The COVID-19 Public Health Emergency expired in May of 2023. That meant that universal masking in healthcare facilities was not tied to guidance from the Centers for Disease Control and Prevention (CDC) but would be determined by risk-based assessments of health care systems, stakeholder input and local metrics (AHA, 2023).

Recently, here in the northeast US, spikes in respiratory illnesses including COVID-19, influenza, and respiratory syncytial virus (RSV), have prompted the reinstitution of masking requirements for many healthcare settings. I decided to take a deeper look at what the evidence shows and recommendations on masking to prevent transmission of these respiratory illnesses, outside of a pandemic or public health emergency.

The research on masking

There is a lack of clinical trials related to masking, however, it is argued that masking during clinical interactions between patients and healthcare workers should be considered a patient safety measure. Laboratory studies have demonstrated that surgical masks and respirators limit the spread of aerosols and droplets from individuals infected with influenza, coronaviruses, and other respiratory viruses (Leung et al., 2020) and substantially reduce the amount of virus expelled when coughing or talking (Adenaiye et al., 2022).

Presenteeism

One thing to consider is presenteeism, which is when healthcare workers work while ill. Reasons for this can include an unwillingness to place burdens on colleagues, feeling that some respiratory infections may be trivial, a fear of punishment for missing work, a moral obligation to care for patients, or a lack of paid sick leave (Palmore & Henderson, 2023).

Researchers at the NIH Clinical Center studied presenteeism during the pandemic via contact tracing interviews and found that among staff who chose an asymptomatic rather than a symptomatic testing pathway and tested positive, more than 50% acknowledged having had some symptoms of COVID-19 at the time of testing (Palmore & Henderson, 2023).

Guidance from the World Health Organization (WHO)

The WHO makes the following recommendations (WHO, 2023):

• If COVID-19 is widely circulating and impacting the health system, visitors, healthcare workers, and caregivers should wear a well-fitting surgical mask in all common areas and when caring for non-COVID-19 patients.
• Those caring for COVID-19 patients should wear a respirator or a surgical mask.

What’s happening in your area?

The CDC has a handy tool to view the transmission of respiratory illness in your area. Simply input your state and county to view the illness activity and trends of COVID-19, influenza, and RSV based on healthcare visits and visits to emergency departments.

References:
Adenaiye, O. O., Lai, J., Bueno de Mesquita, P. J., Hong, F., Youssefi, S., German, J., Tai, S. H. S., Albert, B., Schanz, M., Weston, S., Hang, J., Fung, C., Chung, H. K., Coleman, K. K., Sapoval, N., Treangen, T., Berry, I. M., Mullins, K., Frieman, M., Ma, T., … Milton, D. K. (2022). Infectious Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in Exhaled Aerosols and Efficacy of Masks During Early Mild Infection. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America, 75(1), e241–e248. https://doi.org/10.1093/cid/ciab797

American Hospital Association (AHA). (2023, May 10). CDC updates masking guidelines for health care facilities. https://www.aha.org/news/headline/2023-05-10-cdc-updates-masking-guidelines-health-care-facilities

Leung, N. H. L., Chu, D. K. W., Shiu, E. Y. C., Chan, K. H., McDevitt, J. J., Hau, B. J. P., Yen, H. L., Li, Y., Ip, D. K. M., Peiris, J. S. M., Seto, W. H., Leung, G. M., Milton, D. K., & Cowling, B. J. (2020). Respiratory virus shedding in exhaled breath and efficacy of face masks. Nature medicine, 26(5), 676–680. https://doi.org/10.1038/s41591-020-0843-2

Palmore, T. N., & Henderson, D. K. (2023). For Patient Safety, It Is Not Time to Take Off Masks in Health Care Settings. Annals of internal medicine, 176(6), 862–863. https://doi.org/10.7326/M23-1190

World Health Organization (WHO). (2023, October 10). Coronavirus disease (COVID-19): Masks. https://www.who.int/news-room/questions-and-answers/item/coronavirus-disease-covid-19-masks

 

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