Here's why some systems say they're comfortable relaxing hospital mask requirements

A subset of hospitals across the country are adopting policies to reduce certain face mask requirements—a cautious and calculated decision they say was made for the benefit of weary staff and visitors.

As the public grapples with judiciary rollbacks of federal transportation requirements and back-and-forth decisions from local authorities, health systems are making their own judgment calls based on a range of local factors such as COVID-19 hospitalizations, dominant SARS-CoV-2 variants and vaccination rates.

At UnityPoint Health in the Midwest, the system’s clinical specialist group decided in mid-April to allow its Iowa facilities the autonomy “to make changes to their local masking requirements based on local community transmission levels, while taking into consideration illness severity metrics, vaccination rates and external evidence and guidance,” Kevin Kirkpatrick, a spokesperson for the system, told Fierce Healthcare.

That means masking is currently or will soon be optional for “most” patients and visitors across the majority of UnityPoint Health’s patient care facilities within Iowa, Kirkpatrick said, although employees will still be masking “when providing direct patient care.” The system is also asking those who have respiratory symptoms, are unvaccinated or have had a recent positive COVID-19 test or known exposure to continue masking regardless of community transmission levels.

UnityPoint’s other hospitals in Illinois and Wisconsin will also be making independent decisions based on their local conditions and state executive orders, Kirkpatrick added.

“We feel it’s important to have masking guidelines that keep people safe and are sustainable long term,” he said. “This change allows us to align with the transmission levels we are experiencing in our local communities while taking into consideration illness severity metrics, vaccination rates and external evidence and guidance.”

On the opposite side of the coin, Connecticut health systems Hartford HealthCare, Yale New Haven Health and Trinity Health New England (the local branch of nationwide Trinity Health) each told the Hartford Courant they have no plans to lift masking requirements despite the end of a statewide mandate.

Scott Roberts, M.D., associate medical director of infection prevention at Yale New Haven Health, told Fierce Healthcare in an email statement his system would be upholding the requirement for staff, patients and visitors due to worrying trends inside and outside of their facilities’ walls.

“We are seeing a slow uptick in cases at both the hospital and in the community, which is being driven by the BA.2 omicron subvariant,” he said. “This subvariant makes up a majority of the cases in the state of Connecticut.”

Many hospitals elsewhere in the country are still under statewide orders to maintain indoor masking. Just this week, New Jersey Governor Phil Murphy, for instance, reaffirmed the requirement for healthcare settings across the state while announcing an end to similar rules for mass transit.

“We heard our staff”

For centers in more permissive states that are debating whether or not to roll back masking requirements, it’s vital to understand the initial risks and stay well ahead of potential threats in the weeks to come.

“Always keep your eye on the ball because things can change very quickly and you’ll be caught off guard,” Firas Zabaneh, M.D., Houston Methodist’s director of system infection prevention and control, told Fierce Healthcare. “You don’t want to do that.”

Houston Methodist made headlines earlier this month when it implemented relaxed masking policies for employees and visitors beginning April 4. The updated policy still requires staff to mask in clinical areas or when closely interacting with patients for prolonged periods of time, but allows for more comfort in large public areas such as large open lobbies or cafeterias.

For Zabaneh, Houston Methodist wouldn’t have reached that point without taking a strong stance on workforce vaccination.

“Keep in mind that Houston Methodist was the first hospital system in the nation to mandate vaccination,” he said. “We’re over 99% vaccinated and boosted with the third shot.

“If you have an organization that has a low level of vaccination because they didn’t mandate vaccination, or if you have an organization that has mandated the previous series but didn’t mandate the booster and you’re having very low levels of vaccinations at this point, I would consider that as one of the factors that would make me rethink easing off masking,” he said.

Although workforce vaccination was front of mind at Houston Methodist, Zabaneh said the organization has systems in place to monitor community COVID-19 circulation data and other internal indicators such as hospitalizations, mortality and capacity anywhere from once to three times per day.

Both UnityPoint and Houston Methodist said their organizations are prepared to partially or fully reinstate their masking policies should their surveillance sound the alarm. For the latter, Zabaneh said an emergency response process is in place where a systemwide incident command center could quickly put out the call to nodes at local hospitals or the physician organization to immediately remask should the data warrant it.

“Not only [do we] have an incident command center, but we also have a scientific committee that is chaired by a top scientist and the members are top scientists that work here at Houston Methodist throughout the system,” he said. “If we need to call them, we can call them immediately and have them weigh in on some of the measures we’d want to implement. They’d be advisers to incident command, and incident command would make a decision whether to go or no-go.”

At the end of these risk assessments and constant surveillance is much-needed relief for hospital employees two years into a high-stress public health emergency, Zabaneh said.

As healthcare workers across the country report higher levels of burnout and increasingly begin eyeing the door, Houston Methodist decided the time was right to “capture the moment and allow our staff to have some breathing space,” he said.

“That’s not just Houston Methodist—I can tell you [after] hearing from colleagues on a national level, staff are starting to get desperate. ‘We’re two years into it, why can’t we just have some breathing space to have some semblance of normal?’” Zabaneh said.

“So we heard our staff, we did our risk assessment, our due diligence. From there, incident command—which has been in effect since Day One—decided it’s time to give them some space. … But we’re always ready to pivot, to make adjustments.”