How Have Health Systems, Hospitals Responded to the CDC's Relaxation of Mask Guidance?

Following an announcement from the CDC that fully vaccinated individuals no longer need to wear masks in all outdoor and most indoor spaces, health systems and hospitals responded by continuing to encourage caution.

This past week, health organizations across the United States took the CDC’s revised mask guidelines—stating fully vaccinated individuals can shed their face coverings in all outdoor and most indoor spaces—in stride, with some lauding the confirmation of data on vaccine effectiveness in community settings, and others strongly cautioning against relaxed transmission protocols.

The new guidance was announced on May 13, and specifically stated mask-wearing is still required for crowded indoor settings like health care facilities and on forms of public transportation. In addition, “fully vaccinated people should continue to follow any applicable federal, state, local, tribal, or territorial laws, rules, and regulations,” the guidance reads, while those who have not received a vaccine should still comply with all transmission mitigation efforts in place before the update.

Although some states and businesses immediately put the new guidance into effect, others pumped the brakes and took time to assess the new recommendations prior to instituting any sweeping changes.

For hospitals and health systems, caution continues to take precedence.

The Society for Healthcare Epidemiology of America (SHEA) emphasized the importance of continued transmission mitigation efforts especially in health care facilities as measures begin to relax.

“SHEA is excited that epidemiological data has confirmed vaccine effectiveness in community settings in recent months. We agree with the recommendations relaxing requirements for post-exposure, and post-travel, quarantine and testing for fully vaccinated individuals,” the organization said in a statement.

“However, SHEA strongly cautions against relaxing transmission mitigation efforts, including masking in communities with ongoing high rates of transmission and within healthcare settings.”

According to the CDC, all health care personnel should continue following infection prevention and control recommendations, including universal masking in health facilities, to protect themselves and others from infection.

“For health care personnel, it is often not known whether patients have been vaccinated when they first arrive in need of care, and we provide care for many highly immunocompromised patients who may remain vulnerable to COVID-19 even after vaccination,” SHEA’s statement reads.

“The potential for exposure to SARS-CoV-2 [the virus which causes COVID-19] is not limited to direct patient care interactions since transmission can also occur through unprotected exposures in common areas to asymptomatic or pre-symptomatic co-workers or visitors, whose vaccination status may also not be known,” they stated.

In a similar vein, America’s largest nurses’ union, National Nurses United, condemned the CDC’s announcement and called on it to revise its guidance, stating it would jeopardize the health of frontline workers and the general public, and disproportionately impact people of color, The New York Times reports. Less than 40% of the country’s population is currently fully vaccinated.

"It's important for patients to know that this new guidance doesn't apply to health care settings,” said John C. O’Horo, MD, MPH, a critical care and infectious disease specialist at the Mayo Clinic. "We ask our patients and visitors to continue to wear masks and socially distance to protect our patients. Also, state and local government may continue to require masking, particularly in places with increasing cases and relatively low COVID-19 vaccination rates.”

The Clinic is asking patients and visitors to continue to wear masks and socially distance even if they are fully vaccinated, in an effort to protect patients with weakened immune systems.

The American Hospital Association (AHA), a national organization representing all types of hospitals and health care networks, had requested a clarification from the CDC following the announcement of relaxed guidelines.

Staff, patients, residents and visitors should continue to wear masks in health care facilities, the CDC told the AHA. The Center directed facilities to continue to refer to its infection prevention and control guidance when it comes to source control and physical distancing.

“We appreciate the fact that fully vaccinated people are likely to have sufficient protection to be able to remove their masks now in many other settings, which will likely encourage others to consider getting their vaccination,” said Nancy Foster, AHA’s vice president of quality and patient safety policy.

“At the same time, we recognize that patients in hospitals may be immunocompromised and thus, less likely to be able to fight off the virus if they are exposed. This is why CDC’s directive stipulates that masks and other precautions should still be used in hospitals and other health care settings.”