A CDC Update on the Part One Draft update to the Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings

Posted on by Daniel Jernigan, MD, MPH and John Howard, MD, MPH, JD, LLM, MBA

Confident young Hispanic nurse looks to the side while walking in a hospital corridor. She is wearing scrubs, stethoscope, glasses and id badge. She is carrying medical charts. Medical professionals are walking in the background.

The COVID-19 pandemic has forever changed the approach we take in healthcare settings to protect healthcare personnel, patients, and others from transmission of respiratory infections. Experimental and observational data show that an important pathway for transmission of severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) is via inhalation of small particles in the air generated by infected individuals. There is widespread recognition that inhalation of infectious particles is a primary pathway of disease transmission occurring over short distances in addition to large droplets and sprays landing on the mucous membranes when infectious people cough or sneeze. The observation that infections have characteristic distances over which they can be transmitted reflects factors including greater concentrations of infectious respiratory particles closer to infected individuals and differences in pathogen-specific factors such as the inhaled dose required to cause infection and the amount of time that a specific pathogen is able to remain infective.

The need to update the CDC guideline on isolation precautions to reflect this more up-to-date scientific view of how respiratory infections are transmitted was one of the important motivations for CDC to ask the Healthcare Infection Control Practices Advisory Committee (HICPAC) to undertake an update. HICPAC is a federal advisory committee appointed to provide advice and guidance to the Department of Health and Human Services and CDC regarding the practice of infection control in clinical settings. CDC plans for updates to the guideline to be accomplished in stages over a period of several years. The first step is to complete a framework document that will be part one of the updated Guideline to Prevent Transmission of Pathogens in Healthcare Settings. The framework provides the scientific foundations that will be used when prevention recommendations are developed for specific pathogens and clinical situations that will be subsequently developed through HICPAC as part two of the guideline.

A draft set of framework recommendations was reviewed by HICPAC in November 2023 and approved by the HICPAC committee for sending to CDC for review. The draft recommendations document is posted on the CDC website at https://blogs.cdc.gov/safehealthcare/november-hicpac-public-meeting-recap/.

Based on the significant interest in the draft recommendations, CDC is taking a proactive step of communicating back to HICPAC some initial questions and comments on which we would like additional consideration before submitting the guideline into the Federal Register for public comment. In addition, CDC is working to expand the scope of technical backgrounds of participants on the HICPAC Isolation Guideline Workgroup and eventually among the committee members through established processes in accordance with the Federal Advisory Committee Act (FACA) regulations and guidance. The expanded workgroup and the HICPAC with the newly appointed members will review and discuss these additional considerations and guideline at the next HICPAC meeting, which is open to the public.

A comprehensive CDC review has identified many positive aspects of the draft recommendations. The draft categorizes transmission pathways into two broad categories, air and touch, each with various subcategories. Within the broad category of transmission via air, the past dichotomy between transmission via large droplets versus airborne transmission via small particles has been eliminated, recognizing that there is a continuum of particle sizes that can transmit infection via deposition on mucosal surfaces and inhalation. The importance of the hierarchy of controls in preventing transmission of infection is clearly described. Although the document does not address engineering controls such as ventilation controls in detail, their importance is acknowledged and a separate, subsequent guideline will address the issue. The importance of anticipating transmission through air and using respiratory protection when caring for those with new and emerging pathogens represents another lesson learned from the COVID-19 pandemic.

The CDC review has also generated questions and comments for HICPAC’s consideration. More detailed explanations are provided below.

  1. Should there be a category of Transmission-based Precautions that includes masks (instead of NIOSH Approved® N95® [or higher-level] respirators) for pathogens that spread by the air? Should N95 respirators be recommended for all pathogens that spread by the air?
  2. Can the workgroup clarify the criteria that would be used to determine which transmission by air category applies for a pathogen? For the category of Special Air Precautions, can you clarify if this category includes only new or emerging pathogens or if this category might also include other pathogens that are more established? Can you also clarify what constitutes a severe illness?
  3. Is the current guideline language sufficient to allow for voluntary use of a NIOSH Approved N95 (or higher-level) respirator? Should the document include a recommendation about healthcare organizations allowing voluntary use?
  4. Should there be a recommendation for use of source control in healthcare settings that is broader than current draft recommendations? Should source control be recommended at all times in healthcare facilities?

