INTENT

The intent of this position statement is to emphasize that the New York State Nurses Association (NYSNA) continues to strongly support a mandatory mask policy, particularly in settings where physical distancing cannot be achieved and an individual cannot determine who has been fully vaccinated.

POSITION

It is the position of the New York State Nurses Association that:

• The federal, state, local, and tribal governments must uphold a key principle of medical practice to ‘do no harm’ and use the best available science to guide infection control in public places;
• The federal, state, local, and tribal governments must uphold the key principles of justice and beneficence regarding mandatory vs voluntary mask-wearing decisions to protect those who experience greater rates of disease and worse outcomes (socially vulnerable groups): older adults, people with underlying medical conditions, and people from disadvantaged racial and ethnic groups;
• Mandatory mask wearing in public places appears to be an effective, fair, and socially responsible solution to curb transmissions of airborne viruses. Voluntary mask policies may have yet unknown social and behavioral consequences related to the effectiveness of the measure;
• Voluntary mask wearing would likely lead to insufficient compliance and would potentially intensify stigmatization;
• Under a voluntary policy, those wearing a mask are likely to be judged as belonging to the risk group;
• As high compliance is needed for infection control effectiveness, public policies that encourage or enforce mask wearing need to be in place.

BACKGROUND

On May 13, 2021, the U.S. Centers for Disease Control (CDC) updated its guidance to allow fully vaccinated persons to “resume activities without wearing a mask or physically distancing, except where required by federal, state, local, tribal, or territorial laws, rules, and regulations, including local business and workplace guidance.” This new guidance includes all indoor spaces except those in healthcare, public transportation and schools. On May 17, 2021 OSHA announced that employers should follow CDC guidance and that it would update its guidance to reflect this. Governor Cuomo has announced that, on May 19, 2021, NYS will adopt the new CDC guidance. While everyone is eager to resume our pre-COVID lives, the New York State Nurses Association (NYSNA), representing over 42,000 registered nurses in the state of New York, has serious concerns about the health ramification of this change for both the public and workers.

“Nurses have experienced the devastating effects of this terrible disease first hand. They have watched their patients struggle for breath, suffer severe, life-threatening immune reaction, experience strokes, cardiac arrest and renal failure. Tragically, they have watched patient after patient die. And they, along with other essential workers, have suffered extremely high infection rates themselves. Nurses have despaired watching many states lift safety mandates too quickly leading to additional surges. Lifting the indoor mask mandate too soon puts lives at risk, especially for those most vulnerable to COVID infection,” states NYSNA President Judy Sheridan-Gonzalez, RN.

Recent studies show that most fully vaccinated persons are well protected from serious COVID-19 disease. While vaccination appears to decrease the risk of transmission and severe illness, those with asymptomatic or mild infections may still be capable of transmitting disease to others. Cloth face coverings and disposable masks do appear to offer some protection, particularly against larger droplets, but they are not always well fitted to the face allowing gaps for some air to enter and exit. What is clear is that when everyone -- both vaccinated and unvaccinated -- wears a mask, everyone is safer.

The CDC’s new guidance ignores the unfortunate politicization of masking and vaccinations in American society and seems to believe that everyone will be honest about their vaccination status. Most store owners, managers of large venues, and other indoor sites will be hesitant to demand proof of vaccination, and it is likely that many people who have not been vaccinated, or are not yet fully vaccinated, will remove their masks. The CDC provides no guidance for enforcing the new mask recommendation.

While COVID-19 vaccines have become far more available in the U.S., there are still many who have had difficulty accessing vaccination due to transportation, convoluted appointment procedures, and inability to wait in long lines. Others, such as those who are immunocompromised, may have been vaccinated but are not as protected as those with robust immune systems. Children under the age of 12 cannot be vaccinated currently, and those who are over the age of 12 but under the age of 18 can only receive the Pfizer vaccine. Because of the difficulty of storing the Pfizer vaccine, some areas only have access to vaccines that do not require being frozen at extremely low temperatures.

In addition some people are still hesitant to be vaccinated with such new vaccines. While the large numbers of people vaccinated so far show that the vaccines appear to be quite safe, many are not ready yet for vaccination. Past inequities and abuses in the American healthcare system have made some more wary than others of claims made by the medical community.

Over 30,000 new COVID infections are diagnosed every day in the U.S., and hundreds of people continue to die every single day. This crisis is far from over.

Throughout the COVID-19 crisis, the CDC has made decisions that are not backed up by science nor adequately protective of workers and public health. If the CDC errs on the side of safety, there may be some unnecessary inconvenience. But when it errs in the opposite direction, the public’s health, and many lives, may be lost. While no one is more excited to return to normal than the nurses that just lived through the worst of this hellish pandemic, the U.S. cannot resort to half-measures and lax protocols that will only prolong the pandemic’s presence in the U.S.