CDC recently released new guidance saying universal masking is no longer required in health care facilities in certain areas. However, some hospital leaders have said they will continue to follow state recommendations instead and require masking for their workers and patients, Kristina Fiore writes for MedPage Today.

Background

CDC recently released updated guidance saying that universal masking is no longer required in health care facilities unless those facilities are located in an area of high Covid-19 transmission. According to CDC, the masking guidance was updated "to reflect the high levels of vaccine- and infection-induced immunity and the availability of effective treatments and prevention tools."

Under the new guidance, health care facilities, including nursing homes and hospitals, can "choose not to require" universal masking among doctors, patients, and visitors if community Covid-19 transmission levels are not high.

"Community transmission is the metric currently recommended to guide select practices in health care settings to allow for earlier intervention, before there is strain on the healthcare system and to better protect the individuals seeking care in these settings," CDC's guidance said. Currently, 73% of U.S. counties are considered to be at "high" risk under CDC's community transmission metric.

When health care facilities are in areas of high transmission, CDC recommends universal masking for those in areas of the facility where patients could be encountered. However, health care providers can elect not to wear a mask if they're in "well-defined areas" restricted from patients, like staff meeting rooms.

Masking "remains recommended" during a Covid-19 outbreak among patients or "when caring for patients who are moderately to severely immunocompromised," the guidance states.

Many hospitals continue to keep their mask mandates

Although some health care organizations, including the American Health Care Association and the National Center for Assisted Living, praised the updated guidance, other health experts were more critical.

For example, Megan Ranney, dean of the Brown University School of Public Health, said in a tweet she was concerned that health care facilities with high levels of Covid-19 transmission "can unmask sick patients who haven't yet been tested for Covid, right next to the elderly, chemo patients, people with pulmonary diseases, and pregnant women."

Former Surgeon General Jerome Adams in a tweet also criticized the guidance, saying that CDC is making "a recommendation they know will end masking … while also admitting it's too early to do so."

Currently, several hospital leaders have said their facilities will continue to follow state-based guidelines that recommend universal masking rather than CDC's new guidance.

"Masks are still required for hospitals and health care facilities in California," said Chris Van Gorder, CEO of Scripps Health in San Diego. "We understand that additional guidance might be coming from the [California Department of Public Health (CDPH)] and the state, but for now, it's still required, and we intend to comply."

Similarly, John Cihomsky, a spokesperson for Sharp HealthCare in San Diego, said the health system typically follows the lead of CDPH, which has not yet made any changes to universal masking recommendations for health care facilities.

In New York, Jason Molinet, a spokesperson for Northwell Health, said the state's health department "has not changed its recommendations/requirements. We follow state guidance."

According to Mark Howell, director of policy and patient safety at the American Hospital Association, the organization "understands" why CDC decided to use transmission data to determine masking guidance for health care workers, but noted that workers in most areas of the United States would still need to wear a mask.

"These changes reflect the importance of mitigating challenges related to COVID-19 as early as possible and keeping health care workers and the patients they treat safe and healthy, a goal hospitals and health systems strongly share with the CDC," Howell said. "Current levels of high community transmission across the country mean universal masking is recommended in most communities for everyone in a health care setting, especially when in areas of the health care facility where they could encounter patients." (Fiore, MedPage Today, 9/28)