We will describe two of them in more detail here, both related to preventing transmission of infection through air.

  1. The first issue is the approach to determining how pathogens that are transmitted via air, but not typically transmitted over long distances (such as through ventilation systems), should be managed. The draft document provides two options for this type of pathogen, “routine air precautions” and “special air precautions.” The main difference between them is that “routine air precautions” are directed toward infections that are common and for most people not severe, for which the precautions specify that healthcare personnel should wear a mask (i.e., surgical mask, face mask [sometimes called a procedure mask] or enhanced barrier face covering) while “special air precautions” are indicated to prevent transmission of infections that have greater or unknown potential to cause severe illness, for which the precautions specify that healthcare personnel should wear a NIOSH Approved N95 (or higher-level) respirator. This aspect of the draft has attracted much public comment because many have interpreted current text as limiting “special air precautions” only to new and emerging pathogens that cause severe, life-threatening disease. There is concern that, based on that perception, SARS-CoV-2 would revert to routine air precautions because, at this time, it is no longer new and emerging. There is also concern that adverse outcomes associated with substantial morbidity, such as long COVID, would not be considered in determining whether to apply routine or special air precautions because they might not be considered as representing severe disease.
  2. CDC believes that it would be helpful for HICPAC to clarify that special air precautions will be applied based on an assessment of risk of transmission and associated adverse outcomes. Important considerations for risk of transmission include: (1) that the pathogen is suspected or known to be transmitted via inhalation but not observed or anticipated to spread efficiently over long distances, such as through ventilation systems. New and emerging pathogens in which the major mode of transmission has yet to be determined but do not exhibit the ability to transmit over long distances can be assumed to be transmitted via inhalation until shown otherwise; (2) transmissibility (i.e., ease of spread as determined by factors related to pathogen, infected individuals, at-risk exposed individuals, contact patterns, and environmental conditions); and (3) burden of morbidity and mortality associated with infection among healthcare personnel, patients, visitors and others. Morbidity and mortality are affected by factors such as level of protective immunity in the population from vaccination or previous infection, the availability of effective treatment, and prevalence of personal risk factors that increase the risk of infection.

Another issue relevant to preventing transmission through air is to make sure that a draft set of recommendations cannot be misread to suggest equivalency between facemasks and NIOSH Approved respirators, which is not scientifically correct nor the intent of the draft language. Although masks can provide some level of filtration, the level of filtration is not comparable to NIOSH Approved respirators. Respiratory protection remains an important part of personal protective equipment to keep healthcare personnel safe.

We thank HICPAC for taking on the challenging task of updating our nation’s infection control isolation guidelines. The COVID-19 pandemic will not be the last one we face. We must be better prepared for the next pandemic and use what we have learned to improve approaches to preventing transmission of any pathogen spread through air in healthcare settings. The multi-year effort to update the isolation precautions guideline is a critical part of achieving that goal.

CDC letter to HICPAC

Attribution Statement:  N95 and NIOSH Approved are certification marks of the U.S. Department of Health and Human Services (HHS) registered in the United States and several international jurisdictions.

Daniel Jernigan, MD, MPH and John Howard, MD, MPH, JD, LLM, MBA

Posted on by Daniel Jernigan, MD, MPH and John Howard, MD, MPH, JD, LLM, MBATags ,

109 comments on “A CDC Update on the Part One Draft update to the Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings

