The Comeback of Masking Policies in Healthcare
January 19th 2024
Masking is making a comeback in healthcare facilities across the globe to protect patients and healthcare workers and contain the spread of infectious airborne diseases, including COVID-19, flu, and RSV. This includes individual hospitals and health systems [1], as well as recommendations or requirements for counties, states, and countries [2].
Many hospitals and healthcare systems have universal masking—requiring staff, visitors, and patients to wear masks in all areas—because infections can happen anywhere, and two-way masking is much better than one-way [3]. This includes Robert Wood Johnson Barnabas Health (14 hospitals) [4], UPMC (over 30 hospitals) [5], Marin [6] and Santa Clara Counties (9 hospitals) [7], and the country of Spain (750 hospitals) [8], while masks are recommended everywhere indoors in Greece [9]. Facilities with universal masking are safer than those requiring them only in “clinical areas”, or just for healthcare workers, since the virus spreads like smoke [10], and asymptomatic spread is common [11]. Continuous masking is more effective than intermittent or targeted use [12]. N95 respirators or others certified [13] for respiratory protection [14] are required at USC Keck Hospital [15], LA County hospitals (160 hospitals) [16], and Guam Memorial Hospital [17]; others highly recommend them even if they don’t require them.
The improvements in healthcare safety are taking place during the current worldwide surge [18], the second highest surge in the United States [19], where 1 in 3 Americans could be infected with COVID-19 during just two months, and 1 in 23 are currently infectious, according to estimates [20]. CDC wastewater data [21] is showing surges across the US, with most reporting states at very high levels [22], prompting them to give a Health Alert [23] warning to hospitals. The World Health Organization guidelines state all health facilities should adopt universal masking [24]. It warned that COVID-19 is “still a pandemic” [25] and hospitalizations and deaths are rising. Data is difficult to obtain, but reports show long wait times and healthcare collapse [26], full [27], over capacity [28], and high emergency rooms visits [29].
However, patients CAN use infection prevention policies to assist in finding safer healthcare. The World Health Network has created a living spreadsheet of hospital policies on masking [30], including a safety ranking and links to the policies for hospital systems (tab 1) and jurisdictions (tab 2).
As of January 20th, 2024, it is encouraging to note that more than 120 hospitals and health systems worldwide have gone above and beyond in implementing masking policies that exceed the minimum guidelines set by the CDC. Additionally, over 20 jurisdictions have mandated the use of masks in healthcare settings, which is a significant step toward ensuring the safety and well-being of patients and healthcare workers. By following these policies, hospitals are providing better care and creating a healthier and safer environment for all.
Announcements:
To learn more about WHN Hospital Rankings, and to nominate a hospital, see our new blog: Joining Forces for Safety: Elevating Hospital Standards in the Fight Against Infections
WHN has created a new Provider Database that allows input for COVID precautions at your doctor’s offices, and we are inviting you to use it, add to it, and send feedback to us as it grows.
WHN Science Communications Editorial: SARS-CoV-2 and COVID-19: From Crisis to Solution 18 January 2024
Check out the new WHN Business December Boardroom Briefing for strategies, risk analyses, and vital updates.
WHN’s Press Team is calling on communicators and community activists to strengthen the fight against the Covid pandemic.
Weekly Action: Ask Your State Officials to Reinstate Mask Requirements in Healthcare
December/January Broadcasts:
WHN Update: Being Safe: Masks in Healthcare
WHN Interview with Jose Jimenez: Airborne Transmission and How to Prevent It
WHN Special: How to Be Safe Over the Holidays
WHN Update with Eric Feigl-Ding: Trouble Thinking Concentrating, Making Decisions
WHN Update with Eric Feigl-Ding: COVID Immune Deficiency, Not Immunity Debt
WHN Interview with Dr. David Berger: What Should Medicine Be Doing in the Context of the Pandemic
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References:
[1] Hollowell A. Hospitals, health systems begin to bring back mask policies. www.beckershospitalreview.com. Published August 24, 2023. https://www.beckershospitalreview.com/public-health/hospitals-health-systems-begin-to-bring-back-mask-policies.html
[2] Preve C. Spain reintroduces mandatory face masks over COVID concerns. https://www.euronews.com/next/2024/01/09/spain-reintroduces-mandatory-face-masks-over-covid-concerns . Published January 9, 2024.
