Masking in hospitals did not stop spread of COVID, UK study finds

In a world emerging from the COVID-19 pandemic, hospitals and medical practices have been the last bastions of mandatory masking. But new research finds that in communities where pandemic precautions have largely been abandoned, mask mandates in healthcare settings do little to prevent coronavirus infections in patients.

The findings, presented at the European Congress of Clinical Microbiology and Infectious Diseases in Copenhagen on Thursday, suggest that hospitals, nursing homes and clinics could adopt “mask-optional” policies without putting their patients at increased risk.

The study findings come nearly a year after most European governments decided to let the virus spread unhindered among their highly vaccinated populations. But with some of the latest masking requirements being dismantled in the United States, many here continue to debate the wisdom of declaring an end to the public health emergency.

The US Centers for Disease Control and Prevention continues to recommend indoor masking for all in communities where new infections, hospitalizations and local hospital capacity are combining to push COVID-19 to a “high” level of risk. , and for people who could become seriously ill with COVID -19 if they live in communities where the risk level is “medium”. But for the 96% of counties where the risk is deemed “low,” masks are neither recommended nor discouraged.

This week, California health officials lifted the blanket masking order for healthcare facilities statewide while allowing hospitals, doctors’ offices and other facilities to set their own requirements.

Los Angeles and San Francisco counties have lifted their masking orders for patients and visitors. But under new local ordinances, doctors, nurses and other employees will be required to wear masks when providing patient care or working in patient areas in hospitals, clinics, skilled nursing facilities. , dialysis centers, etc.

LA County rules also require continued masking by janitors, security guards, secretaries and volunteers who work in patient care areas, as well as firefighters, emergency medical technicians and police officers who enter these places.

The British authors of the new study appeared to question the value of such broad masking policies, both in the absence of masking outside hospital walls and in light of evidence that the pandemic virus has become less likely to kill than it was three years ago.

“A low-tech, inexpensive intervention with no well-established benefit was reasonable in the context of the early pandemic,” the authors of the new study wrote, referring to the widespread use of face coverings. “However, with a reduction in COVID-19 disease severity, in later variants the risk-benefit balance becomes more questionable.”

Dr Aodhan Breathnach, an infectious disease physician at the National Health Service Foundation Trust and one of the study’s authors, said many hospitals “have retained masking at significant financial and environmental cost and despite the hurdle important to communication”. He expressed the hope that the results of the study “can help inform a rational and proportionate mask policy in health services”.

In the UK as in the US, the pursuit of mask mandates “has become politicized”, Breathnach said. “Rather than people just flocking to their political tribe, we said, ‘Let’s see how hard they actually work.’ The data was right there.

Breathnach and colleagues at the UK’s National Health Service set out to test whether changes in masking policies for visitors and hospital staff led to changes in infection rates among patients on the wards. St. George’s Hospital in South West London. They focused on a 40-week period that began in December 2021, when the Omicron variant emerged as the dominant strain of coronavirus.

For the first 26 weeks, mask-wearing was mandatory for all hospital visitors and healthcare workers. Researchers captured infection rates in patients upon admission and rates of hospital-acquired coronavirus infections during that time. In-hospital infection rates were much lower than those detected on admission, but the two rose and fell largely in tandem.

On June 2, 2022, masking became optional for healthcare workers and visitors in most areas of St. George’s. However, in cancer wards, in dialysis suites and intensive care units, and during medical admissions, the mask mandate remained in place. This allowed these areas of the hospital to serve as a control group for the study.

Over the next 14 weeks, the researchers found that patients admitted to wards where masks were optional were no more likely to become infected inside the hospital than patients in units where masking remained mandatory.

For both groups of patients, the relationship between infections on admission and nosocomial infections followed the patterns established during the first 26 weeks of the study. This held up even in July 2022, when London saw a huge surge of Omicron: infections among newly admitted patients increased dramatically, and hospital-wide infection rates continued their usual pattern of less dramatic increases.

Breathnach said the stability of the group’s findings, even as a wave swept through London, gave them confidence that universal masking in hospitals had become difficult to defend. Still, he said he understands why continuous masking requests would be the last resort for many people.

“There is a certain psychological aspect to masking: it is the most visible measure of control, and you feel that you have control over it. And other public health measures, like social distancing, are so much harder to do,” he said. But when virtually all other restrictions have been overridden and only hospital workers wear masks, their face coverings barely make a difference.

“They have a marginal ability to protect against less and less severe disease,” Breathnach said.

At the meeting of microbiologists in Copenhagen, experts continued to debate the seriousness of COVID-19. Another study presented on Thursday assessed the potency of the virus in the context of another common respiratory illness, influenza.

While the Omicron variant appears to have made the coronavirus less virulent, research from Israel claims it is still deadlier than the flu.

The scientists compared the characteristics and outcomes of 167 Israeli hospital patients admitted with COVID-19 between December 2021 and January 2022 to those of 221 admitted with influenza infection during the same period.

COVID-19 patients, half of whom were over the age of 71, were more likely to need oxygen support, be put on a ventilator and die than slightly younger flu patients . Of the 167 patients hospitalized with COVID-19, 26% died within 30 days of admission. In contrast, 9% of the 221 flu patients died during this period.

This is consistent with a study published Thursday in JAMA Network Open, which found that among people 65 and older treated in US veterans hospitals, the death rate for patients with COVID-19 (6%) was close. twice as high as for patients with influenza (3.75%).

Israeli research has highlighted that COVID-19 is increasingly a disease that wreaks havoc on older, sicker patients. Most patients hospitalized with influenza had asthma, while those hospitalized with COVID-19 had diabetes and high blood pressure more frequently, and needed more help with daily activities.

Both studies have been peer-reviewed by a panel of the European Congress of Clinical Microbiology and Infectious Diseases and have been submitted to medical journals for publication.

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