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    A lot of people argue that since “everyone” is out there living their “best lives” and could be catching Covid anywhere else that medical staff don’t need to wear respirators since the patients could have been catching Covid all over the place anyway. This statement rests of several fallacies. First, “everyone” is not out there all the time maskless. Many people are still taking a lot of precautions. They aren’t going to the nightclubs, the bars, the restaurants, the climbing gyms, the dojos, the indoor swimming pools, in person church, city council meetings in person, or any of that. We are wearing n95s when we have to vote in person. We are wearing n95s for Jury Duty. We are wearing n95s for dentist appointments. We are wearing n95s to get our groceries. We are either working from home or wearing n95s all day, every day at work. We absolutely reduce the number of places we are going and we are wearing n95s (and being as vaccinated as appropriate, but the science has shown vaccines do nothing to stop forward transmission, and there’s a lot of symptomatic transmission happening) all the time. So far (knock wood), my family and I have been able to avoid any known Covid infections to this date. I was absolutely concerned I was going to get Covid when I went to the hospital for a routine colonoscopy because it would be the only time I would be partially unmasked and have a “leak” in my n95 (3M V-Flex, if you’d like to know) and it took me numerous tries to get the personnel working with me to mask for my appointment–and they would only wear surgical masks, and Oooooh goodness, was that a nasty process to ask for something so simple. You’d have thought I was asking for their first born instead of wearing a mask for me for the two hours I was there.

    So no. Many people are still taking Covid seriously and not out and about catching Covid.
    And no. Almost none of us have a way to completely avoid health care that we need for emergencies or routine care. Should I skip my colonoscopy? My mammogram? Geeting my skin checked for skin cancer? Stop getting my teeth cleaned at the dentist? Because I need the people working in those positions to help protect me when I go there for medical care. Where I can’t mask (dentist appointment) or have a compromised mask (colonoscopy) or someone very close to my face as they position me (mammogram appointment), unlike when I am grocery shopping or working at my job when I am competently wearing an n95 and able to further distance (to allow air handling to do its job to mix or disperse airborne particles, not because I’m worried about droplets).

    So no. Many of us (still living our best lives anyway) are not out in the community catching Covid, we are taking as many mitigations as possible (like consistent n95 wearing) and the ONLY place we’re likely to catch Sars-CoV-2 is AT the healthcare setting. And we need safe access to healthcare. So please make it safer.

    Immunocompromised patients are continually rebuffed when they ask for reasonable accommodations like having their care provider wear a respirator while attending to them—even in instances where the patient is physically unable to wear any kind of mask themself and are utterly dependent on those around them to protect them from illness such as measles, TB, and Sars2. The patient has to use energy to advocate for the masking, risk being seen as ‘troublesome’, and then deal with being told No after making a good faith effort to be protected. This is shameful on the part of medical providers and the CDC and HICPAC need to be strenuously forceful in correcting this. No one should be catching a hospital acquired infection FROM the hospital staff because they can’t be bothered to mask up. Absolutely egregious and disgusting.

    Healthcare organizations need guidelines that can be easily operationalized and are best practices that are known to prevent the spread of infection. Healthcare organizations are complex and ever changing and the guidelines need to be written and developed to be simple to implement while keeping our workforce and patients safe. A strong focus on expanding standard precautions to include use of respirators and solidifying when it’s appropriate to use a respirator. We should not consider blanket respirator use but offer a recommendation that staff are allowed to use one if they choose to.

