Posted 3 weeks ago by Alice Wong Guest Blog Posts

Masking in healthcare is basic infection control. Why must vulnerable San Franciscans keep begging providers to take life-saving protections?

Jillian Crochet and Britta Shoot

We all know it didn’t have to be this way. Nationwide, over the past few months, we’ve been in one of the most severe surges of the ongoing Covid-19 pandemic. More than 25,000 people died of Covid-19 in the U.S. from January to early March, according to Kaiser Family Foundation data.

It is in this dark moment of public health — and four years into this ongoing, now completely unmitigated airborne pandemic — that current masking requirements for staff in San Francisco healthcare settings was taken away on April 30, 2024.

We use language about protections being taken away from us — and we co-organized the large action outside the San Francisco Department of Public Health on April 16 — because the city and county’s Health Officer Dr. Susan Philip has the power to extend these basic infection control protocols in medical facilities. By refusing to extend Health Order 2023-01b, she is abdicating her responsibility to public health and actively choosing to put vulnerable San Franciscans in danger.

Two people, facing to the left of the camera, are holding a black sign with white writing that says “Keep masks in healthcare”. In front of them is a crowd of people also faced to the left of the camera, at the corner of San Francisco's column enshrined City Hall. — Two people, facing to the left of the camera, are holding a black sign with white writing that says “Keep masks in healthcare”. In front of them is a crowd of people also faced to the left of the camera, at the corner of San Francisco’s column enshrined City Hall.

It is not controversial that masks work. A well-fitting respirator mask, such as an N95, is extremely effective at reducing the spread of numerous potentially deadly and preventable airborne illnesses such as the flu, Covid-19, and measles. Universal masking — which requires patients and visitors, as well as staff, to wear masks — should be the norm in any medical setting, given what we’ve learned in the past few years about viral infections spread through the air. But even requiring healthcare providers to mask offers some protection to at-risk patients (which means all of us, given that Long Covid can impact anyone). It isn’t enough. But it’s something. And in San Francisco, Dr. Philip had the authority to set and sustain policies that protect us all in one of the most necessary, unavoidable, and high-risk settings in society but she failed all of us despite over 250 individuals and 42 organizations joining us in a statement urging her to do just that.

As members of Senior and Disability Action’s Masks for Equity working group, we have met repeatedly with Dr. Philip and with hospital system administrators asking for masking protections to be upheld and strengthened in healthcare settings. Our group members, many of whom are disabled or elderly, have given public comment to the Board of Supervisors, called in to the Mayor’s Office on Disability and San Francisco Health Commission meetings on numerous occasions. We’ve done this for the past several years, even when we’re shown little or no respect for the extensive time and exhausting labor we put into compiling scientific information and crafting arguments that we hope will finally convince healthcare and political officials to care about us, their patients, constituents and fellow San Franciscans.

One member of our group, Elizabeth, is immunocompromised and has several conditions including severe asthma and CRPS, a disease of the autonomic nervous system that affects her ability to walk and stand. A Covid infection would exacerbate her health struggles, further disabling or even killing her. She recently made the anguished choice to visit a dermatologist to have possibly precancerous facial growths examined. Since universal masking was dropped in healthcare settings, she’s avoided many needed appointments due to the likelihood of contracting Covid in a medical facility. “If providers weren’t required to mask, there’s no way I’d even consider unmasking in a clinic,” she says. “These are impossible decisions that no one should have to make. It’s cruel and unethical to force us to risk our health or our lives in order to receive necessary care.”

It’s also unfair — and impractical — to put the burden of requesting masking on patients, which some officials suggest as an alternative to the current staff masking requirements. “Even when asked, most providers are not prepared to provide any sort of extra protection to their vulnerable patients,” Elizabeth says, noting she regularly has to give doctors N95s from her own self-funded supply.

Telling patients they can mask if they want to ignores the patient-provider power imbalance, as well as emergency situations in which patients may be unable to advocate for themselves. Folks for whom English is a secondary language may not know they can or feel comfortable demanding a provider mask. The examples of these impracticalities are too numerous to name. The burden of this policy change will be shared by many who are already disempowered.

