As masking requirements and other Covid-19 precautions loosen, some patients, particularly those who are at high risk, feel like they are "more and more on [their] own" to protect themselves against the virus—even in health care settings, Megan Molteni writes for STAT.

Lax Covid-19 protections in medical offices may be putting patients at risk

Currently, CDC guidance recommends everyone in a health care setting, including workers and patients, practice physical distancing and wear face masks to reduce the risk of transmitting the coronavirus to others, particularly in areas with high community transmission.

However, some patients are now reporting reduced adherence to Covid-19 protections at medical offices—leading many to feel "increasingly anxious about contracting Covid while accessing necessary routine health care," Molteni writes.

For example, Sarah Fama, a 48-year-old woman with an autoimmune disorder, said that at a recent visit to a lab get some blood work done, several employees and patients were not wearing masks, even though the lab's website said that masks were required inside the building. 

"I was just floored to see medical providers doing that," Fama said. "I've been trying to do everything to keep me and my parents safe and it just makes you feel like you don't matter."

Similarly, Amanda, a kidney transplant recipient, said she encountered several unmasked staff members in the waiting room of a nephrology clinic.

"Even in clinics where the job is to provide care for people who are really high risk, you can't even feel safe somewhere like that," she said. "It just feels like we're more and more on our own."

What is the risk of Covid-19 in outpatient settings?

So far, there has been little research on the risk of coronavirus transmission in outpatient settings. They are believed to be relatively low-risk areas because patients are typically only there for a few hours at most.

However, one study from researchers at a Veterans Affairs health system in Ohio found that seven out of 14 Covid-19 clusters in the first year of the pandemic were traced back to community-based outpatient clinics. In many of these clinics, transmission occurred between workers, but there were two cases where health care workers transmitted the virus to patients.

"Clearly from our study there is a lot of transmission among personnel working in outpatient settings," said Curtis Donskey, an infectious disease physician and hospital epidemiologist who led the study. "And there's always the potential that they could transmit Covid to patients they're seeing there, but thankfully that seems to be relatively infrequent."

According to Donskey, universal masking requirements for patients, health care personnel, and other staff likely reduced the risk of coronavirus transmission at the time of the study, but it's not clear how transmission would be affected as masking requirements are dropped or loosened.

Separately, another study published in the American Journal of Infection Control found that many clinic rooms in offices failed to meet ventilation requirements to reduce the risk of respiratory infections. Out of 105 clinic rooms, 10% did not meet general requirements for exam rooms, 40% did not meet requirements for treatment rooms, and over 80% did not meet requirements for aerosol-generating procedures and minor surgeries.

A lack of proper ventilation in these spaces "may inadvertently increase the risk to workers and the potential spread of the disease within the clinic," the study authors wrote.

How health care providers can reduce the risk of respiratory infections

According to Michael Barnett, an associate professor of health policy and management at the Harvard T.H. Chan School of Public Health and a primary care physician at Brigham and Women's Hospital, there are "relatively straightforward things that are not particularly costly that could be done in most clinical office settings that could interrupt common chains of respiratory infection transmission."

For example, low-risk patients who have respiratory symptoms should be treated through virtual visits by default. And individuals who come for in-person visits should wear a mask and quickly be taken into an exam room to minimize the time they are waiting with others.

"With that combination we could probably drastically reduce the potential of people getting sick from each other inside an outpatient office," Barnett said.

In addition, several studies have shown that Covid-19 measures, including masking and social distancing, significantly impacted the spread of respiratory diseases during the pandemic. Over the past two years, the United States has experienced some of the mildest influenza seasons on record, and cases of respiratory syncytial virus and the common cold virtually disappeared.

However, Barnett said that he is not sure whether Covid-19 infection prevention and control measures will last beyond the pandemic, even though they have been shown to be effective at reducing the risk of respiratory infections.

"Honestly, it's not something that a lot of outpatient offices want to think about," Barnett said. "Most medical professionals recognize it's obvious that masks make a difference even if they're not perfect. But it's still a hassle and a big culture change." (Molteni, STAT, 9/7)