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The U.S. Centers for Disease Control and Prevention has revised its Covid-19 guidance to allow health care facilities in certain areas to drop mask mandates for patients, visitors and staff. But for the time being, the state’s largest medical providers, University of Vermont Health Network and Dartmouth-Hitchcock, are planning to keep mask requirements in place.
UVM Health Network, which includes UVM Medical Center, Central Vermont Medical Center and doctor’s offices scattered across the state, plans to continue requiring masks in patient-facing areas, according to Annie Mackin, a spokesperson for the organization.
Mackin said via email that the network has evaluated its policies based on CDC recommendations “as well as our own data and experiences.” There are currently 18 Covid patients at UVM Medical Center and three at Central Vermont Medical Center.
Dartmouth Hitchcock Medical Center in Lebanon, New Hampshire, has no current plans to change its mask policy, said spokesperson Cassidy Smith. Nor does Mt. Ascutney Hospital, a Dartmouth-affiliated hospital in Windsor.
The CDC changed its guidance late last week after recommending that health care facilities mandate masking throughout the pandemic.
The updated guidance applies to a broad range of health care settings, including hospitals, doctor’s offices, long-term care facilities and home health agencies. It states that such settings “could choose not to require” masking in communities with low, moderate or substantial Covid transmission, according to the CDC’s county-level map of case counts and positivity rates.
The CDC has four levels of community transmission: low, moderate, substantial and high. As of Thursday, seven Vermont counties have high community transmission, which means they would not qualify for the new guidance, according to the CDC. But eight counties — Orleans, Franklin, Grand Isle, Chittenden, Addison, Washington and Orange — are substantial or below, meaning health care facilities could choose to drop masks under the CDC guidance.
Ranu Dhillon, a physician and health equity advisor at Brigham and Women’s Hospital in Boston, said the guidance was “problematic” because hospital patients are more often at high risk for experiencing the worst effects of Covid.
“I just actually finished a hospital shift, and at least a quarter of the patients that I saw overnight, for example, are immunosuppressed for one set of issues or another, including being on chemotherapy,” he said.
Doctors often have to lean in close to patients to examine them, and nurses often turn or lift patients in close proximity, leading to higher risk of transmission, he said. He said masking is a “relatively simple thing” that can help reduce the chances of hospital staff causing harm to those patients.
Anne Sosin, a health equity researcher at Dartmouth College, said via email that health care facilities “do not want to force people with high-risk medical conditions to choose between deferring care for COVID concerns or risking exposure to seek care.”
She added that Covid could complicate and worsen the conditions that patients are seeking care for in the first place.
Dhillon said the pandemic has actually changed the way that hospitals think about masking for other respiratory viruses, which have seen a downturn during the pandemic.
“It’s the same reason we wash hands, the same reason we wear gloves, right? We're trying to prevent causing harm to our patients, especially when they're at risk for bad outcomes,” he said.
The Vermont Department of Health plans to update its own guidance to follow the CDC’s. Patsy Kelso, the state epidemiologist, said that masking has been a “burden” to medical providers who have been wearing face coverings since the beginning of the pandemic.
“Some health care facility workers are probably distressed by the idea that masks will come off in their facilities at some point, while others are relieved and thankful,” she said.
Asked about the risk to high-risk patients, Kelso said health care facilities can still opt for masking based on their own best judgment.
Health care facilities have always routinely used different forms of transmission precautions, she said. “It's a return to the way health care has always been practiced,” making those precautions at the discretion of the facility, she said.
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