SCOOP: White House Suppressed VA Guidance Encouraging Mask-Wearing

Jasper Craven and Suzanne Gordon
Sep 11 2020

The coronavirus pandemic, unlike many other health emergencies, has created dual physical and mental health crises. These threats are particularly acute for military veterans who, on the whole, are older, sicker and poorer than civilian patients. They also disproportionately suffer from mental afflictions that can flare up under stress. In short, their risk of suffering and death these days is particularly high.

As such, masks are an especially critical tool for veterans, and are required to be worn by all patients receiving care inside the Veterans Health Administration (VHA), the largest healthcare system in the country. Like many Americans, veterans have expressed complex and sometimes ambivalent feelings about masks. A tragic illustration of these views comes in the story of Richard Rose III, an Ohio Army veteran who died from COVID-19 in late July after going viral online for refusing to wear one.

Some veterans with mental health conditions have also felt uncomfortable wearing masks or unsettled when confronted by VHA staff with covered faces. “A lot of veterans with PTSD couldn’t see other people’s faces, which made some feel unsafe,” a VHA clinical psychologist told us. “Others thought they were suffocating in the masks, or that it was impeding their communication.”

In May, a Marine Corps veteran in Michigan explained to his local TV station that his unique struggles around masks stemmed from his service during Operation Iraqi Freedom:

I’ve been diagnosed with PTSD from my time served in an imminent danger zone. Because of what I’ve experienced, I am unable to wear a mask without experiencing reoccurring flashbacks to wearing a gas mask with ordinance exploding around me. Due to the recent events of requiring people to wear masks, again which I support, I have had a flood of unpleasant memories come back that I prefer not to deal with.

In response to these pressing issues, VHA clinicians began reaching out in the spring to the Department of Veterans Affairs’ National Center for PTSD seeking standardized messaging that could be used nationwide to help veterans feel more comfortable wearing masks.

As the pandemic has raged on, this Center has developed a number of helpful guides for managing stress, PTSD, and loss during this prolonged crisis. The’ve also created a calming phone application called “COVID Coach” that’s available to all.

In response to mask concerns, the Center drafted two sets of guidelines – one for providers and one for veterans. These recommendations, which we reviewed, were simple and straightforward. Here’s an excerpt:

Wearing face coverings like masks, bandanas, or scarves over your nose and mouth will help stop the spread of the virus that causes COVID-19. The recommendation to wear face coverings in order to prevent the spread of COVID-19 might last a long time. If you find it difficult to wear a face covering, becoming more comfortable with this new routine is more important than ever.

Helpful suggestions included gradually increasing mask wearing over time and mobilizing “meaningful and reassuring thoughts to help with any difficulty wearing your face covering.”

These guidelines were drafted not only to keep vets safe but also to ensure that they didn’t stop coming to their local medical facilities for care due to discomfort around masks. The guidance was also seen as potentially helpful in allowing veterans to continue with daily routines in places where masks are required. This sense of normalcy, clinical professionals reasoned, could mitigate isolation and depression.

Yet these simple suggestions flew in the face of President Donald Trump’santi-mask orthodoxy, so they were squashed.

For weeks, the White House slow-walked approval of the guidelines despite support from virtually all clinical leaders inside the VHA. By mid June, numerous officials were becoming frustrated that approval for the public release of these guidelines had been “stalled” by the White House’sOffice of Management and Budget (OMB). In a June 15 e-mail, a VHA official inside the department’s COVID-19 Command Center suggested that the White House’s stonewalling amounted to “withholding guidance that could help our staff deal with difficult situations.”

This official then asked if the guidelines could be approved only for internal use. Yet even this compromise measure was shot down by OMB officials, who, after reviewing proposed language, said it “cannot go out as-is.”

The following weeks were marked by confusing and conflicting messages. On August 11, the guidance went out internally to VA hospital directors, with mental health professionals offering supplemental services to any staff in need. Yet this guidance was almost immediately rescinded.

