Right now, local and national guidance on wearing masks to prevent covid transmission is changing quickly. The omicron spike has mostly passed in my local area, and there's a mix of people trying to get back to "normal" and people feeling concerned that a rush to remove restrictions will lead to a new spike in caseloads or in their personal risk exposure.
Meanwhile I spent the omicron spike working in healthcare, in a setting where our covid patients were mostly not wearing masks, and at times made up about 50% of our caseload.
To the best of my understanding, neither I, nor any of my closest colleagues, contracted covid at work this winter. I know I didn't contract it at work, because I didn't contract it at all—I've been PCR tested twice weekly with consistent negative tests, as part of our surveillance testing at work. (A PCR test is so sensitive that it can stay positive for some time following an infection—patients and staff with a positive test are exempt from our surveillance testing for 90 days, because it is presumed their positive tests will reflect the known infection. For this reason, the specific day of testing is not as important with PCR as with antigen (rapid) tests.)
I work in a rehab department in a skilled nursing facility. In my building, the rehab team has tended to have better compliance with personal protective equipment guidelines than other teams, and in some cases our masking behavior has been more conservative than required by guidelines. For example, several of us on the rehab team were wearing N95s for all patient contact prior to our facility implementing a requirement for all staff to wear N95s for all patient contact this January. I would guess there are two main factors here: rehab staff are likely more educated than facility staff on average due to licensing requirements, which correlates to beliefs around the importance of mask wearing, and rehab staff have more separation of times when we are and are not around patients compared to nursing staff in particular, making it easier to wear good masks properly whenever we're around patients.
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| The variety of N95 most people use at my workplace. |
For myself and my closest colleagues, this means that the majority of our at-work covid exposure took place when we were wearing fit-tested N95s, eye protection, gown, and gloves. However, the other person in the scenario was usually not taking any transmission prevention steps—we were treating covid positive patients in their rooms, and most were not wearing masks. We were in close contact with covid patients, helping them eat, drink, or move their bodies. Patients might cough or sneeze without covering their mouths. It is not possible to socially distance from someone if your job is to help them stand up safely.
I do have some colleagues from the rehab department (2 out of 6 team members) who contracted covid this winter. In both cases, they had other family members who were sick and tested positive for covid before they did, with known exposures from their own daily activities before developing symptoms. Neither was trying to isolate from the symptomatic family member(s) at home, while both were being especially careful at work just prior to testing positive, because of their home exposure. It is possible that these colleagues actually contracted covid from their masked exposures to patients at work, but I think it's much more likely that unmasked close contact at home was responsible.
I also know, of course, many staff and patients who presumably (or certainly, in the case of some patients) did contract covid at our facility. Because covid was so prevalent this winter, it's hard to know where all these infections came from and how they were passed around. Some seem very likely to have arisen from patient-visitor or patient-patient contact, which is usually unmasked on both sides. (Regardless of guidance issued to visitors, they tend to remove masks once in a patient room—and no one wears a mask all the time around their roommate!) Some seem very likely to have passed from staff to and/or from patients, with staff who were wearing a surgical mask or an N95 and patients who were mostly unmasked.
Besides mask-related behavior, it is worth noting that vaccination rates are very high at my workplace—staff have been required to be fully vaccinated for covid since August, and everyone in the rehab department was boosted before the omicron wave arrived at our facility.
Of course, my anecdata should not substitute for real data in assessing the risks and benefits of various policies around masking. But stories are helpful for calibrating our feelings and risk tolerances in ways that numbers usually are not. And that's my story, for now.