[3] Bagheri G, Thiede B, Hejazi B, Schlenczek O, Bodenschatz E. An upper bound on one-to-one exposure to infectious human respiratory particles. Proceedings of the National Academy of Sciences. 2021;118(49):e2110117118. doi:https://doi.org/10.1073/pnas.2110117118
[4] COVID19: Your Safety and Health Are Our Highest Priorities. RWJBarnabas Health. Accessed January 13, 2024. https://www.rwjbh.org/patients-visitors/what-you-need-to-know-about-covid-19/ensuring-your-safety-at-our-facilities/
[5] UPMC to begin requiring face masks due to rising RSV, flu, COVID cases. pennlive. Published December 14, 2023. Accessed January 13, 2024. https://www.pennlive.com/health/2023/12/upmc-about-to-begin-requiring-face-masks-due-to-rising-rsv-flu-covid-cases.html
[6] Health Orders in effect for Marin County | Marin County Coronavirus Information. coronavirus.marinhhs.org. Accessed January 13, 2024. https://coronavirus.marinhhs.org/health-orders
[7] Health Order Requiring Use of Face Masks in Patient Care Areas of Health Care. https://covid19.sccgov.org/. Accessed January 13, 2024. https://covid19.sccgov.org/health-order-requiring-use-face-masks-patient-care-areas-health-care-delivery-facilities-during
[8] Spain reintroduces mandatory face masks over COVID concerns. euronews. Published January 9, 2024. Accessed January 13, 2024. https://www.euronews.com/next/2024/01/09/spain-reintroduces-mandatory-face-masks-over-covid-concerns
[9] Greece advises public to wear masks amidst COVID outbreak. NEOS KOSMOS. Published January 5, 2024. Accessed January 13, 2024. https://neoskosmos.com/en/2024/01/05/news/greece/greece-advises-public-to-wear-masks-amidst-covid-outbreak/
[10] United States Environmental Protection Agency. Indoor Air and Coronavirus (COVID-19). US EPA. Published June 17, 2020. https://www.epa.gov/coronavirus/indoor-air-and-coronavirus-covid-19
[11] Michael A. Johansson, Talia M. Quandelacy, Sarah Kada, et al. SARS-CoV-2 Transmission From People Without COVID-19 Symptoms. JAMA Network Open. 2021;4(1). doi:https://doi.org/10.1001/jamanetworkopen.2020.35057
[12] MacIntyre CR, Wang Q, Seale H, et al. A Randomized Clinical Trial of Three Options for N95 Respirators and Medical Masks in Health Workers. American Journal of Respiratory and Critical Care Medicine. 2013;187(9):960-966. https://doi.org/10.1164/rccm.201207-1164oc
[13] CDC, NIOSH, NPPTL, The Respiratory Protection Information Trusted Source, https://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/respsourceTypes.html
[14] FDA, N95 Respirators, Surgical Masks, Face Masks, and Barrier Face Coverings https://www.fda.gov/medical-devices/personal-protective-equipment-infection-control/n95-respirators-surgical-masks-face-masks-and-barrier-face-coverings
[15] The Visitor Safety Policy for Keck and USC Norris hospitals and outpatient clinics on the USC Health Sciences Campus. Accessed January 13, 2024. https://www.keckmedicine.org/wp-content/uploads/2022/01/current-visitor-policy.pdf
[16] ORDER of the LOS ANGELES COUNTY HEALTH OFFICER ANNUAL INFLUENZA IMMUNIZATION or MASKING and ADDITION of UPDATED COVID-19 IMMUNIZATION or MASKING REQUIREMENT for HEALTHCARE PERSONNEL. Accessed January 13, 2024. http://publichealth.lacounty.gov/ip/Docs/2023/Influenza_HOO_IZorMaskingforHCWs_2023.pdf