    Masks do help. The science of masks is really about the physics of masks. Masks exist in the physical world and the laws of physics apply to them. It is important to be clear that the word “masks” covers a lot of ground, as does the word “facial coverings”. Cloth masks, surgical (‘blue’) masks, kn95, n95, respirator, p100, elastomeric, and more. All these words have specific meanings, and general meanings. So let it be clear that to use the general word “mask” is to cloud the situation. We must begin to separate out these different items and understand what each does and how they do it. Surgical masks (typically blue, pleated, ear loops) have the appropriate material, but the ear loops mean that the material is not secure enough against the face to seal the edges, therefore there will be leakage of air around the edges; these ‘masks’ only help against droplets and some smaller percentage of airborne pathogens. In situations where everyone is wearing them–“universal”–then the accumulated protection of all persons goes into a range where a higher percentage of airborne transmission will be reduced, causing reduced transmission. This is because having a surgical mask on the *infected* person will greatly reduce the amount of contagion released into the air, but not eliminate entirely. Respirators, like the n95, have a much greater ability to reduce transmission because the straps pull the material more flush against the face, disallowing air to escape around the edges. They are more effective when the *infected* person is wearing the respirator, but also very effective for keeping the non-infected person safer. While fit testing would be useful and improve metrics, a non-fit tested n95 is going to out-perform a surgical mask across a population just because of the design of the ‘mask’. It is also important to note that the material in surgical masks and respirators is not just performing a filtering task. Respirators are designed with several different methods being deployed to capture different sized particles–including the size ranges that involve Sars-CoV-2. These include: inertial impact, interception, diffusion, and electrostatic attraction. No policy about “mask” (respirator) use should be accomplished without including experts who understand these concepts. Perhaps the three most important points to make about *why* it is important to understand why respirators are more useful, and universal wearing is more useful are these: 1) Sars-CoV-2 is airborne. Primarily airborne. 2) People without symptoms (asymptomatic) — meaning they will have no fever, no sore throat, no symptoms telling them they are ill–are typically infectious and transmitting airborne particles for around two days before they may become symptomatic, if they become symptomatic at all, telling people to “mask up” after having symptoms is like closing the barn door after the horses got out, most of the transmission has already occurred, and 3) Sars-CoV-2 causes Covid-19, which in the acute phase even for people up to date on their vaccinations causes higher levels of severe illness and death than the virus most commonly compared to (influenza), and in the post-acute phase (more than 30 days after acute recovery) people have greatly increased chances of other health issues such as diabetes, heart attack, stroke, balance/ear issues (leading to falls), vascular problems, brain damage/’fog’, immune system dampening including T-Cell senescence, and death, indeed in many locations more people are dying of Covid-19 than are dying from car accidents. So it is most important that individuals who are entering into the healthcare system for whatever purpose (regular exams, surgeries, or emergency situations, etc.) do not come out of the healthcare appointment with an extra tag-along hospital-aquired-infection that they should not be subjected to because they did not go into that healthcare appointment with a viral infection in the first place, and that viral infection is likely to impact them for the rest of their lives. Knowing all this, and not doing the appropriate thing, is problematic on many levels. First, it is ethically incorrect. There are downstream ramifications to people for catching Covid-19 at their healthcare appointments, even if those downstream ramifications happen sometime after 30 days. Morally, it is repugnant. And eventually the law is going to catch up to this issue; it may take some time, because the law works ever so slowly, but have no doubt that the multitude of comments like this one will be in the public record and there will be no way to say that you were unaware or didn’t know or the science wasn’t yet clear, or were still learning things. There is more than enough sufficient knowledge available and so many people are leaving knowledgeable comments, and there will be cases that cannot be denied because of the evidence, situation, narrative, and derived facts, and there will come a day. It would be so much better that it wasn’t just enormous payouts, but to do the right thing now, so that lives would be saved.

    There is a lot of confusion regarding these issues. My current confusion: are new CDC guidelines targeted at health? Or the needs of the economy?

    I’m reading that upcoming updates to COVID recommendations are as much about “what people will do” as they are about actual health impacts.

    I just had my doctor tell me that if I have mild symptoms, I can be in a small room with coworkers without a mask for several hours, even if a home test shows mild positive. That seems frankly insane to me. If I have no symptoms, I could almost see that, but even then, being in an enclosed space in that way feels risky.

    But there is another aspect of this: while COVID may be much less likely to kill you (and other illnesses may have even less danger), what about the effect on an individual if you contract a non-deadly illness, but have to stay away from work for a week or two? That happened to me recently, and between the cost of a replacement (I’m a sole proprietor) and simply missing being there, it’s a big problem for me.

    Over the years, I would often get sick 2-3 times a year. I improved things like not touching things in bathrooms and being more conscious of the apparent illness state of those around me, and I reduced it to once a year. With the pandemic, and following stricter guidelines, I NEVER GOT SICK. And it was a blessing!

    I finally contracted COVID this month, and while it wasn’t debilitating, there were at least 10 days where I would not be able to work, even if I hadn’t tested solidly positive.

    There needs to be more consideration for this issue; it’s not just about not dying, it’s about not being able to live normally because you lose weeks at a shot.

