Universal masking in healthcare as a disability accommodation
Universal masking in healthcare as a disability accommodation
My letter to Geisinger Health System in Pennsylvania, including footnoted references.
When I started this newsletter a year ago, I didn’t imagine that I would find myself a year later pleading for basic infection mitigation in healthcare settings. But here we are. Feel free to take what you want from my letter and its references, for your own advocacy.
The letter I’m sending is to Geisinger, which is both my healthcare insurance, and my narrow network healthcare provider, which it is apparently not uncommon to have the outfit as both insurance and provider in the US. I’ve sent letters before about masking in healthcare, but it didn’t get through because they’ve loosened the mask requirements and made them optional in elevators, corridors, bathrooms, and crowded waiting rooms. I’m sending this letter to all of the facilities I need to use, and also to the headquarters. I’m also sending a copy to my local representatives because why are they not stepping in to help us damn it? With my letter, I’m also sending the additional documentation including:
the article from Infection Control & Hospital Epidemiology, Back to the future: Redefining "universal precautions" to include masking for all patient encounters.
(Maybe I’m also including the beer guy meme on the envelope.)
Scranton, Pennsylvania
April 2023
Dear Healthcare provider,
I am requesting universal masking in all healthcare settings, including waiting areas, elevators, stairwells, and corridors, as ADA reasonable accommodation. I am over 50 years old, I have Medical PTSD, and I have multiple high-risk conditions described in the CDC list of “certain conditions” that put one at higher risk for and with Covid-19.1 Geisinger facilities have required universal masking prior to lifting this requirement, and so it has been shown that it is indeed, a reasonable accommodation. Healthcare providers morally need to require universal masking in all healthcare settings to protect everyone, both patients and workers, but you have a specific legal requirement to accommodate the high risk disabled.2
The virus has not changed in nature, it is still dangerous,3 it’s still airborne and moves through doorways and vents.4 High risk people are still at risk, high risk settings are still high risk settings.5 Especially since around half of healthcare workers work while sick.6 People are still hospitalized and dying of covid,7 and suffering long covid and post-covid complications.8 This knowledge must be well known to healthcare providers, so it would seem to be an admission that my healthcare providers no longer care about the health and life outcomes of people such as myself. One wonders why y’all went into medicine in the first place. I do everything I can to avoid getting infected, and being forced into exposure at healthcare settings is like a kick in the face.
People go to healthcare to get better - not to get worse conditions than we already have, or acquire new disabilities, from preventable infections, and become higher risk, just from seeking preventive care in your facilities. Spreading communicable diseases deliberately, when the mitigation is well understood, is not even a reasonable business practice, let alone humane or scientifically sound medical practice. Healthcare settings seem on track to become nothin’ but death traps where people go in and get sicker and worse diseases than they went in with. It doesn’t even make sense in a modern society where the benefit of masking is well known.9 What’s next, filthy drinking water? Stop hand washing? Stop cleaning altogether? Healthcare providers need to stop following the politics,10 and engage in critical thinking.11 Respiratory diseases circulating including the pandemic SARS-COV-2, make it clear that universal masking in healthcare should be common sense and scientifically sound going forward.12
This virus is serious even for young and healthy people like Physics Girl,13 and deadly especially to older people like David Crosby who also had “certain medical conditions.”14 But none of us should be viewed as expendable. There’s a word for that ideology, and it shouldn’t even be in the minds of people I trust with my care, and it’s absolutely unacceptable as practiced policy.
References:
CDC - COVID-19 - People with Certain Medical Conditions - Updated Feb 10,, 2023 - (The Internet Archive Wayback Machine, Archived April 2023) This means that a person with one or more of these conditions who gets very sick from COVID-19 (has severe illness from COVID-19) is more likely to: - Be hospitalized, - Need intensive care, - Require a ventilator to help them breathe, - Die https://web.archive.org/web/20230331224337/https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html
ADA National Network - Information, Guidance and Training on the Americans with Disabilities Act - Health Care and the Americans with Disabilities Act 202 The ADA requires that health care entities provide full and equal access for people with disabilities. This can be done through: • Reasonable Modifications of Policies, Practices, and Procedures. Adjusting policies, practices, and procedures, if needed, to provide goods, services, facilities, privileges, advantages, or accommodations. https://adata.org/factsheet/health-care-and-ad
GovExec Daily podcast: Americans' Changing Views of the COVID-19 Pandemic. University of South Florida professor Feng Hao joins the podcast to discuss a new survey on the coronavirus. APRIL 7, 2023 Feng Hao: “There are 2 messages for public health officials to continue to communicate with the public about covid-19. One, is to remind people covid-19 is still a risk. It’s still a threat. It’s still a danger especially for the people who are unvaccinated. Nowadays people kind of gotten tired of the covid-19. But even if we are tired of the pandemic, the pandemic is still there. That is one message that the public health official wants to deliver to say that well the risk is still there and we still have to wear a mask we still have to be vaccinated. It’s necessary.” https://www.govexec.com/management/2023/04/americans-changing-views-covid-19-pandemic/384924/
