In face of 'tripledemic,' masking mandates might make a comeback

When the Centers for Disease Control and Prevention (CDC) relaxed masking guidelines for healthcare workers in October, some experts voiced concern.

The Association for Professionals in Infection Control and Epidemiology (APIC), for instance, argued that “numerous indicators, including wastewater surveillance and rising case counts overseas, point to a potential wave of new COVID-19 cases in the coming months. When that happens, we will have to shift back to universal masking. Having a policy that changes back and forth is confusing to healthcare personnel and erodes trust," the organization said.

APIC underscored the importance of masking among healthcare workers “especially as we enter what is predicted to be a severe flu season, with COVID-19 surges looming on the horizon.” The prediction about a severe influenza season that arrived earlier than normal turned out to be correct, according to CDC data. What seems to have taken many by surprise has been the onslaught of respiratory syncytial virus (RSV), which hits children particularly hard.

For these reasons, researchers with Brown University wrote an op-ed for the NBC News website that calls for the issuance of masking mandates to get us through the holiday season. The authors—William Goedel, Ph.D., Abdullah Shihipar and Abigail Cartus—argue that “widespread masking during the first two years of the pandemic contributed to the historically low rates of flu and RSV observed in those years.”

Employers will take their cues from the CDC.

A spokesperson for the Purchaser Business Group on Health, which comprises about 40 large private and public employers that spend $350 billion on coverage for approximately 21 million individuals, tells Fierce Healthcare that “we’re not seeing employers broadly implementing new [masking] mandates, but they continue to watch [COVID-19] infection rates and the policies of the CDC. Of course, folks are still required to stay off work if they are infected in alignment with CDC guidelines.”

Stephen Seminack, executive vice president and CFO of Modern Group Limited, an industrial equipment supply company based in Bristol, Pennsylvania, tells Fierce Healthcare that his company “will monitor the CDC guidelines throughout the holiday.” When asked whether Modern Group Limited might go further than the CDC guidelines, he said that “it’s unlikely that we would initiate it, unless we saw an immediate need.”

But what constitutes an immediate need? Seminack points out that before the pandemic, people would often come to work even if they had colds. Now, “when people get sick, they don’t come in. They used to come in with colds, but now they know better.”

Linda Spaulding, an infection prevention and control expert, isn’t so sure about that. Yes, says Spaulding, some people pay attention to the warning signs of a cold that are often the same symptoms as COVID-19 and decide to stay home. But many do not and go to work.

“I think COVID is still very much with us,” says Spaulding. “The numbers are very high around us. And it’s a matter of: Do you want to get it and have possibly long-term health problems that affect the rest of your life? Or do you wear a mask, so you don’t get it?”

According to the Johns Hopkins Coronavirus Resource Center, the seven-day average for cases ending Nov. 23 was 39,342, and for deaths, 359.

Any healthcare worker who interacts with patients should wear a mask, Spaulding believes.

“It bothers me that healthcare workers don’t wear masks when they’re around patients. Some hospitals do have that policy, but not all hospitals will enforce that policy.”

In their op-ed on the NBC News website, Goedel, Shihipar and Cartus note that RSV spreads through the air and on surfaces, and that “this means that RSV—for which a vaccine is still being developed—can be mitigated through both mask-wearing and hand-washing.”

They note that the Supreme Court recently said the Transportation Security Administration can implement mask mandates.

“Coming out of our COVID experience, disease mitigation should be an ongoing practice that can be dialed up when necessary rather than a switch that turns on or off completely,” write Goedel, Shihipar and Cartus. “We should always encourage mask-wearing during fall and winter seasons (as these respiratory viruses tend to transmit more efficiently in colder weather due to changes in humidity and how much time people spend indoors) and in busy places like mass transit and grocery stores.”