    An absolutely useless organization and liers. Sending people back to work on day 6! They are still contagious! The situation in schools is out of control since December. The third month and we can not stop the spread of Covid! Extend the quarantine period or exempt schools and medical staff.
    Last year, it was 7 days quarantine, and it did not work. Instead they reduced to 5 days. Where is logic? I had a nurse in the urgent care who was still on day 8 wearing a mask and was allowed to come back to work! The school administration tells you to come back to work in a mask on day 6. In my building all staff has had it. And it does not stop.

    The world should take its lead from science. Knowing that covid -19 is airborne, a super spreader, and potentially deadly; n95 masks should be in place for health care facilities. This should be for all employees and patients.

    People talk about their rights and the freedom to do what they want. However, laws may sometimes supersede these for the betterment of mankind.

    Even though wearing masks would not be a law, it is for the benefit of mankind.

    Sweden never mandated masks (and practically no one there wore them at any point). Sweden also never locked down. Sweden also has far, far, far better public outcomes than the U.S. and other mask and lockdown countries. THAT’S the story, end of.

    As someone who has worked in a long-term care facility for the last 18+years, who has not had covid once to date, and never been fit-tested, never missed a day of work, etc… it disgusts me that anyone thinks it’s appropriate to mandate anything more than a surgical mask in this setting! Visitors and outsiders are allowed to walk in without a mask on, so who are we really protecting, other than ourselves (maybe)? Kids go to school with no mask mandates, no one cares if they get covid/long-covid! But by golly, punish the people who’ve cared for the elderly, through the whole “pandemic” even when family/friends/visitors weren’t allowed in. Mind you, in 18 years ,I can confidently tell you that the people residing in this setting suffered more from not having their loved ones at their side than any of them did from a covid infection. Granted, some lost their lives, some were ill for a short time, while some were totally unaffected. When you look at the big picture, like people living too long and over-using their retirement/Medicare benefits, maybe it wasn’t such a horrible thing. Most of these people have lived their best life, prior to getting thrown in a place like this. More often than not, folks living in a nursing home or assisted living facility are the ones asking (out loud) “why am I still here?”, “why spend my money like this? I wanted my kids to enjoy it!”, “I’m not living, I’m existing, what’s the point?”. But I truly don’t think the entire work force should be punished/mandated to take on more hardships than we already do, on a normal basis. And for more consideration: remember all the low lifes’ who sat home and collected unemployment plus $600 weekly? None of us (working in LTC settings) were them! When do we get our extra $600 weekly for over a year?!?! It’s a disgusting thought! We all make dangerous choices and decisions daily, like driving, crossing the street, etc. So just live and make the best choice for yourselves! If you truly believed these N95 and respirators are going to save anyone, then wear yours and save yourself, don’t worry about me/us/everyone else. If you’re that confident in the mask then you must know as long as you wear yours, you’ll be safe…. regardless of whether someone walking by you does or doesn’t have one on!

    Mask use has become as common as glove use based on the HCWs perception of risk or if a patient has a mask on. These are important lessons learned from the COVID19 pandemic that we just lived through and part of our “new normal”.
    It would be helpful to keep our language consistent and simple and build on what we have and recognize what is in place. I believe the questions/comments in the box are included in transmission-based precautions, respiratory etiquette and the OSHA Respiratory Protection Program. I think it would be helpful to continue to use the same language.
    Mask use (including source control) is addressed with respiratory etiquette.
    Mask use is also addressed with droplet precautions and airborne precautions.
    N95 respirator use is addressed in transmission- based airborne precautions and the OSHA Respiratory Protection Program

    It would be helpful to keep our language consistent and simple and build on what we have and recognize what is in place. I believe the questions/comments in the box are included in transmission-based precautions, respiratory etiquette and the OSHA Respiratory Protection Program. I think it would be helpful to continue to use the same language.
    Mask use (including source control) is addressed with respiratory etiquette.
    Mask use is also addressed with droplet precautions and airborne precautions.
    N95 respirator use is addressed in transmission- based airborne precautions and the OSHA Respiratory Protection Program

    COVID is a disabling and lethal airborne disease. A surgical mask does not offer anywhere near the level of protection as an N95 respirator or a K95 mask. Do the right thing and do not let hospital workers and patients feel lulled into a false sense of security. With 1 in 10 people being diagnosed with long COVID and mortality rates as high as before, how can you sleep at night? There is still time to course correct and make things right.

