“Seek care elsewhere:” When mask mandates and patient care collide

Several weeks ago while catching a game at Jack Trice Stadium, I realized that the hat and sunglasses I was wearing to prevent sunburn were resting on my head and face in a manner that was causing what I knew would become a debilitating headache if I didn’t remove them. I spent most of halftime and part of the third quarter watching the game from the shaded part of the concourse, praying that I would not have to grab my friend and duck out early.

Headaches like that are not an uncommon occurrence for me, which is no surprise given the severity of my oft-mentioned rheumatoid arthritis. RA can sometimes result in additional medical issues, and my own latest diagnosis could suggest that the increase in headaches I’ve experienced of late aren’t necessarily a coincidence. I’ve had to start being careful to avoid things that I’ve figured out will trigger them, lest I lose a whole day to lying in a dark room disoriented by pain and nausea. Unfortunately, some of my worst headaches over the last six months or so have occurred when I’ve been required to wear a face mask.

A year ago, I wrote an article highlighting the problems experienced by K-12 students for whom masking is difficult or impossible, as at the time a federal judge had just blocked Iowa’s prohibition on mask mandates in schools. The justification was that requiring all students to mask was a reasonable accommodation for disabled students at increased risk of contracting COVID-19.

I found the ruling at the time to be flawed, and still do. For some students whose disabilities make them unable to tolerate masking, mask mandates that may serve as an accommodation for others can also violate their own rights to reasonable accommodation and equal access to an education by disrupting their ability to learn and function in the classroom.

After an appeal process that most recently found that the issue is moot due to changing COVID conditions, Iowa schools can no longer mandate masks in the classroom. But while access to education is currently not an issue for those who experience difficulty masking, access to health care is another story. Most hospitals and clinics, including all four major systems serving the I-380 Corridor, currently require masks for all patients, staff and visitors. For those who can tolerate a mask, it is an exceedingly reasonable expectation. For those who can’t, things get difficult. And if wearing a mask is required to just to get in the door, how can a person who cannot tolerate a mask receive care?

Unfortunately, this question pertains to my own treatment at the University of Iowa Hospitals and Clinics, where I’ve been a regular patient for three decades. After wearing masks without issue for almost two years, I suddenly stopped tolerating them last spring due to those searing headaches they cause. I’ve also become averse to using a face shield, which is the only option offered for patients who “cannot wear a face mask for medical reasons.”

The alternative of a face shield is a curious one, as the Centers for Disease Control and Prevention (CDC) makes it very clear in the text of their own mask mandates that face shields “do not protect others from respiratory droplets exhaled by the wearer.” It also specifies that face shields do not protect the wearer from others’ exhalations. With such a clear rejection from the CDC, UIHC’s use of face shields for those with mask issues seems counterproductive, especially if face shields present their own problems to the wearer. (While it is unknown who specifically advises the policy, it is notable that an article was published in the June 9, 2020 issue of the Journal of the American Medical Association in which the use of face shields as an alternative to masking was endorsed by three UIHC infectious disease physicians, including Chief Quality Officer Dr. Michael Edmond.)

So what is a patient who can’t tolerate a mask or face shield to do? Researching this issue has made for a strange intersecting of the personal and the professional. As a journalist interested in exploring the topic in my Sunday opinion column, I had a very positive conversation with a representative from the hospital’s Media Relations Team, who seemed fairly receptive to my questions about the UIHC’s mask mandate policy. (An official response was not yet available at the time this article went to press.)

As a patient with a very real need for an exemption from the requirements of a mask or face shield, however, my experience was nothing short of a nightmare of conflicting responses, transferred calls, and dead-end conversations, during which I was told by staff from two different clinics that I might have to “seek care elsewhere.”

Seeking care elsewhere is easier said than done for patients with complex issues and specialized needs, and many who can’t tolerate a mask or face shield could fall into that category. So without the availability of even the narrowest or most specifically tailored exemptions, the choice for mask-averse patients may actually be quite a simple one: Suffer the difficulty of masking, or go without care. For patients with chronic migraines or spinal issues that means suffering the headache; for patients with anxiety, suffering the panic; for people with sensory disorders, suffering the confusion; for people with dermatologic conditions, suffering the itching and burning. In lieu of suffering? Go without the blood test. Without the X-ray. Without the neuro check. Without the treatment itself.

With governments, employers, schools, hospitals, and local communities all reminding their citizens ad nauseam for over two years now that masking is vital to preventing the spread of COVID, it’s so easy to dismiss the concerns of those harmed by masking. Especially when one does not experience that same struggle, and when opinions so easily bleed between professional and personal. One of the staff who told me that I might have to look elsewhere for care was a clinic administrator whose public social media account includes a post stating that “Compliance with mask wearing is a measure of societal IQ.”

But what happens when compliance becomes incompatible with care? That’s a difficult question to answer for an institution that averaged over 5,100 clinic visits each day last year from patients who, we’re reminded, could each be unwittingly carrying the COVID-19 virus. It’s a daunting task for a hospital to balance the needs of its patients with the risk of transmission, one for which I don’t envy hospital leadership. But no matter how relatively rare instances of mask resistance are, if the UIHC is going to tell patients who can’t tolerate masks that they could be putting others in harm’s way, it’s worth considering whether that mandate does the same to those patients.

Comments: 319-398-8266; althea.cole@thegazette.com

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