With mask mandate relaxed, UI Hospitals patients and staff can refocus

Last week was an interesting week.

On Sunday, my column detailing my experience being denied my appointment at the University of Iowa Hospitals and Clinics’ Iowa River Landing facility in Coralville was published. I had been ejected from the building for refusing to wear a face mask, despite presenting an exemption letter from a licensed physician that had previously been accepted by other UIHC clinics.

On Monday, it was announced that beginning March 8, masks at the UIHC would be optional for most patients and staff. On Tuesday, I called to reschedule the appointment I had missed. I was offered an appointment for the following day. So on Wednesday, the first day without a mask mandate, I visited the Iowa River Landing clinic for an appointment with my physician. I got to have the appointment without being expected to do anything that could trigger a searing headache. That was nice.

I had predicted that a majority of people would still be wearing masks inside UIHC facilities. It had been impressed upon us ad nauseam for a week or so shy of three whole years: Not only that masks were necessary to prevent the spread of the COVID-19 virus, but more importantly, that neglecting or refusing to wear one would put both ourselves and other people at risk of becoming ill from COVID-19. For three years, every person who walked in the doors of any UIHC facility was treated as a potential carrier of a disease before they were ever treated as a person. A harsh assessment to be sure, evidenced nonetheless by checkpoints set up at every one of the buildings’ authorized entrances.

All that considered, I was a bit surprised when I walked into the building prior to my rescheduled appointment. The first person I saw was the security guard who only eight days earlier had refused to view my exemption letter and ordered my removal by police escort when I refused to wear a face covering. The security guard was not wearing a mask.

Neither were the clerks behind the clinic’s front desk, who were instructed last week not to check me in for my appointment. A couple of the patients in the spacious waiting room did wear masks — as they should have, if they so preferred. Most did not. Neither did the nurses who emerged from behind the waiting room door to collect patients one by one. Only a relative few physicians, lab techs, clerks and patients donned a mask.

So, my prediction was incorrect. On the first day that they were made optional at the UIHC, a majority of patients and staff at the Iowa River Landing facility shed their face masks. Clearly, most of those patients and staff had not been wearing them for the sake of protecting others. They did because they were compelled — staff, as a matter of retaining employment; patients and visitors, in order to enter the hospital for treatment. Naturally, (most) everyone complied. No one wants to lose their job. No one wants to be denied care. I certainly didn’t — and I wouldn’t wish on anyone what I experienced when my exemption letter was denied.

Does this mean that a majority of UIHC staff, patients and visitors are reckless and irresponsible? Did we take off our masks out of “selfishly wanton disregard for other patients’ and staff safety,” as my refusal to wear a mask was characterized by one reader? The UIHC has over 11,000 staff members and received patients for over a million clinic visits last year. To make a case that the majority of us shed our masks out of carelessness would be an exhausting exercise in cynicism.

Opting not to wear a mask doesn’t even necessarily mean that a person disagrees that masks prevent virus spread. For the past three years, we’ve been admonished to “trust the science,” and told that “studies show” that masks can prevent the transmission of COVID-19. Many have cited a large randomized trial released in September 2021 to support masking and measures to encourage or require it. The trial, which studied over 300,000 people in rural Bangladesh, claimed to find “clear evidence that surgical masks are effective in reducing symptomatic seroprevalence” of COVID-19, by up to 35% for individuals at over the age of 60. Some believe that studies show masking makes no difference. A re-analysis of the Bangladesh study published in September 2022 found that staff behavior potentially convoluted the study’s ability to draw a link between masking and a reduction in reported COVID-like illnesses. Which is correct, the initial trial or the re-analysis? Consensus doesn’t seem to be an easy thing to come by in a day and age when almost anyone can find almost any study to confirm their own viewpoint or debunk someone else’s.

Lost in the shuffle of the debate — not only about mask mandates, but about vaccinations, school and business closures, and stay-at-home orders — is the reason we were urged to take mitigation measures in the first place when the pandemic reached critical mass at the beginning of the third week in March 2020. It wasn’t to eradicate the novel coronavirus. Only two diseases in history have ever been completely eradicated. Only one — smallpox — was capable of infecting humans. Our mitigation measures weren’t about stopping COVID-19 in its tracks; it was to slow its spread to avoid overwhelming the health care system, lest the rate and severity of cases cause it to collapse.

That’s not to say that the pandemic has never put stress on our health care system, or that it has never felt overwhelming to patients and staff. The UIHC entered Phase One of its surge plan on Nov. 16, 2020 to prepare for the influx of COVID patients after cases skyrocketed in early November. On that day, 98 inpatients were infected with COVID.

Since then, UIHC COVID inpatient numbers have fallen by over 90%. Over 85% of all Americans age five and older have had at least one dose of a vaccine. Treatments have become available, and in August 2022, the CDC acknowledged that combined with those treatments, immunity — including “infection-induced immunity” — have substantially reduced the risk of severe COVID-19 illness. As of Thursday, March 9, 2023, the total number of UIHC COVID inpatients was 9.

COVID-19 has not ceased to exist, but happily, it is ceasing to pervade. Given that, rigid mitigation measures no longer make sense. At the U of I, the way they were enforced at times was beyond reason, as I found out the hard way. Given that, I was very pleased — and very grateful — to learn that the UIHC rescinded its mask mandate for most patients and staff.

For my rescheduled appointment, I saw the specialist who treats me for rheumatoid arthritis for the final time before his upcoming retirement. For 23 years, he excelled in the science of treating RA and the art of treating this goofy teenager-turned feisty adult. Our consultations didn’t center so much on an affliction that dictated my life, but on my life itself and how my condition played into the bigger picture. When the news was good, I was happy to share the joy. Once, when the news was bad, he looked at me soberly and said, “I wish I had a magic wand.”

But nobody has one of those. There’s nothing we can wave to wipe away painful and deadly diseases. When suffering happens, it’s easy to lose sight of the bigger picture. But as our immunity to COVID strengthens and case counts remain seemingly manageable, perhaps it’s finally time for that bigger picture to come back into focus. And without such harsh mitigation measures, maybe that’s possible — including at the University of Iowa Hospitals and Clinics.

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

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