Fox-Lewis A, Williamson F, Harrower J, Ren X, Sonder G, McNeill A, et al. Airborne Transmission of SARS-CoV-2 Delta Variant within Tightly Monitored Isolation Facility, New Zealand (Aotearoa). Emerg Infect Dis. 2022;28(3):501-509. Solo traveler A and person E from a 5-person travel group (BCDEF) tested positive. After transfer to the MIF, person A and group BCDEF occupied rooms >2 meters apart across a corridor. Persons B, C, and D subsequently tested positive; viral sequences matched A and were distinct from E. The MIF was the only shared location of persons A and B, C, and D, and they had no direct contact. Security camera footage revealed 4 brief episodes of simultaneous door opening during person A’s infectious period. This public health investigation demonstrates transmission from A to B, C, and D while in the MIF, with airborne transmission the most plausible explanation. https://doi.org/10.3201/eid2803.21231
United States Department of Labor - Occupational Safety & Health Administration - Directorate of Standards and Guidance Infectious Diseases Rulemaking Employees in health care and other high-risk environments face long-standing infectious disease hazards such as TB, influenza and MRSA, as well as new and emerging infectious disease threats. OSHA is considering the need for a standard to ensure that employers establish a comprehensive infection control program and control measures to protect employees from exposures to infectious agents that can cause significant disease. https://www.osha.gov/infectious-diseases/rulemakin
Linsenmeyer, K., Mohr, D., Gupta, K., Doshi, S., Gifford, A., & Charness, M. (2023). Sickness presenteeism in healthcare workers during the coronavirus disease 2019 (COVID-19) pandemic: An observational cohort study. Infection Control & Hospital Epidemiology, 1-4. doi:10.1017/ice.2023.47 Sickness presenteeism among healthcare workers (HCW) risks nosocomial infection, but its prevalence among HCW with COVID-19 is unknown. Contemporaneous interviews revealed a sickness presenteeism prevalence of 49.8% among 255 HCW with symptomatic COVID-19. Presenteeism prevalence did not differ among HCW with and without specific COVID-19 symptoms or direct patient care. https://www.cambridge.org/core/services/aop-cambridge-core/content/view/C20BC892BAF9B9BDF26F9D81A24C7260/S0899823X23000478a.pdf/sickness-presenteeism-in-healthcare-workers-during-the-coronavirus-disease-2019-covid-19-pandemic-an-observational-cohort-study.pd
People's CDC COVID-19 Weather Report, April 10, 2023 Hospitalizations for confirmed COVID cases remain high at national rates of 3.11 per 100,000 for ages 70+ and 0.63 per 100,000 for all ages as of April 4. For the week ending April 5, 2023, 1,773 people died of COVID nationally. At least 1,127,104 people have in total died from COVID in the US. https://peoplescdc.substack.com/p/peoples-cdc-covid-19-weather-report-e0
Forbes: Long Covid Is Keeping Millions Of People Out Of Work by William A. Haseltine Sep 2, 2022 He then used Covid-19 case counts and labor force participation rates to estimate that 3.5 million people are out of work due to long Covid. Culter estimated lost wages at approximately $200 billion per year. It is also important to remember that, staggering as they are, these estimates do not represent the full economic burden of Long Covid. They focus only on lost wages and not the reduced capacity of caretakers and the significant healthcare costs for Long Covid patients. https://www.forbes.com/sites/williamhaseltine/2022/09/02/long-covid-is-keeping-millions-of-people-out-of-work/?sh=2de66e3b52cc
Efficacy of face masks against respiratory infectious diseases: a systematic review and network analysis of randomized-controlled trials Eleven out of 16 RCTs that underwent a pairwise meta-analysis revealed a substantially lower infection risk in those donning medical face masks (MFMs) than those without face masks (RR 0.83 95% CI 0.71-0.96). Given the body of evidence through a systematic review and meta-analyses, our findings supported the protective benefits of MFMs in reducing respiratory transmissions, and the universal mask-wearing should be applied-especially during the COVID-19 pandemic. https://pubmed.ncbi.nlm.nih.gov/34407516
Teams Human: Following the Politics instead of Following the Science. By Chloe Humbert, MAR 21, 2023 Healthcare providers and others are making critical medical decisions about masking based on a political football. https://teamshuman.substack.com/p/following-the-politics-instead
Scientific American: Why Do Smart People Do Foolish Things? Intelligence is not the same as critical thinking—and the difference matters. By Heather A. Butler, October 3, 2017 Critical thinking means overcoming all kinds of cognitive biases (for instance, hindsight bias or confirmation bias). Critical thinking predicts a wide range of life events. In a series of studies, conducted in the U.S. and abroad, my colleagues and I have found that critical thinkers experience fewer bad things in life. https://www.scientificamerican.com/article/why-do-smart-people-do-foolish-things
Kalu IC, Henderson DK, Weber DJ, Haessler S. Back to the future: Redefining "universal precautions" to include masking for all patient encounters. Infect Control Hosp Epidemiol. 2023 Feb 10:1-2. doi: 10.1017/ice.2023.2. Epub ahead of print. PMID: 36762631. Despite recent guidance from the Centers for Disease Control and Prevention (CDC) allowing institutions to relax in-facility masking strategies and due to our evolving understanding of respiratory pathogen transmission during the coronavirus disease 2019 (COVID-19) pandemic, we propose an updated standard for universal precautions in healthcare settings: permanently including universal masking in routine patient-care interactions. Such a practice prioritizes safety for patients, healthcare providers (HCPs), and visitors. https://pubmed.ncbi.nlm.nih.gov/36762631
Skepchick - Physics Girl & the Devastating Effects of Long COVID. By Rebecca Watson Mar 31, 2023 Her friends and family write that she is almost completely bedbound, overly stimulated by lights and sounds (a commonly reported symptom of the disease), unable to hold conversations or even manage her own care. When you compare that to her bubbly, vivacious personality prior to COVID, the difference is horrifying. https://skepchick.org/2023/03/physics-girl-the-devastating-effects-of-long-covid
Rolling Stone: Graham Nash Says David Crosby Died During Covid-19 Bout. by BY DANIEL KREPS, April 8, 2023 While it was rumored that Crosby had again contracted Covid-19 prior to his death, his former band mate Nash confirmed it in an interview on the Kyle Meredith With podcast. https://www.rollingstone.com/music/music-news/graham-nash-david-crosby-death-covid-19-1234711868/
