As the biggest hospital system in Arizona rations masks for doctors and nurses, its executives are now telling staff that they can instead wear "social comfort masks" so that they "feel comfortable as they care for their patients."

Banner Health "does not endorse" those masks as preventing the transmission of diseases like COVID-19, Dr. Marjorie Bessel, the company's chief clinical officer, told staff Monday morning in an email, which was obtained by Phoenix New Times.

The term "social comfort mask" is a new one. Doctors and nurses don't know it. The Centers for Disease Control and Prevention has nothing on the term.

CDC

Banner has explicitly told staff that they cannot wear medical face masks and N95 respirators except under highly limited circumstances, as New Times previously reported.

Now, the nonprofit hospital system's suggestion that front-line staff can begin "social comfort masking" that provides little-to-no protection during an unprecedented global pandemic comes as other hospitals elsewhere in the country implement requirements like "universal masking."

UMass Memorial Health Care, for example, told staff that starting Tuesday morning, they had to wear hospital-supplied face masks whenever they entered a facility. UMass Memorial Health Care has 13,000 employees across its hospitals in Massachusetts, where more than 1,100 people have tested positive for the virus and nine people have died.

"Never heard this term ever," said a doctor who works at Banner of the phrase "social comfort mask." The doctor, speaking to New Times on condition of anonymity, called Bessel's email "highly insensitive" and suggested that "Banner thinks staff is expendable."

As of Tuesday, 326 people in Arizona have tested positive for the new coronavirus, but the true number is likely far higher, as testing remains limited and difficult to obtain. Five people have died from the virus in Arizona.

Banner's definition of "social comfort mask" is that it must be self-supplied, cannot be a mask provided by Banner Health, and must look "substantially different" from the masks that Banner provides. It can be home-sewn, but scarves and bandannas don't count, according to Bessel's email.

Nurses and doctors are still required to follow Banner's protocol for wearing personal protective equipment, which lays out specific circumstances when they can wear masks and other PPE, as Bessel reminded them in her email.

"Social comfort masks may not be worn in isolation or procedure rooms; in those rooms Banner approved PPE will be provided and must always be used," she wrote.

This is what a "social comfort mask" can look like at Banner Hospital. Banner Health

Shortages of personal protective equipment are a national phenomenon. A month ago, the CDC warned that demand for N95 respirators and face masks was up tenfold and that gaps in supply "may be anticipated to continue for the next 3-4 months."

In an acknowledgement of these shortfalls, the CDC's website has a page euphemistically titled "Strategies for Optimizing the Supply of PPE," which lays out mask usage guidelines that escalate in stringency in accordance with shortage severity.

There's "conventional capacity," which is when there are no shortages, then "contingency," and then "crisis," the most extreme.

Banner's mask restrictions appear to align with "crisis" mode.

When shortages of masks have reached crisis capacity, the CDC says, "Cancel all elective and non-urgent procedures and appointments for which a facemask is typically used by [a health care provider]."

"Use facemasks beyond the manufacturer-designated shelf life," "implement limited re-use of facemasks," and "prioritize facemasks for selected activities," it adds.

Those "selected" activities include "prolonged face-to-face or close contacted" with a potentially infectious patient, and "performing aerosol generating procedures."

When no face masks are available, the CDC, health care providers "might use" homemade masks like a bandanna or a scarf, but those are not considered personal protective equipment, "since their capability to protect ... is unknown."

"We don’t have an endless supply of nurses. You gotta take care of the ones you have.” - Banner nurse Facebook

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As of last week, Banner's internal directives to its health care workers told them to disinfect and reuse certain equipment, including masks and goggles. Those workers are also barred from wearing personal protective equipment in hallways, as New Times reported last week.

The directives also said N95 masks, which fit snugly over a person's nose and mouth, should be worn only in airborne isolation rooms or when doing certain procedures on people confirmed or suspected to have COVID-19.

The hospital's restrictions on masks has left health care workers fearful.

“My coworkers are scared," said one nurse at a Banner hospital, who also spoke on condition of anonymity out of fear of retribution from administrators. "Nobody can really say anything. A lot of them are like, 'I have to work; I have to have this job.'"

"I know there’s a PPE shortage," added the nurse, who said she has underlying health conditions but was explicitly told by superiors that she could not wear a mask, even her own.

But, she said, "we don’t have an endless supply of nurses. You gotta take care of the ones you have.”

In her email Monday, Bessel told staff that Banner does have enough personal protective equipment, even as she indicated that it was trying to limit usage.

The hospital was working "to ensure the adequate use and conservation of Banner provided PPE so we can take care of our patients, and one another, for the long term," she wrote. "We are offering social comfort masking because we recognize it will allow some team members to feel more comfortable in the workplace."

In her email, Bessel promised that "the health, safety and well-being of our team members is of paramount importance during the COVID-19 pandemic" and that "we will continue to do our part to ensure you feel protected and valued."

A spokesperson for Banner did not respond to a voicemail, email, or text message from New Times seeking comment for this story.