Petition: A Call for the Universal Use of Respirators in Healthcare (deadline October 31st)

[Kalliope]

I belive there are several members here who'd like to add their name in support of this letter from scientists and professionals to WHO urging universal use of respirators in healthcare. Everyone who supports this can sign, you don't have to be a professional to add your name.

Description

In an effort to advance global public health through turbulent times, a group of experts from around the globe in medicine, public health, law, industrial hygiene, and other disciplines, met at the Unpolitics Summer 2025 Conference and came together to write a letter out of deep concern — and with sincere hope for change — to the World Health Organization to urge them to change their historical and ongoing position failing to advocate for the use of respirators in healthcare settings.


In the letter, (you can read the letter here) we urge WHO to recommend true respirator use (N95/FFP2-3) in all healthcare settings, rather than ineffective surgical masks (or nothing at all). We think this will save tens of thousands of lives as SARS-CoV-2 continues to circulate and mutate. In the longer term, this is an overdue attempt to change the culture of respiratory protection for healthcare workers and their patients, as surgical masks provide little if any reduction in airborne exposures to infectious aerosols.

If you would like to add your name to the letter before it is sent to the WHO, please submit your information below before Friday, October 31st, 2025. Thank you!

A Call for the Universal Use of Respirators in Healthcare - Add Your Name

In an effort to advance global public health through turbulent times, a group of experts from around the globe in medicine, public health, law, industrial hygiene, and other disciplines, met at the Unpolitics Summer 2025 Conference and came together to write a letter out of deep concern — and...

docs.google.com

 

[Yann04]

Would it help or hurt this if I sign it without any credentials. (Seems like an Open Letter more than a petition).

 

[Kalliope]

Would it help or hurt this if I sign it without any credentials. (Seems like an Open Letter more than a petition).

It would help. They are now asking for anyone and as many as possible to sign.

Sorry if petition was a wrong word. I thought of it as a petition for support of the letter.

ETA: I see how it could be misunderstood and have edited the first post to make it clearer.

 

[Creekside]

Isn't there also a downside to using respirators? I don't know how much one of those respirators will interfere with vision, concentration, etc, but certainly wouldn't want my surgeon to be doing serious work on me while wearing a WWII-style gasmask. I'm sure the new ones are much less handicapping, but probably still more than a surgical mask.

How many patients have died due to infections that would have been prevented by respirators, vs ones that died due to errors made due to the handicaps caused by respirators?

 

[Sasha]

Isn't there also a downside to using respirators? I don't know how much one of those respirators will interfere with vision, concentration, etc, but certainly wouldn't want my surgeon to be doing serious work on me while wearing a WWII-style gasmask. I'm sure the new ones are much less handicapping, but probably still more than a surgical mask.

How many patients have died due to infections that would have been prevented by respirators, vs ones that died due to errors made due to the handicaps caused by respirators?

Ordinary N95 masks seem to be called 'respirators', which confused me because I initially thought of a respirator as essentially a gas-mask. Here's a photo.

 

[Creekside]

The N95 does cause difficulty breathing, so that might interfere with concentrating on surgery.

"It is important to recognize that the optimal way to prevent transmission of microorganisms, such as viruses, is to use a combination of interventions from across the hierarchy of controls, not just PPE alone."

Add to that the variety of circumstances. Some patients are at greater risk from a viral infection than others. If a dangerous virus is common at a place and time, then extra measures are required. If the patient has a robust immune system and there's no dangerous virus going around at that time, why impair the doctors unnecessarily?

I disagree with a blanket regulation on masking. Hospitals are supposed to apply appropriate measures to prevent harmful infections, so let them decide what is appropriate in their specific situation. They have a better understanding of the risks and benefits of specific types of masks than a bunch of random people who are simply told "You might die of surgery if your surgical team isn't wearing the latest super-duper respirator!!!!" and asked to sign a petition.

 

[Yann04]

If the patient has a robust immune system and there's no dangerous virus going around at that time, why impair the doctors unnecessarily?

Because a seemigly mild infection can be the difference between a life of health or severe disability.
Plus hospitals tend to be a place for an abundance of vulnerable people so it’s the number one place transmission should be kept to 0.

 

[Creekside]

Because a seemigly mild infection can be the difference between a life of health or severe disability.

It's a matter of numbers. You probably can't reduce it to 0.00000%. Also, the countermeasures, whether it's respirators or intense UV illumination or whatever, likely has a non-zero chance of harm. The countermeasures also have a dollar cost, which means less money available for other important purposes. You could probably spend the health care system's entire budget lowering the chance of an unwanted infection from 1/10000 to 1/1000000--which is still non-zero. Requiring expensive masks in situations where there's little chance of spreading an infection means less money available for better countermeasures in situations where there's a much greater chance.

