Sanford Health's chief executive told his employees that he will not wear a mask because he is immune from contracting or transmitting COVID-19 since he tested positive, although that assertion is disputed by physicians and researchers.
Wearing a mask "defies its efficacy and purpose" and sends an "untruthful message that I am susceptible to infection or could transmit it," Sanford CEO Kelby Krabbenhoft wrote Thursday to 50,000 employees in an internal memo, as first reported by Forum News Service. But those who study immune response said the evidence of immunity after someone contracts COVID-19 is not definitive.
"I have no interest in using masks as a symbolic gesture when I consider that my actions in support of our family leave zero doubt as to my support of all 50,000 of you. My team and I have a duty to express the truth and facts and reality and not feed the opposite," Krabbenhoft wrote, noting that he is immune for at least seven months, according to "the best information and advice that we have at Sanford and beyond."
Sanford said in a statement that Krabbenhoft's views do not reflect those of the health system.
"Sanford Health's position is the same as it has always been—consistently wearing masks, avoiding crowds and staying home if you're sick are critical to preventing the spread of the virus," Micah Aberson, executive vice president of Sanford, said in prepared remarks. "It is important to follow (Centers for Disease Control and Prevention) guidelines. We continue to be incredibly grateful to our front-line workers who are stepping up every day to take care of our patients."
A group of Sanford executives—including Aberson and excluding Krabbenhoft—wrote in an email to employees Friday that "when it comes to immunity, the science is evolving and we must continue to follow CDC guidelines." They recommended wearing masks whether or not someone had contracted the virus, and that they "regret that (Krabbenhoft's) message left many frustrated and disappointed."
The World Health Organization said there is not enough data to confirm if antibodies protect individuals from contracting the virus again, what antibody levels are required or how long protection will last. Risk of reinfection remains unknown, according to a recent analysis in JAMA of more than 200 healthcare workers' antibodies.
An infectious-disease specialist wrote in JAMA in September that "anecdotal case reports of reinfection mostly after initial mild COVID-19 illness are appearing." An October study published in Lancet seemed to confirm those anecdotes, revealing five reinfection cases globally.
The patient safety organization ECRI reviewed around 28 studies involving immunity, and the data was "inconclusive at best," CEO Dr. Marcus Schabacker told Modern Healthcare, adding that coronaviruses mutate constantly.
"We highly object to a statement like that from Mr. Krabbenhoft, and we are particularly disappointed that a leader of a healthcare organization would make such a statement. It absolutely sends the wrong message," he said. "Even if maybe he is not at risk of being reinfected by this particular strain, he is potentially someone who could infect others."
Wearing masks and distancing greatly reduces transmission rates, Schabacker said, citing a New York Times analysis that found a correlation between states with the fewest containment measures and the highest case counts and hospitalization rates. A recent study published in Health Affairs also found a correlation between state mask decrees and declining COVID-19 cases.
"That tells you what Krabbenhoft is doing is irresponsible," Schabacker said.
South Dakota, where the 46-hospital system is based, has around 70,000 COVID-19 cases, increasing by about 1,000 a day over the past week, according to Johns Hopkins University data. North Dakota cases are trending similarly. Capacity is stretched, particularly when it comes to finding caregivers.
Bob Sutton, CEO of neighboring Sanford competitor Avera Health, said in prepared remarks that he wears a mask because "I care about our employees, my neighbors, friends and family members."
Science supports masking and the CDC has affirmed that wearing masks consistently and correctly can help communities slow the spread of COVID-19, Avera said in a statement.
"Also, masking is a simple act that each of us can do to protect others and it supports our caregivers who are treating COVID-19 daily," the organization said.
Country singer Chris Young was scheduled to perform at the Denny Sanford Premier Center, an indoor arena in Sioux Falls, S.D., in October. But the health system, which was sponsoring the event, and state officials canceled it after backlash about the safety risks. Sanford went forward with the Sanford International golf tournament at Minnehaha Country Club in Sioux Falls in September.
While South Dakota Gov. Kristi Noem hasn't imposed a statewide mask mandate, North Dakota Gov. Doug Burgum recently changed course and enforced a decree.
"I have a lot of respect for Kelby and his organization," said Jeff Goldsmith, founder and president of consultancy Health Futures. "His entire region is on fire, and his care system is overwhelmed with COVID cases. I respectfully disagree with him; regardless of the merits of his position on the science of viral risk, the symbolism is really important. It is part of leadership. His remarks are both arrogant and unhelpful in a lethal fight we are losing."
Mask-wearing has become highly politicized over the course of the pandemic, and Americans with conservative leanings have generally expressed more skepticism about its public health benefits.
Krabbenhoft has made political campaign contributions almost entirely to Republican candidates in recent years. In the 2020 cycle, he gave $1,000 to Sen. Lindsey Graham's (R-S.C.) reelection effort, $1,000 to the South Dakota Republican Party, and $900 to Sen. Mike Rounds (R-S.D.), according to federal filings.
In the 2018 election cycle, Krabbenhoft gave $9,000 to committees affiliated with Sen. John Thune (R-S.D.), $500 to the Republican National Committee, and $4,700 to Rounds. He also gave $7,500 to Democratic former Sen. Heidi Heitkamp from North Dakota, an incumbent who lost her reelection bid. Sanford Health has a presence in North Dakota and its medical center in Fargo opened in July 2017.
Sanford has plans to merge with Intermountain Healthcare, and the combined system would be led by Intermountain CEO Dr. Marc Harrison. Intermountain declined to comment on whether the memo impacts the deal.
"If we want to beat this pandemic, everyone has to minimize their risk of exposure," Schabacker said.
Rachel Cohrs contributed to this report.
