Back in the spring, around the end of the COVID-19 public-health emergency, hospitals around the country underwent a change in dress code.
During the pandemic, hospitals required staff to wear masks at all times. However, as the situation improved, hospitals started to relax their masking policies. At UChicago Medicine, for example, masking policies were softened at the end of May.
However, this decision was met with mixed reactions from colleagues. Some thought the requirement to wear masks was lifted too late, while others were concerned about the safety of immunocompromised individuals. At Vanderbilt University Medical Center, on the other hand, many people expressed gratitude when the hospital did away with masking in April.
Despite the varying policies, infection-prevention experts were certain that masks would need to return in the future. The question was when.
For some hospitals, the answer is now. As COVID-19 hospitalizations have been rising nationwide, stricter masking requirements have been reintroduced in certain hospitals in Massachusetts, California, and New York. However, there is no uniform response across the country.
The upcoming respiratory-virus season will be the first without the crisis-level funding, routine tracking of community spread, and preemptive healthcare precautions that were in place during the public-health emergency. Hospitals are once again operating independently.
The decision to reintroduce masks in hospitals is logical. Sick patients come into close contact with healthcare workers, and medical procedures can produce aerosols. This creates an environment that is ideal for the transmission of microbes. Hospital staff play a crucial role in disease response and must prioritize the protection of vulnerable individuals. With another deadly respiratory virus expected during the winter, it is logical for precautions to increase.
However, the challenge lies in the fact that Americans have already formed strong opinions about masks, and hospitals must work within those boundaries.
When hospitals relaxed their masking policies earlier this year, each institution did so at its own pace and established different baselines. Some hospitals, like Brigham and Women’s Hospital in Massachusetts, dropped their mask mandate on May 12 when the public-health emergency expired. Other hospitals, such as UVA Health, took a more gradual approach, slowly reducing the use of masks over a 10-week period.
Now, at Brigham and Women’s Hospital, masks are only worn on a case-by-case basis. They are used when a patient has respiratory symptoms or when a healthcare worker has recently been sick or exposed to the coronavirus. Masks are still required for vulnerable patients, such as those undergoing bone-marrow transplants, who received extra protection even before the pandemic. At UVA Health, masks are mandated for everyone in high-risk areas, such as certain intensive care units and cancer wards. At their hospital, all patients are asked upon admission if they would like healthcare staff to wear masks.
Most experts I spoke with believed that masks would need to make a comeback at some point. However, unlike earlier in the pandemic, there is currently no guidance from the top on this issue. The CDC’s recommendations on mask usage are geared towards the general public and do not provide clear guidelines for hospitals. It is up to each hospital to create their own plans to handle mask usage.
This leaves hospitals with two options. They can either establish a specific timeframe for when masks should be worn based on their own predictions of rising cases, or they can react to the data as it comes in and adjust masking policies accordingly. With the virus being so unpredictable, many hospitals are choosing the latter option. The challenge lies in defining what constitutes a surge in cases, as there is no universal definition for this. Additionally, the availability of data has decreased, making it harder to monitor COVID in the community.
Some hospitals are relying on in-house statistics to guide their decisions. For example, Duke has set a threshold of 2 to 4 percent of emergency and urgent care visits being related to respiratory viruses as a trigger for increased masking. UVA Health, on the other hand, considers taking action if 1 or 2 percent of employees are sick. However, internal metrics are also challenging due to decreased testing and reporting.
Hospitals that have maintained mask requirements are better prepared to reintroduce universal masking if necessary. At UChicago Medicine, a color-coded system has been developed to guide mask usage based on various metrics, and the hospital plans to assess the situation weekly. Duke intentionally kept some masking requirements in place to ease the transition back to stricter standards, recognizing the difficulty of changing habits.
For hospitals that have gone without masks for several months, reintroducing universal masking presents a more significant challenge. Staff members may not be receptive to the change, and finding the right balance is crucial. Some hospitals may choose to preserve mask-free zones in certain areas and implement masking policies based on local health department guidelines.
Ultimately, hospitals are navigating this decision without clear guidance from higher authorities. They are left to rely on their own plans and adapt as the situation evolves.
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