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Patients and visitors arriving at Concord Hospital masked up and ready to go were caught off-guard when staff told them their cloth masks were no longer adequate and they would have to wear hospital-provided blue paper procedure masks instead.

The policy change, which went into effect earlier this month, brings Concord Hospital in line with other New Hampshire hospitals where cloth masks are being banned, in favor of disposable, medical-grade masks.

Jenn Dearborn with Concord Hospital’s public affairs department said the change reflects the fact that more personal protective equipment, like masks and gowns, are now available for use which makes it easier for hospitals to offer the masks. It’s also an acknowledgment that disposable masks offer better protection against COVID-19 than cloth masks.

“PPE supplies of masks are now at a level where we can provide all patients wearing a cloth mask a procedure mask. Procedure masks are more effective at protecting against COVID-19 when compared to cloth masks,” Dearborn said. “We are making this change because we can now safely supply patients with a procedure mask and still have an adequate supply for the hospital and practices.”

Cloth masks are currently the norm in most settings, most notably public schools where a debate over their efficacy is currently raging. On Friday, administrators at Deerfield Community School banished unmasked children to the gymnasium after the school board suddenly imposed a mask mandate with little notice. On Monday, they began turning unmasked children away.

Concord Hospital isn’t the only hospital requiring procedure masks. Lauren Collin-Cline, director of communications at Catholic Medical Center, said the Manchester hospital now requires people to wear either a paper procedure mask, or a KN-95, or N-95-type mask.

“The reason for this is consistency in filtration,” she said. “Cloth masks vary widely in materials, layers, and fit around the nose and we don’t know what level of protection they offer. In the healthcare setting, we need to be confident in the level of protection people have given the current level of transmission in the community.”

Collins-Cline said the hospital did allow for cloth masks in the summer when the virus levels were going down. But that changed as cases have gone up and the delta variant is rampant. 

“We have always had a mask requirement. Earlier in the summer, we did relax to allow cloth masks but went back to procedural and higher when the positivity rate began to climb back up,” she said.

Adam Bagni, director of communications and community relations at Wentworth-Douglass Hospital in Dover, said the use of facility-provided masks has been required throughout the pandemic at their facility.

“This is to ensure the quality and cleanliness of every mask in our facilities. We carefully select and assess the masks that we provide to staff, patients, and visitors, for traits like performance, layering, and breathability. We issue a new mask each day, or visit, to ensure they are both sanitary and effective,” he said.

Martha Wassell, director of infection prevention at Wentworth-Douglass, said that in order for a cloth mask to be effective in curbing the spread of COVID-19, it must be double-layered, comfortable, fit snugly, and easy to breathe through.

While cloth masks are fine for general settings, like the grocery store, medical masks should be used in hospitals and health clinics, Wassell said.

“Medical-grade masks are typically prioritized for healthcare settings,” she said.

The debate over masks and mandates began almost as soon as the COVID-19 pandemic started, in part because public health officials told the general public — falsely, it turned out — that masks were unnecessary.

“There’s no reason to be walking around with a mask,” Dr. Anthony Fauci said during a 60 Minutes interview on March 8, 2020. “When you’re in the middle of an outbreak, wearing a mask might make people feel a little bit better and it might even block a droplet, but it’s not providing the perfect protection that people think that it is. And, often, there are unintended consequences — people keep fiddling with the mask and they keep touching their face.”

Fauci now acknowledges he wasn’t telling the truth, out of concern there wouldn’t be enough masks for health care workers.

Beginning with the outbreak of COVID-19 at a nursing home in Kirkland, Washington, policymakers were on notice as to the contagiousness, and lethality, of the virus in a congregate care setting with residents who are medically fragile.

The nursing home resident population is very elderly, with 41.6 percent of all residents 85-or-older according to the most recent federal data. New Hampshire is one of 10 states where more than 10 percent of nursing home residents are 95-or-older. Prior to the pandemic, I traveled around to my state’s nursing homes to interview centenarians.

One of the disturbing findings in Washington was reported in the New England Journal of Medicine: “More than half of residents with positive test results were asymptomatic at the time of testing and most likely contributed to transmission.” The stealthy nature of COVID-19 made it immune to the infection control procedures of nursing homes that had been so successful in the past against contagions such as the respiratory flu or the norovirus.

What was known about COVID-19 makes it inexcusable that some policymakers, including the governors of New Jersey and New York, insisted on bringing it into nursing homes, by forcing facilities to take COVID-positive hospital discharges, even as a state like Louisiana barred facilities from admitting hospital discharges positive with COVID-19.

Health experts warned against the consequences, beginning with a March 26 article in the Wall Street Journal. But it was clear nursing homes were to be sacrificed to free up hospital capacity.

While New York Gov. Andrew Cuomo in April described the nursing home setting as a “feeding frenzy for this virus,” that did not cause him to change his administration’s policy of continuing to feed the virus new victims. It was only in May that Cuomo finally rescinded the policy, a point at which the worst was past for New York’s hospitals — but unimaginable horrors had occurred in the state’s nursing homes.

It was reported by the Wall Street Journal on May 14 that “[d]espite the homes’ elderly, frail populations, the state long put its major focus on the safety, staffing and supplies of hospitals, according to researchers, consumer groups and nursing-home executives.”

And, typically, Cuomo did not apologize for the tragedy his administration had created.

Instead, as the New York Post editorialized, Cuomo “ordered an investigation that’s plainly supposed to pin all the blame on nursing and adult-care facilities: It’s led by state Attorney General Tish James, who got her job with Cuomo’s crucial assistance — and it’s only looking at what homes did wrong.”

In March, the Medicare Payment Advisory Commission’s annual report to Congress had found that the nursing home sector operated at a loss in 2018 for the first time since 2000. Now Cuomo, who has actively worked to cut nursing home funding, is ordering nursing homes to pay for a twice-weekly testing regime — an unfunded mandate with new costs that reportedly might be as high as $60 million a week for the beleaguered sector.

Cuomo may yet succeed in decimating the safety net for New York’s most vulnerable citizens.  It is small wonder that nursing homes, and their heroic staff members, feel abandoned amidst this pandemic.