Covid-19 Patients refusing to wear face coverings

We have been asked on a number of occasions if practices can refuse to see patients that will not wear a face covering in a face-to-face consultation.

You cannot refuse to see someone on the basis that they refuse to wear a face covering.

However, there are factors that you can control:

• Everything should be done remotely that can be.
• Patients should be seen at times that minimise exposure and risk for other patients e.g., in waiting rooms.
• Can you see the patient outside?
• Can you socially distance effectively in a room. Is the biggest room available to see these patients?
• Would they accept wearing a scarf if not a mask? Would they accept covering their mouth / nose for the closest part that is needed, with the understanding that the health care professional can step away if the patient needs a break from covering their mouth / nose?
• Can they face in a different direction especially for anything that involves close contact? There is evidence that direct face to face, as in standing opposite each other, is the highest exposure.
• Can you maximise ventilation of the space where they are seen?
• The health care professional wears appropriate PPE for the risk. Do they wear a different level of mask e.g., FFP3 mask correctly fitted?
• Which health care professional they are seen by. Carry out a risk assessment.

Viral exposure seems to depend on ventilation, occupancy, and exposure time - https://www.bmj.com/content/370/bmj.m3223 - this article is an interesting read.