For all I know, the fancy respirators would only prevent a small percentage of patient infections, which are caused by other methods of transmission (opening a door).

I wonder whether a small static charge on a mask, perhaps with an opposite charge on the clothing beneath the face, would reduce microdroplet transfer to the patient. Oooh, or a similar charge on the patient, to repel the microdroplets. Darn, now I can't patent that!

 

[Hutan]

Hospitals are supposed to apply appropriate measures to prevent harmful infections, so let them decide what is appropriate in their specific situation. They have a better understanding of the risks and benefits of specific types of masks than a bunch of random people who are simply told "You might die of surgery if your surgical team isn't wearing the latest super-duper respirator!!!!" and asked to sign a petition.

I'm not a super strong proponent of masking and think that there are other things that need to be done like good ventilation systems. And I acknowledge that there are tradeoffs between the cost of PPI and the provision of other health promoting goods and services, especially in highly resource constrained facilities, but

1. No one is proposing saying 'you might die if your surgical team isn't wearing the latest super-duper respirator'. The N95 isn't high tech. The message from staff might be 'we wear these to protect ourselves and to protect vulnerable people in our care'.

2. Hospital administrators often aren't very good at weighing the risks or training staff.

Here's an anecdote from when I took my delirious elderly relative to hospital, and supported her for two weeks there a couple of months ago. This is a hospital in the main city of a first world country. In the emergency department, we scarcely saw a nurse in the many hours we were there. I helped my relative with toileting as she had a bladder infection. I didn't use gloves. The toilet was not cleaned in the time we were using it. Bedding was soaked in urine. The orderly who changed the bedding did not wear an apron.

The next day, my relative was transferred to an assessment unit. This is essentially an extension of the emergency department which enables the hospital to claim adequate ED clearance rates despite the wards being full. The assessment unit is completely inadequately resourced. People were stacked up in the corridors. Many people were coughing.

I noticed a sign on the curtain around my relative's bed, telling staff to take extra care with hygiene, I.e wear a gown or apron, wear gloves and wash hands. It took me two hours of asking why the sign was there to get an answer; no one wanted to tell me.

Eventually, I was told that my relative had been found, on a previous hospitalisation, to have an antibiotic resistant bacteria in her gut - probably acquired during that hospital stay. Given her symptoms, it was quite likely that the bacteria could be transmitted in urine. When I mentioned this to the doctor and said that staff were often not following the precautions and that I hadn't been, he said 'it's no big deal, we probably all have the bacteria and we are fine'.

A man in the bed next to my relative was constantly coughing and didn't seem to be mentally well, he kept on calling out for his mother. Few staff wore masks. Some doctors came to the man in the bed across from my relative, drawing the curtains around him to tell him loudly that he had stage 4 cancer. All of those patients were using the same toilet, which was often soiled.

In the following two weeks I noted that sometimes the hygiene alert sign would be on my relative's bed and sometimes it wasn't. When she got to a ward she initially had a one bed room with the hygiene alert sign on the door. When we left the room to take my relative to a toilet, we were told off and instructed to return to the room. A little while later that same day, my relative was moved to a group ward with no sign on the curtain and no restrictions on movement, so that an elderly patient who looked very unwell indeed could be moved into the single bed room. When I asked about the absence of the hygiene alert sign, I was told the 'situation had been de-escalated'. The sign was back another day.

I would take my relative to a toilet used by people from multiple wards and, because she had been given a laxative, the cubicle would end up soiled. Once I alerted a nurse and yet hours later the cubicle was still soiled. I asked a cleaner what she knew about the hygiene alert sign and she looked confused and said that she thought it was 'something to do with poo' (when actually urine can spread the bacteria). People dealing with soiled bedding and clothing routinely did not wear aprons. No one gave me any instruction in hygiene management or self-protection even though, due to staff shortages I was helping my relative a lot.

It looks to me as though hospitals are a major vector of antibiotic resistant bacteria, creating a problem for future health care that is difficult to overstate in its magnitude.

I could go on and of course that is an example of a contact contamination issue, not an aerosol, but hopefully you can see @Creekside, that actual practice in terms of staff making good decisions about infection control and there being good communication with everyone who needs information can easily be a long way short of ideal. Staff in the front line are likely to downplay risks and administrators tend to want to save money.

The only time another relative has had Covid-19 was when he acquired it in hospital while recovering from brain surgery (he also subsequently developed scabies).

Anyone who thinks current practice in infection control is fine and hospital administrators with discretion can be relied on to make good decisions about when masking should happen should go sit in an ED or a busy ward for a day.