[17] News JTIPD. Rise in number of COVID-19 cases, including 48 hospital members, prompts GMH to bring back mask use in patient care areas. guampdn.com. Published January 10, 2024. Accessed January 13, 2024. https://www.guampdn.com/news/rise-in-number-of-covid-19-cases-including-48-hospital-members-prompts-gmh-to-bring/article_dab3ed18-af8a-11ee-9873-43ae2b0004aa.html
[18] WHO Reports Disturbing Surge In COVID 19 Cases Deaths JN 1 Variant Spreading Worldwide. BW Defence. Accessed January 13, 2024. https://bwhealthcareworld.businessworld.in/article/WHO-Reports-Disturbing-Surge-In-COVID-19-Cases-Deaths-JN-1-Variant-Spreading-Worldwide/12-01-2024-505813/
[19] The US is starting 2024 in its second-largest COVID surge ever, experts say. TODAY.com. Published January 6, 2024. https://www.today.com/health/news/covid-wave-2024-rcna132529
[20] Hoerger, Michael PhD, MSCR, MBA, Pandemic Mitigation Collaborative. U.S. SARS-CoV-2 Wastewater Levels, COVID-19 Case Estimates, and 4-Week Forecast: Report for January 8, 2024,. pmc19.com/data. https://www.pmc19.com/data/PMC_Report_Jan8_2024.pdf
[21] CDC. Wastewater COVID-19 National and Regional Trends. Centers for Disease Control and Prevention. Published November 3, 2023. Accessed January 13, 2024. https://www.cdc.gov/nwss/rv/COVID19-nationaltrend.html
[22] CDC. COVID-19 Current Wastewater Viral Activity Levels Map. Centers for Disease Control and Prevention. Published December 7, 2023. Accessed January 13, 2024. https://www.cdc.gov/nwss/rv/COVID19-currentlevels.html
[23] WHO, NEW: COVID19 variant of interest JN.1, https://worldhealthorganizationdepartmentofcommunications.cmail20.com/t/d-e-vkkjyud-jyyhcddb-f/
[24] Health Alert Network (HAN) – 00503 | Urgent Need to Increase Immunization Coverage for Influenza, COVID-19, and RSV and Use of Authorized/Approved Therapeutics in the Setting of Increased Respiratory Disease Activity During the 2023 – 2024 Winter Season. emergency.cdc.gov. Published December 14, 2023. https://emergency.cdc.gov/han/2023/han00503.asp
[25] Karlis N. WHO leader says COVID-19 is “still a pandemic.” Salon. Published January 4, 2024. Accessed January 13, 2024. https://www.salon.com/2024/01/04/leader-says-19-is-still-a-pandemic/
[26] Italian hospitals collapse: Over 1,000 patients unattended in Rome. euronews. Published January 3, 2024. Accessed January 13, 2024. https://www.euronews.com/next/2024/01/03/italian-hospitals-collapse-over-1100-patients-waiting-to-be-admitted-in-rome
[27] As respiratory illnesses spike, NH hospitals warn: “Hospitals are busy, and beds are full.” New Hampshire Public Radio. Published January 10, 2024. Accessed January 13, 2024. https://www.nhpr.org/health/2024-01-10/covid-flu-rsv-respiratory-illnesses-new-hampshire-hospital-capacity-masks
[28] Rassy S. Quebec emergency rooms see continued overcrowding amid surge in respiratory infections. CityNews Montreal. Published January 2, 2024. Accessed January 13, 2024. https://montreal.citynews.ca/2024/01/02/quebec-emergency-rooms-overcrowding/
[29] CDC. COVID Data Tracker. Centers for Disease Control and Prevention. Published March 28, 2020. Accessed January 13, 2024. https://covid.cdc.gov/covid-data-tracker/#ed-visits_all_ages_combined
[30] Hospital Ranking. Accessed January 20, 2024. https://docs.google.com/spreadsheets/d/11GHhENUNUXXHSglhKWHPLvHzmqTaDHU5BhWq87ZwLFc/edit#gid=1453605130