from the editor
from the editor
It ’ s Time to End Universal Masking in Healthcare Settings , Experts Say
A welcome release from the grips of the COVID pandemic comes more than three years after the world as we knew it was forever changed . In a recent commentary in Annals of Internal Medicine experts are advocating for the end to policies mandating universal masking in the healthcare settings .
“ While critically important in the earlier phases of the pandemic , we ’ ve entered a more stable phase , with substantial population-level immunity , durable protection against severe disease , a series of less virulent variants , and other important and favorable changes ,” says Erica S . Shenoy , MD , PhD , medical director of infection control for Mass General Brigham and an infectious diseases physician at Massachusetts General Hospital ( MGH ). “ As conditions change , we need to re-evaluate our infection prevention policies , including masking requirements in healthcare settings , and adapt .”
In the commentary , the authors emphasize different phases of the pandemic and say that while universal masking was justifiable before medical countermeasures were available , advancements and population immunity have changed the appropriateness of the policy . Highlighting a theme of constant and ongoing change , they review the rationale for initially expanding mask use in healthcare settings , the reasons why de-escalation is needed , and conditions that could prompt reconsideration of use of masks more widely again .
“ After three years of universal masking in healthcare , the risk-benefit calculation has shifted ,” says Shira Doron , MD , chief infection control officer for Tufts Medicine health system and hospital epidemiologist at Tufts Medical Center . “ Masks do have downsides , such as impaired communication and disrupted human connection . We are at a stage of the pandemic where it now makes sense to end mandatory masking .”
The authors advocate for a more prudent management of SARS-CoV-2 , similar to how other respiratory viruses are managed in healthcare settings . This includes ensuring healthcare personnel use masks and eye protection when engaging in activities that could generate splashes or sprays and having patients mask if they have respiratory symptoms .
“ As the pandemic moves into an endemic phase , we need to transition prevention efforts to incorporate all respiratory viruses .
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Performing risk assessments and applying lessons learned from COVID-19 , including about how to apply masking , will permit a more flexible , durable response now and in future seasons ,” says co-author Sharon Wright , MD , MPH , chief infection prevention officer at Beth Israel Lahey Health .
“ The best evidence-based policy making is dynamic , and adapts to changing conditions , evidence , and contexts . As all these factors change , even policy goals may need to be updated ,” says senior author Westyn Branch-Elliman , MD , MMSc , an infectious diseases specialist and clinical investigator at VA Boston Healthcare System . Since 2020 , she explains , society has been living in a constant state of change during which major preventive and therapeutic advancements have been achieved and the infection fatality rate has fallen dramatically . “ At the same time , we know universal masking is not without costs , even in healthcare . Given these realities , it is time to update policies once again , recognizing this is unlikely to be the last update . Change and adaptation are expected . That does not mean ‘ the science has changed ’, but almost everything around it has .”
The authors say that throughout the pandemic , widespread use of universal masking in healthcare settings was justifiable for reducing the risk of transmission between healthcare personnel , patients , and visitors , and preserving the healthcare workforce to maintain operations during surges . Universal masking was one element of a larger bundle of strategies implemented to limit transmission during a time when little was known about the pathogen and effective interventions had not yet been identified . Since then , the burden of SARS-CoV-2 has been mitigated through access to testing , substantial population-level immunity acquired over time , emergence of less virulent variants , and widespread availability and use of vaccines and treatments . In addition to ending universal masking , the experts suggest that other pandemic-era strategies , such as asymptomatic testing and contact tracing , should be reconsidered in the endemic era .
Until next month , bust those bugs ! Kelly M . Pyrek Editor & Publisher kelly @ healthcarehygienemagazine . com
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6 may 2023 • www . healthcarehygienemagazine . com