 

[Kalliope]

oh my @Hutan
And I thought tapping with ungloved and unwashed finger on the skin before inserting a needle (which happens more often than not) was bad..

 

[Hutan]

I think the letter is very good. It notes that objections such as the idea that these more effective masks have significant problems with breathability e.g. CO2 buildup are unfounded.

 

[Creekside]

Here's an anecdote from when I took my delirious elderly relative to hospital,

Given that hospital's hygiene practices, what would the result of a government "recommendation" for N95 masks to be worn at all times? If it's not enforced, it won't be followed. If it is enforced and not supported by additional funding, hygiene might be cut further in other areas.

I'm not against guidelines, or education about the risks of not using appropriate hygiene measures; I'm against expecting changes due to a simple letter to a government, signed by a bunch of people who are not experts in the matter. I think a properly done study showing overall healthcare costs with or without a given measure would more likely affect decisions in hospitals. If requiring those respirators to be worn during surgeries would lead to an estimated $3 million/yr savings for a hospital, I expect the administrators would act on that.

 

[Hutan]

Given that hospital's hygiene practices, what would the result of a government "recommendation" for N95 masks to be worn at all times? If it's not enforced, it won't be followed. If it is enforced and not supported by additional funding, hygiene might be cut further in other areas.

That's like saying that there shouldn't be legislation requiring seatbelts to be worn because it is useless without an education program and a culture change and it might result in car manufacturers cutting corners on anti-skid braking systems.

I think a properly done study showing overall healthcare costs with or without a given measure would more likely affect decisions in hospitals. If requiring those respirators to be worn during surgeries would lead to an estimated $3 million/yr savings for a hospital, I expect the administrators would act on that.

We actually do have studies already:
We know that contagious pathogens are spread through the air. We know that well fitted N95 masks are very effective in stopping the transmission of pathogens in aerosols. We know that the common masks are better than nothing but not nearly as good. If you are going to spend money on masks at all, why not make them effective ones?

As an analogy, why put up with a situation where seat belts are way less strong than they could easily be and legislation that leaves it up to people whether they wear them or not? The reason most governments don't do that is that effective seat belts reduce injury and death with little cost to the wearer, and that saves societies (not just the seatbelt wearer) money.


There needs to be a change in health to thinking longer term about costs and benefits across the board. Stopping hospitals being massive vectors of antibiotic resistant bacteria has long term benefits to society, just as stopping them being mega spreaders of airborne pathogens is.
But it's okay to push for an improvement on one thing without having to fix all the other problems at the same time.

 

[Kitty]

That's like saying that there shouldn't be legislation requiring seatbelts to be worn because it is useless without an education program and a culture change

But it did need an education programme and a culture change. Same when motorcycle crash helmets were made mandatory.

Culture change is more effective than legislation because people do the policing themselves. I bought a secondhand car when I passed my driving test, and it came with a sticker on the back of the driver's seat saying "No seatbelt = no lift". Enough people still thought it should be their choice whether or not they wore a seatbelt in the back that I decided to leave it.

Outside special areas (ICU, HDU, cancer wards, very sick children), it seems impractical to ask all staff to wear N95 masks all the time. It would cost a staggering amount, and apart from the sheer discomfort, staff can't see facial expressions or hear speech clearly. Communication barriers aren't without risk, and it's especially hard for hearing impaired people or those with English as an additional language.

There'd also be a risk of significant ancillary staff losses, which would be disastrous in the UK—we can't find nearly enough of them as it is. Ward assistants, housekeepers, porters, catering staff, etc., could all earn the same low wage elsewhere without having to deal with the acute discomfort of working hard eight-hour shifts in overheated buildings wearing close fitting face masks.

It's not necessarily impractical for patients to wear them if they want to, provided they're conscious and not having breathing difficulties (in which case staff giving close care did ought to wear them). The only arguments against patients being provided with masks are probably financial, and they're much weaker than those against making staff wear them.

Masks are provided in the outpatient clinics of hospitals where I live, but they're the surgical type rather than N95s. I've never seen anyone wearing one, but at least they're offered the choice. They might think differently if they were ill enough to be inpatients too.

 

[Creekside]

staff can't see facial expressions or hear speech clearly.

Two significant issues I hadn't thought of. Hard to calculate the psychological costs to patients by covering faces. For a greatly exaggerated example, imagine how you'd feel as a patient if all the staff wore WWII gasmasks. Definitely hard to hear what they'd be saying. Do masks for pediatric staff have cartoon figures on them, or other such means of making them seem less scary?

