Lessons From the #COVID-19 Pandemic: Updating Our Approach to Masking in Health Care Facilities | Annals of Internal Medicine
▻https://www.acpjournals.org/doi/10.7326/M23-1230
In a recent article, Shenoy and colleagues (2) proposed a transition back to prepandemic approaches to mitigating health care–associated respiratory viral infections by using Standard Precautions and Transmission-Based Precautions in health care settings. This recommendation assumes that our prepandemic approach to preventing hospital-acquired respiratory viral infections was adequate. In fact, it is likely that before the pandemic, we vastly underappreciated the degree of harm caused by hospital-acquired respiratory viral infections that were preventable by masking among patients and HCWs (7). Prior policies focused exclusively on limiting health care–associated infections from identified ill patients to HCWs. As Palmore and Henderson highlight (3), the lessons learned from the COVID-19 pandemic have led to a greater appreciation of asymptomatic, presymptomatic, and pauci-symptomatic transmission of SARS-CoV-2 and other endemic respiratory viruses (8). Prior policies assumed that patients with active infection are identified, tested, and isolated appropriately. Yet it is estimated that asymptomatic and presymptomatic cases account for the majority of SARS-CoV-2 spread (9). These findings mean that it is not possible to consistently identify patients and HCWs who are capable of transmitting virus, especially as hospitals discontinue universal SARS-CoV-2 admission testing. We also recognize that nonrespiratory symptoms and diagnoses (10) may further delay identification of ill persons and may require a clinician to suspect and then place patients on traditional transmission-based precautions.
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We should be mindful of continuing areas of uncertainty while integrating the lessons learned into our hospital-based practices to prevent harm to vulnerable patients rather than reverting to suboptimal prepandemic behaviors.
