There has been a lot of discussion about the recent CDC update regarding masking recommendations.
I want to begin by expressing that the following information is very challenging to digest, even for the most experienced and knowledgeable scientists and physicians. The CDC guidance is very nuanced and much less straightforward than prior recommendations. It is not easy to create a flow diagram (which I attempted) of ‘if this occurs, then do that’. Please know that all of us are trying to provide the best advice while balancing the health and safety of our patients, our teammates and our communities.
On September 23, 2022, the Centers for Disease Control and Prevention updated its COVID-19 infection control guidance for U.S. health care settings based on current information acknowledging that the pandemic is under better control lately and that we now have more widespread immunity, vaccines, boosters and treatments that are reducing the severity and risks associated with the infection.
The guidance updates the circumstances when source control (respirator and face mask use) and universal personal protective equipment are recommended, and no longer uses vaccination status to inform source control, screening testing or post-exposure recommendations. It also updates recommendations for testing frequency, and clarifies that facilities may use their discretion regarding screening testing for asymptomatic health care personnel, among other changes. To allow for earlier intervention to prevent a strain on the health care system, the guidance recommends health care facilities use data on COVID-19 community transmission rather than community levels.
While some headlines proclaim “CDC no longer recommends universal masking in health facilities” many public health experts are critical of the announcement. The new CDC policy is very nuanced and the general population may incorrectly interpret this guidance as a complete departure from universal masking policies throughout the pandemic. Indeed, we have experienced patients and visitors becoming unruly and upset that they are still required to mask. In my experience and informal polling of colleagues, nearly every major health system near our practices has continued its prior universal masking policy, despite the CDC update.
I am going to try to clarify the guidelines below, and emphasize that these will likely change again soon or revert to prior policy, as Europe and the UK are seeing the beginning of the anticipated ‘fall surge’ with new variants that may be even more transmissible. How well our natural and vaccine immunity prevents serious disease is yet to be fully understood.
Furthermore, you will have to rely upon your individual state/market leadership to some degree since the recommendations are VERY DEPENDENT upon your local conditions.
It is also important to note the differences between COMMUNITY TRANSMISSION and COMMUNITY LEVEL, a potentially confusing concept.
Community transmission measures the presence and spread of SARS-CoV-2 virus in the population. This can be measured by wastewater surveillance, test positivity, eg.“Covid-tracker”
Community levels “place an emphasis on measures of the impact of COVID-19 in terms of hospitalizations and healthcare system strain, while accounting for transmission in the community,” CDC said. These are typical color coded as high, medium and low.