I don't know how inconvenient the N95s are to wear, but there's probably a non-zero effect on willingness to work in that career.

 

[Creekside]

We know that well fitted N95 masks are very effective in stopping the transmission of pathogens in aerosols.

Sure, and you can drop it to nearly zero ... at ridiculous cost. What I was suggesting was a study with the intended audience of hospital administrators, showing the overall effect on the annual budget of requiring masks for specific tasks (or requiring aprons for toilet-cleaning). We don't need another study showing that a more expensive option reduces infection rate; we need ones that show that it's in the hospitals best interests to choose an option.

Handwashing for surgeons was a hard sell at one time, but having more patients survive proved to be good for future income. Self-interest is more effective at changing practices than threats of punishment. If requiring staff to wear N95s will save hospitals lots of money (clearly shown in dollars by studies), it will happen even without legislation. If it's required by legislation and not proven to be cost-effective, self-interest will lead to looking for ways to cut corners.

 

[Kitty]

Two significant issues I hadn't thought of. Hard to calculate the psychological costs to patients by covering faces.

It's not only that, you end up with the situation we faced in the early stages of the pandemic. Elderly relatives, who couldn't cope with wearing masks themselves, were unable to hear what healthcare professionals were saying even through simple surgical masks. The HCPs were obliged to wear them, so there either had to be an interpreter present who wasn't masked, or the consultations had to take place publicly in the open air. If it hadn't been such an awful time it would have been funny.

I don't know how inconvenient the N95s are to wear

If you do a job where you tend get warm, they're constantly damp with breath condensate. When they have to be worn every day, some folk develop sore, unsightly skin rashes. It doesn't affect everyone, of course, but it's not much fun if you're one of the unlucky ones.

They're just uncomfortable, and some people never really resolve the issue of glasses steaming up. I wanted to use high quality filtering masks so I tried every mask brand and every internet tip I could find, but my face just seems to be the wrong shape. The only workable solution was to do without glasses and put a magnifier in my wheelchair bag in case I needed to read anything. I've never known so many people in supermarkets ask each other if they could see the price mark on the shelf, presumably because they had the same problem.

 

[Hutan]

Yes, and another issue is that deaf people (and even people like me whose hearing isn't wonderful) struggle to know what someone is saying if their mouth is covered. And another issue is how people with facial hair get a good seal. For sure, there are real problems.

But, similar arguments could be made about problems with an expectation of regular handwashing (skin can crack, dermatitis), or of wearing gloves (allergies). If people can see that there is value in the practice, ways around the problems can usually be found. And masks are always only part of a collection of efforts needed to improve infection control.

As I said to start with and despite my arguments above, I'm not a mask fanatic. I regularly travel on planes unmasked. But I think there is a lot of inconsistency and ineffectiveness in infection control in health care settings.

If all this petition does is raise the profile of the problem and increases the pressure on governments to think harder about what is done and yes, as Creekside suggests, fund some soundly designed studies, well, that will be something good.

 

[Sean]

and apart from the sheer discomfort,

You make some fair points in your comment, but this one is not a big issue anymore as evolving mask design has largely got around that, for general purpose N95/P2 standard at least.

I use a brand of N95/P2 standard called Halyard Fluidshield 3 that are very comfortable and can be worn all day without any real discomfort. Highly recommend them. Men will probably need to shave at least every couple of days to get a decent seal though.

As to the glasses fogging up problem, there is not much that can be done about that without blocking off air flow through the top 1/3 or so of the mask, as exhaled air is warm and will rise regardless of whether it leaks out under the seal or passes through the filter material. Which, incidentally, is why using glasses fogging up as a sign of a poor seal is not actually a reliable indicator. Even well sealed masks will do that.

 

[Midnattsol]

On masks being scary: I wear masks around children, and none have acted scared. The same with a friend of mine (who wears it when picking up her own child from childcare, I don't do pick-ups at the moment). My son, wanting to do the same as we do, also points to masks and asks to wear one, he doesn't seem particularly bothered by it. It's standard equipment when we go biking in the city: helmet and masks. I see no reason why he should breathe in exhaust fumes and other pollution found close to the ground where he is located. Adults seem more scared than the piece of fabric than children do.

Comparing an ffp2/N95 to a gas mask is not a fair comparison. As @Sean Ive found masks that I find comfortable for all-day wear. I can understand this is not the case for all though.

Having looked at sickleave statistics, at least in Norway where sickleave is paid 100% the first year and "travelling nurses/doctors" are a lot pricier than keeping your regular staff healthy and able to work, I can't see masks being prohibitily expensive. Although I would rather have better ventilation, far-UVC lights etc. for lower risk situations than requiring everyone to wear masks.