The guidelines were also posted publicly online by the PTSD Center following informal indications of approval. But then, last Friday, an email came down to VA employees involved in the guidance with the subject line: “Difficulty with Masks.” The short message made clear that the mask guidance again needed to be “rescinded.” And so it was. Today, this critical but totally uncontroversial guidance no longer sits on the VA’s COVID mental health page and cannot be otherwise distributed to veterans or clinicians inside or outside the VA.

The incident, which we confirmed through internal documents and three knowledgeable sources, is illustrative of the Trump administration’s broader posture during this pandemic, when science and clinical care take a backseat to political posturing. In the case of the VA, the months-long battle over this guidance has, in essence, discouraged vets from wearing masks, which one senior VA official called “flat-out wrong.” A VA spokesperson did not respond to written questions submitted by Battle Borne.

The brouhaha over the VA’s mask guidance is just the latest in the administration’s inconsistent messaging on masks since COVID-19 landed on American shores.

According to two knowledgeable VA sources, senior clinical leadership — in particular Dr. Richard Stone, the VHA’s Executive in Charge — have long been supportive of efforts to encourage mask-wearing. Yet Stone and others have faced roadblocks in this work. It wasn’t until late July, for instance, that Stone launched a PR campaign — #IWearAMaskFor — that encouraged veterans to lead their communities in compliance. This and other logjams came, as one source noted, because “federal content related to COVID-19 needs to be cleared through the White House, which has shown ambivalence on clearing any mask-related content.”

VA Secretary Robert Wilkie, a Trump loyalist, has worn masks in virtually every VA site visit he’s made since the pandemic began. Yet during a May ceremony at Washington’s World War II memorial, Wilkie, along with President Trump and Defense Secretary Mark Esper, didn’t wear masks even as their veteran honorees ranged in age from ninety-six to a hundred. “We need the president and his closest aides to immediately start modeling CDC guidelines and behavior that keeps veterans and elderly Americans safe, because what they’re doing right now is going to get people killed,” Kristofer Goldsmith, a respected veterans advocate, said to the Washington Post, which covered the event. In August, U.S. Sen. Bill Cassidy, a Louisiana Republican, was diagnosed with COVID-19 mere days after conducting an event at his local VA facility. (In a video from the visit, Cassidy is wearing a mask, though it doesn’t consistently cover his nose.)

The VA suffered the same sorts of shortages of Personal Protective Equipment (PPE) as other private healthcare networks. Yet there were a number of uniquely puzzling VA moves on mask policy. First, the VA contracted with Trump buddy Mike Lindell, owner of the MyPillow company, even though Lindell admitted to POLITICO that he would have to subcontract out the work as his facilities could only make cloth, not KN95 masks. The VA also contracted with Robert Stewart Jr., a disreputable dealer who let a ProPublica reporter accompany him on his private jet as he searched the country haphazardly to make good on a $34.5 million VA contract to obtain six million N-95 masks. (The VA canceled Stewart’s contract after ProPublica went to the agency with the story.)

ProPublica also reported that VA employees in a New Mexico facility were, for a time, counseled against wearing masks in apparent violation of guidelines from the Centers for Disease Control (CDC).

It’s unclear exactly what frustrated the Trump administration about the VA’s critical mask-wearing documents. Perhaps it was their assertion that masks are crucial to protect veteran health. Or maybe it was the simple statement that “wearing face coverings to prevent the spread of COVID-19 might last a long time.” This public acknowledgment of the pandemic’s prolonged nature and serious dangers contradicts everything President Trump has been publicly saying about it.

One mental health clinician who has worked at the VA for decades told us that politics have long been tangled up in the VA, but made clear that this mask kerfuffle represented dangerous new step:

Most of us who work in the VA have learned that we are continually the subject of political disagreement and influence and have come to terms with that. It’s part of the tax we pay to work in this system and pay our debt to veterans who entrust us with their healthcare. We get many mandates from Congress and whatever administration is in office. We meet those mandates and continue to provide healthcare.

This is the first time in my long VA career that political issues have interfered with direct clinical care. That’s unacceptable.