The new guidance CDC is considering

In June, members of HICPAC presented a draft of their report which cited studies finding there was no difference in infection rates among healthcare providers who wore N95 masks compared to surgical masks in the clinic.

The researchers noted potential flaws in the research, including the fact that many healthcare providers who tested positive for COVID-19 in the trials were not infected while wearing a mask at work, but maintained their conclusion.

The draft said that a surgical mask instead of an N95 was recommended for protection against a category of viruses they created for "common, endemic" viruses that spread over short distances and "for which individuals and communities are expected to have some immunity." Alexander Kallen, chief of the Prevention and Response Branch at CDC's Division of Healthcare Quality Promotion, noted the committee put the coronaviruses that cause the common cold in this tier but not the coronaviruses causing COVID-19.

The next tier of viruses included those in a "pandemic-phase" where a pathogen is new and there is little immunity present through infection or vaccination. When treating patients infected with those viruses, it's recommended that healthcare providers wear an N95 mask. The final tier of viruses included those that cause diseases like measles and tuberculosis, which the draft claimed can spread further than lower-tier viruses and require an N95.

In the report, the researchers noted the benefits of N95s against the potential drawbacks, citing a Singapore study where almost a third of healthcare providers said wearing N95 masks negatively affected their work and caused acne and other problems as a result of hot and humid conditions and long shifts. Instead of getting rid of the masks, the authors of the study recommended better-fitting masks and rest breaks.

The report's conclusion runs contrary to a 2022 report from CDC that found N95 masks reduced the odds of testing positive for COVID-19 by 83% compared to 66% for surgical masks and 56% for cloth masks. The report also excluded a clinical trial from 2017 that found N95 masks were significantly more protective than surgical masks in protecting healthcare providers from influenza.

The report also contradicts an evaluation by the Royal Society in the United Kingdom, which found that N95 masks were more effective against COVID-19 than surgical masks in healthcare settings worldwide.

The committee was initially supposed to vote on the new guidance on Aug. 22, but postponed the vote until November.

Health experts express concern over potential recommendation

A number of health experts expressed concerns over the potential changes in guidance from CDC, especially in light of rising COVID-19 numbers across the United States.

"Health care facilities are where some of the most vulnerable people in our population have to frequent or stay," said Gwendolyn Hill, a research intern at Cedars-Sinai Medical Center. Hill noted that N95 masks, ventilation, and air-purifying technology have the ability to lower COVID-19 transmission rates within hospitals and "help ensure that people are not leaving sicker than they came."

"It's shocking to suggest that we need more studies to know whether N95 respirators are effective against an airborne pathogen," said Kaitlin Sundling, a physician and pathologist at the University of Wisconsin-Madison. "The science of N95 respirators is well established and based on physical properties, engineered filtered materials, and our scientific understanding of how airborne transmission works."

Some experts specifically expressed concern over the committee's categories for different airborne pathogens, as a pathogen's ability to spread isn't affected by how common it is.

"Large COVID outbreaks in [GP1] [KW2] [KOK3] prisons and long-term health care facilities have demonstrated that the behavior of infectious aerosols is not easily classified, and these aerosols are not easily confined," said Eric Berg, deputy chief of health at Cal/OSHA.

Noha Aboelata, a doctor and CEO of Roots Community Health Center, noted there are other things that can be done rather than replacing N95 masks. "There are other strategies to bring to bear, like improved mask design and better testing," she said.

Aboelata, alongside hundreds of other health experts, signed a letter to CDC Director Mandy Cohen in July expressing concerns about the potential new guidelines, warning that they will weaken protections in hospitals and could have repercussions on emergency stockpiles.

"If they end up codifying these standards of care, it will have a disastrous impact on patient safety and impact our ability to respond to future health crises," said Rocelyn de Leon-Minch, an industrial hygienist for National Nurses United.

Noting that the guidelines are far from final, Kallen said CDC is "very happy to receive feedback. It is our goal to develop a guideline that is protective of patients, visitors, and health workers." (Maxmen, KFF Health News, 9/18)

According to recent CDC data, COVID-19 hospitalizations continue to increase, with a roughly 9% increase nationwide for the week ending Sept. 2. To help protect against infection, health experts recommend people take precautions, including getting an updated COVID-19 vaccine when possible.