From Monday August 1, wearing a mask in hospital will no longer be compulsory, but only “very strongly recommended” declared the Minister of Health. This decision comes at the end of the state of health emergency, without being a direct consequence since the simple application of the common law of the Public Health Code (Art L3131-1) would allow the Minister of Health to prescribe “any regulatory or individual measure relating to the organization and functioning of the health system” in the event of a serious health threat, “in particular in the event of a threat of an epidemic”.
Having long since passed the stage of a simple threat, the Covid-19 pandemic is now manifesting itself in a succession of waves, the seventh of which is still in progress. To date, viral circulation is still intense, with an incidence rate of 700 per 100,000. Just for the “summer” wave, still in progress, we have already counted more than 40,000 hospitalizations, including 6% of children and adolescents, and already more than 3300 deaths, including 12 minors. Thus, maintaining the wearing of the compulsory mask in the hospital is not only possible, but it is necessary if we want to preserve the health of people, and consequently also the hospital, which is not a place like the others. By definition, the hospital welcomes sick and therefore vulnerable people, and its professionals are overexposed to pathogens.
Without masks, caregivers and patients will be at increased risk of infection, with dire and predictable consequences for a healthcare system already on its knees. Caregivers risk chaining infections and being absent for illness, while the hospital crisis is already manifesting itself in a staffing problem. We also risk seeing increased conflicts in an already very stressful daily life, because of a protective measure that has become, inexplicably, more and more divisive. Many city doctors testify to the difficulties in enforcing the obligation to wear a mask in their offices, for lack of a national obligation. What will happen in an environment like that of the hospital, where the caregiver-patient relationship is sometimes already very strained? After the debate on the reintegration of unvaccinated caregivers, this management, which de facto leaves the management the choice of whether or not to keep the obligation of the mask, is not likely to appease relations at the hospital.
Concerning patients, in addition to the direct risks of infections, other consequences are to be feared: since the lifting of the obligation to wear a mask in closed places, some immunocompromised people have limited their outings to closed public places to what is strictly necessary, for many to the care institutions that care for them. Such a decision could lead vulnerable people to stop consultations, care and screening. Further distancing the most vulnerable patients from the care pathway, not securing the places they frequent, are major inconsistencies at a time when the authorities seem to have decided, without consultation, to tolerate a significant circulation of the virus, by focusing protection only for those most at risk of developing serious forms.
Hospitals should therefore have the option of deciding to maintain the mask in their establishments, and some have already announced it. Thus, the protection of people’s health will depend on their place of residence, further accentuating inequalities in access to care and working conditions.
The choice to apply to the hospital the same principle as in other public places, a call for “individual responsibility”, comes up against the failure of this strategy which anyone who takes public transport can see: under the pressure social, the proportion of people who wear a mask is very low, far from the 71% who wanted it to return at the start of the seventh wave. A trend also consistent with the results of the Coviprev survey by Public Health France, showing at the end of June the fall in the proportion of French people who continued to wear a mask indoors[1].
The principle of “individual responsibility” implies that people are informed and understand the risks of Covid-19, including the risk of long Covid and sequelae, that they know the effective means of minimizing these risks and that they it is always possible to use them effectively. It also requires that the authorities, for their part, propose a rational and coherent health management policy, accessible and understandable by all. In all places, the lifting or introduction of preventive measures should be based on reliable indicators reflecting viral circulation. Obviously, to date, these conditions have not been met.
Other countries, such as the United Kingdom, have lifted the obligation to wear masks in hospitals, to reintroduce them shortly after, in the face of the observation of the increase in nosocomial cases of covid-19 (up to 100 %), including the number of patients admitted to intensive care beds and the increase in covid-19 related staff absences [2].
We, caregivers, patients, scientists and researchers, ask that the obligation to wear a mask be maintained in hospitals by national decision and that scientific, anticipated and concerted criteria guide health management decisions.
Mathieu MOLIMARD, President of CCM Pellegrin Hospital, Bordeaux University Hospital
Yvanie CAILLE, founder of Renaloo
Francis BERENBAUM, head of department, professor of rheumatology
Vincent DARROUZET, PUPH, head of department at the CHU DE BORDEAUX
Guillaume DEBATY, Professor of Emergency Medicine
Jérôme MARTY, UFMLS President
Christian LEHMANN, general practitioner
Armelle VAUTROT, academic, therapist
Franck CLAROT, radiologist, pathologist
Hélène POIRIER, doctor
Claude-Alexandre GUSTAVE, medical biologist
Dominique LANG, infection prevention and control nurse
Matthieu PICCOLI, hospital doctor
Corinne DEPAGNE, pulmonologist
Emilie BRUNET, nurse
Jérôme GUISON, specialist in internal medicine
Thierry BAUBET, professor of child and adolescent psychiatry (AP-HP)
Nicolas RUSSIER, FFCS
Jean-Daniel KAISER, hospital pharmacist practitioner
Emmanuelle DUMARCHAT, liberal nurse
Louis, LEBRUN, public health physician
Axelle JAQUARD, nurse
Christophe LAMARRE, doctor in Roubaix
Marie-Anne PANET, doctor
Cristina MAS, Long Pediatric Covid Collective
Michaël ROCHOY, general practitioner
Amélie CAISSIAL childcare nurse
David SIMARD, Doctor of Philosophy of Medicine
Yannick FREYMANN general practitioner,
Cathie ERISSY, Secretary General of the APPI Association for the Promotion of the Nursing Profession
Jonathan FAVRE, general practitioner
Matthieu CALAFIORE, general practitioner, director of the department of general medicine at the University of Lille
Caroline FOURNIER patient, Renaloo
Sayaka Oguchi, President of the National Union of Young General Practitioners (SNJMG)
Igor AURIANT, intensive care physician
Alexis GIRARD, emergency doctor
[1]https://www.santepubliquefrance.fr/etudes-et-enquetes/coviprev-une-enquete-pour-suivre-l-evolution-des-comportements-et-de-la-sante-mentale-pendant-l -covid-19-epidemic
[2]Covid-19: Hospitals and GP clinics return to universal mask wearing as rates rise | The BMJ
