which is frustrating, as new outbreaks like Covid-19 are inherently uncertain.”

She explains that inevitably, as we learn more about the virus, guidelines will continue to change. “I hope people want us to develop our processes with the latest data and research,” says Popescu. “What worries me is when politics is the public health agenda, not the other way around.”

When caregivers need to treat mask refusers

A nurse at a VA hospital in Kansas, who asked for anonymity because she was afraid of losing her job, also told Vox about a patient who refused to wear a mask this month. “We have a mask policy for all employees and all patients,” she says. Because equipment for personal protective equipment (PPE) in the hospital is still limited, nurses receive one surgical mask per day and patients without masks are given cloth masks on loan that the hospital washes after they have been used.

The patient was “raging and enthusiastic,” she says. “He said he tried to get it and didn’t catch it, so he didn’t think he needed to wear a mask. I wish I could be so confident and willing to take everyone in the life of this building in my hands . ”

Despite his refusal to put on a mask, the patient was cared for, although the staff wore gowns and masks as if he had Covid-19. “Some [staff] were irritated, “he was treated, the nurse says,” but it’s not their job to arm someone from the clinic. What do you want them to do? ”

She does not know what will happen the next time a patient refuses a mask. Although the entire VA medical system requires anyone who enters a medical facility to wear a mask, the nurse’s clinic has no security personnel to enforce it. So far, management has only authorized personnel to wear additional PPE if patients refuse to follow the mask policy.

“At the end of the day, as nurses, we can’t just kick a sick person out,” she says. “We should try to help them, even if they are stubborn. We should try to educate them even if they don’t want to, “she says. “It’s part of the performance.”

Ryan Shannon, an ER physician in Florida, describes a patient who refused to wear a mask even though she was in a room next to an immunocompromised person at high risk for serious Covid-19 disease and death. “She declined, threw the mask on the floor and accused myself and my staff of being part of the ‘conspiracy and hoax’ that is Covid-19,” he said wrote in a Facebook post of May 11.

After the patient’s refusal to follow guidelines, her husband insisted on sitting in the waiting room intended for patients with respiratory complaints such as Covid-19, rather than in his car, as instructed. “We are about to turn social media into a cesspool of misinformation. Wrong information that endangers people’s lives, “Shannon wrote. “We are about to politicize a pandemic. Where a person’s political belief almost determines whether or not he wears a mask, ”he concluded. “Just wear the damn mask.”

Yet mask rules in health care institutions are not consistently or state-by-state communicated to staff to enforce them. Medical boards of some states, such as Texas, have issued There are clear requirements throughout the state that “a mask must be worn by both the patient and the physician”. But Florida, for example, does not seem to have issued universal guidelines for the use of masks, leaving these decisions to individual institutions, meaning that mask rules can vary from hospital to hospital.

Confusion about where and when to wear masks also takes place in other high-risk places that provide medical care, such as nursing homes. Sue Krohn-Taylor is a manager of a low-income retirement home of 72 apartments in the major city of Grand Island, Nebraska, where a resident has tested positive for Covid-19. She says she’s fighting a number of residents who refuse to wear masks and is exhausted.

“This week, the son of one of the residents told me that I was taking away their freedoms by having them wear a mask in the common areas,” she says. “If they only harm themselves, I would withdraw, but they endanger every resident here, my staff and our families.”

“I can fight the virus, but fighting the lies is going to be overwhelming,” she says.

Lois Parshley is a freelance investigative journalist and the Snedden Chair of Journalism 2019-2020 at the University of Alaska Fairbanks. Follow her Covid-19 report on Twitter @loisparshley.

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