Template for Letter to Healthcare Institutions

Dear [ADDRESSEE],

We appreciate the dedication of [HOSPITAL/HEALTHCARE NAME] to providing quality care and ensuring the well-being of patients, staff, and visitors.

With this in mind, we are writing to share our concerns regarding the current infection control policies at [HOSPITAL/HEALTHCARE NAME], particularly in relation to masking and other airborne pathogen prevention strategies. The harms from SARS-CoV-2, influenza, RSV, and measles—all of which are known to be transmitted via airborne aerosols—necessitate robust and science-based infection prevention measures to reduce in-facility transmission and protect all occupants. Healthcare facilities are inherently settings wherein infectious individuals and vulnerable people congregate, necessitating appropriately robust infection control measures to protect patients,staff and visitors.

A recent study conducted within Massachusetts General Brigham Hospitals [1], demonstrated a 25% increase in hospital-onset respiratory viral infections following the discontinuation of universal masking and testing policies. Importantly, the reinstatement of staff masking led to a 33% reduction in these infections [2]. The universal use of N95 respirators, which are proven to provide significantly greater protection against airborne aerosolized pathogens, could achieve even greater reductions and better protect patients, healthcare workers and visitors. Additionally, the study highlighted possible severe outcomes, including an mortality rate of 8% among patients who acquired respiratory infections in the hospital. These acute risks are compounded by the substantial body of evidence linking SARS-CoV-2 infections to post-acute chronic illnesses, further underscoring the need for effective prevention.

The importance of these findings is echoed by data from a separate Australian study, which found that 9.5% of hospital-acquired SARS-CoV-2 infections resulted in death [3]. Together, these studies underscore the significant risks of inadequate airborne infection prevention measures and the opportunity for [[HOSPITAL/HEALTHCARE NAME] to lead in adopting evidence-based practices.

We also understand that these data are not just statistics; they represent the actual preventable, adverse lived experiences of patients, visitors and staff. Our organization (WHN) has serious concerns about the adequacy of currently endorsed and promulgated guidance and policies which do not align  with the science of airborne transmission, as it has been elaborated in the course of the SARS-CoV-2 pandemic. These concerns are shared by many providers, patients and families. We would welcome the opportunity to engage in a direct discussion with [hospital leadership, infection control teams, and frontline healthcare workers], bringing together scientific evidence and documentation, as well as real-world experiences to address this pressing issue.

By aligning your healthcare facilities’ policies with the best available evidence and acting decisively, you can strengthen your reputation as a leader in healthcare safety and reaffirm your commitment to patient and staff well-being.

Given these circumstances, we urge [HOSPITAL/HEALTHCARE NAME] to take immediate action to:

1. Establish policies requiring the universal use of respirators (e.g., N95s) for all healthcare staff and ensure adequate training for their effective use. This measure has the potential to significantly exceed the infection reductions observed in recent studies, which primarily relied on surgical masks.
2. Honor patient requests for staff to wear N95 respirators as a reasonable accommodation.
3. Invest in infrastructure improvements, including enhanced ventilation and air filtration systems, to achieve effective air exchanges and reduce airborne transmission risks in all areas of your facilities.

By implementing these measures,  [HOSPITAL/HEALTHCARE NAME] can lead by example, demonstrating your dedication to evidence-based practices and patient-centered care. We appreciate that attention to this issue will require leadership for serious consideration and investment. Nonetheless, this is an excellent opportunity to mitigate proven risks. We look forward to your response and to an opportunity to discuss these matters in detail.

Please contact us at teams@whn.global, Attention Infection Prevention Team.

Sincerely,

World Health Network

References:

1) Pak TR, Chen T, Kanjilal S, McKenna CS, Rhee C, Klompas M. Testing and Masking Policies and Hospital-Onset Respiratory Viral Infections. JAMA Netw Open. 2024;7(11):e2448063. https://doi.org/10.1001/jamanetworkopen.2024.48063
2) Robertson, R. (2024, November 27). Want to Limit Respiratory Virus Infections? Mask and Test in Hospitals — Healthcare workers masking makes a difference, study found. MedPage Today. Retrieved from https://www.medpagetoday.com/infectiousdisease/rsv/113155
3) “Documents obtained by ABC News under Freedom of Information laws reveal at least 6,212 patients caught COVID in hospital in 24 months — 3,890 in 2022 and 2,322 in 2023. Of those, 586 died — almost six per week, on average — with men dying at a higher rate than women (11 per cent vs 8 per cent).” Gleeson, H. (2024, May 5). Hundreds of patients died after catching COVID in Victorian hospitals, new data shows. ABC News. Retrieved from https://www.abc.net.au/news/2024-05-06/hundreds-died-catching-covid-victoria-hospitals-testingmasking/