Amid the surge in COVID-19 cases, influenza, and Respiratory Syncytial Virus (RSV) infections, our healthcare systems are facing even more significant challenges with nearly 30,000 hospitalizations and approximately 300 deaths daily due to COVID-19. A forecast from January 8 wastewater data reveals an alarming peak of over two million infections per day with one out of every 23 individuals actively infectious. It is predicted that one in three people in the U.S. will be infected during the peak two months, marking one of the largest epidemic spikes witnessed.
An essential strategy to manage this crisis is the reestablishment of widespread masking. However, hospital responses to this proposition have been diverse. According to a paper published in the New England Journal of Medicine, despite the high prevalence and underappreciation of hospital-acquired infections caused by non-SARS-CoV-2 respiratory viruses, masking in healthcare settings such as hospitals is vital due to the large number of vulnerable patients.
The authors suggest a shift towards more significant masking protocols in periods of high community transmission and particularly when interacting with at-risk patients. Paradoxically, some hospitals, like Massachusetts General Brigham (MGB), have been slow to reestablish masking due to reasons like a preference for the ‘urgency of the normal’ and masking fatigue. MGB even maintains that surgical masks are equally effective as N95 respirators, drawing backlash from experts.
Unfortunately, some hospitals permit patients and visitors to remain unmasked and only require healthcare providers to use masks when deemed clinically necessary. This leniency creates an environment of mistrust for patients vulnerable to airborne-transmitted infections.
These concerns are reinforced by escalating instances of patients avoiding needed medical care due to the risk of acquiring hospital-spread COVID-19 when healthcare staff decline to use masks. A coalition named the ‘People’s CDC’ is rallying for intervention against potential infection-control requirement loosening by CDC-advising Healthcare Infection Control Practices Advisory Committee as such changes could heighten infection risks for susceptible patients.
Interestingly, MGB and various other hospitals require patients using N95 respirators to additionally wear a surgical mask. Contrarily, an Infection Control & Hospital Epidemiology study revealed a drop in mask fit-test passing rates when an additional mask is used, suggesting potential leakage. The CDC cautions against wearing procedure masks with gaps around the sides of the face or nose, extending this warning to surgical masks due to inherent side gaps.
The masking policies adopted by different hospitals are diverse. Some have yet to recommence face masking protocols; others insist on masks during patient encounters in response to the surge in local cases. A proactive approach towards respiratory virus infections led RWJBarnabas Health to initiate a masking policy running from October through March of 2024 underscoring the significant role of masks in preventing respiratory infections.
Taking protective measures also makes sound business sense. Masks make patients feel safer, increasing their comfort levels while in healthcare settings. Being proactive about patient safety, therefore, is a win for both the patients and the healthcare institutions.