Jillian, one of the co-authors of this piece, is a visibly disabled person who uses a powerchair and is extremely used to self-advocacy in medical settings and the world at large. But recently she was faced with the Sisyphean task of getting an ADA accommodation leading up to a necessary procedure at UCSF, where she had to advocate for herself with at least eight different people, not knowing whether or not they would meet her needs until the moment she was wheeled into the procedure. And they didn’t. One of the prep-nurses had a surgical mask that kept falling below her nose and Jillian was left vulnerable to catching Covid despite her many access requests, when she was in a small confined room with unmasked people before and after the procedure. While she was lucky enough to convince her doctor and the procedure room nurses to wear N95 respirators, that is not the norm, and luck shouldn’t be the determining factor for whether or not healthcare staff take simple and easy steps to protect your life.

Robyn, another comrade in Masks for Equity, wears an N95 in all public spaces but has gotten Covid twice. “I am proof that one-way masking is not enough,” they say. If healthcare staff are no longer required to mask, Robyn will be at heightened risk of contracting Covid in a medical setting, even when they are wearing a highly effective respirator mask. “I am having to decide whether my chronic pain and mobility issues are worth risking an infection that would, statistically speaking, further disable me and potentially even leave me bedbound,” they add.

And of course, plenty of patients can’t mask. They must rely on their physicians and care teams to keep them safe. It’s been shown that without a mandate to do so, many so-called health providers may actively put their patients in danger by refusing to wear a well-fitting mask.

“Dr. Philip tells us she cares about seniors and disabled people, but she refuses to take any action to keep healthcare safe and accessible for us – or for anyone else who wants to avoid a potentially deadly or disabling Covid infection,” Elizabeth adds.

Two people in black clothing and wearing n-95 respirators hold a large black banner with white all-caps text that reads “covid disables”. They are in a green grassy area next to the ornately adorned SF City Hall. Two people are just to the left of them, you can’t read the banner they are holding, but it is black with white text and it says “covid kills”.

We urged Dr. Susan Philip and the SF Department of Public Health to uphold — and to strengthen — staff masking requirements in healthcare. Medical providers who swore an oath to do no harm should want to protect their patients by wearing well-fitting respirator masks.

We welcome fellow community members — those of you who want to be protected against additional, avoidable illness when seeking medical services — to join our work. Our fight continues! Please email Dr. Susan Philip at susan.philip@sfdph.org to tell her to bring back the requirement for staff in healthcare settings to wear masks! To join Senior and Disability Action and help build our movement, visit: https://actionnetwork.org/fundraising/become-an-sda-member-today. And follow us on Instagram, X, or Facebook for updates and action alerts!

With many preventable viruses widely circulating and greatly impacting San Franciscans’ lives, this is not the time to compromise on basic infection control. We all deserve safe access to basic care. We should not have to keep asking our leaders to do the right thing.

Masks for Equity advocates for masking and related protections to make public places, such as healthcare facilities and public transit, accessible for all. Our all-volunteer group is organized through San Francisco non-profit Senior and Disability Action.

Attribution: photos by Britta Shoot.

ABOUT

A photo of Britta Shoot, a white woman with brown hair wearing a black respirator mask and sunglasses on her head. She is holding a sign that reads FREE MASKS and wearing a black t-shirt that says in white letters KEEP MASKS IN HEALTH CARE

Britta Shoot is a writer in San Francisco. She is a member of her local mask bloc and SDA’s Mask for Equity.

A selfie of Jillian Crochet, a white woman with tan skin and curly brown hair, wearing a black mask and tortoise shell glasses is laying against her chartreuse green Lumpy Bed sculpture/lounge. In the background is a wall of tiny sketches by the artist José Figueroa.

Jillian Crochet is a disabled artist, writer and activist in the Bay Area. She is an active member of SDA’s Masks for Equity.

Masking in healthcare is basic infection control. Why must vulnerable San Franciscans keep begging providers to take life-saving protections?