    Thank you for doing the right thing. Healthcare settings are the ones nobody can avoid forever, and there’s no way we can slow the spread of COVID, and further variants, without stemming transmission however we can. Masks and improved ventilation are the least we can do to protect our most vulnerable citizens.

    Thank you for not accepting the inadequate draft from the deficiently-staffed HICPAC.

    SARS-CoV2 is still among the top contagious diseases year after year, disabling and killing millions year after year. NIOSH-approved respirators protect against airborne infection despite the popular interpretations of certain meta-studies regarding masking and use of respirators. Surgical or procedure masks do not provide anywhere near the same level of protection. (As the CDC is aware: https://www.cdc.gov/niosh/npptl/pdfs/infographic-n-95-508.pdf)

    Many people are unable to wear a mask or respirator. These include infants, people with some medical devices, people with specific disabilities affecting respiratory insufficiency, certain subsets of cancer patients, and others. This fact makes it ALL THE MORE IMPORTANT that *everyone* in healthcare settings who is able to wear a NIOSH-approved respirator mask DO SO at *all times*.

    It is extremely important that the requirement for respirator mask use be in place at all times and in all healthcare settings since many airborne illnesses are transmittable while the infected person is asymptomatic.

    We should not be waiting until AFTER more providers, patients, and other staff and visitors become ill: the CDC should be preventing diseases (especially when there is such an obvious, inexpensive, and simple-to-implement way to do so)

    Keep it simple. N95 or better respirators in healthcare settings. Always. For everyone.

    Fit-tested respirators should be standard equipment for healthcare workers, and N95 respirators can be made available for patients or visitors who do not have their own.

    Please help make healthcare safe for those who need it! And that is all of us, each and every one, because we will *all* need it at some point.

    PLEASE PLEASE require proper masking in ALL healthcare settings. And education about how to wear a mask properly. As science knows, covid and many other viruses are aerosol, like smoke, and a surgical mask does little to protect the wearer or patient. I got sick from a mammogram, since I was wearing an N95 and no one else was wearing a well fitting mask properly. My cousin got covid from a dentist visit. We cannot protect ourselves when we have to remove masks for some procedures, like surgeries, dental and ENTs offices. Proper fitting masks WORK better than anything else to tame this pandemic, which is in no way over. I am now frightened to go to my dentist, fearing for my quality of life! Proper masking needs to be required (maybe a better word than “mandate”) in all healthcare settings, public and private, please. Government funding for improving ventilation in all offices and clinics and hospitals would be wonderful. And the use of CO2 monitors to educate our doctors. Doctors do not have time to research these things on their own, they need to be told the guidelines. PLEASE!!!!!

    We need universal respirator use in healthcare settings. Sars-CoV-2 is airborne. Up to 60% of the transmission is from people who are asymptomatic. Sars2 causes Long Covid and other health issues well after the acute infection has passed. No one should go to a healthcare provider (surgery, wellness visit, emergency visit, etc.) and come away with an infection that could have been easily avoided. The whole point of healthcare is to make people better, not to make them sick. Respirators are not the same as surgical masks and they should not all be lumped in together. Surgical masks are not tight to the face, thus allowing air to flow around the edges; they are good to stop people spitting on each other. Respirators are needed for airborne viruses, which Sars-CoV-2 is a virus that infects through inhalation because it hangs about in the air, because it is airborne.

    I have to say this, just how long do any of you think a pandemic is supposed to last? My learning is pandemics only lasts several years? After vaccines, masks, cleaning of places inside and out (only what your responsible for, like daily house cleaning), and air ventilation how long do you think a pandemic is supposed to lasts? Eventually, you talk about the bad effects of COVID-19 everyday happening to you, you will be the only one! Sure the world still needs help, and definitely need to still take precautions, now you need to think in terms of what will get this thing entirely done and over with? I will be the first to say that I do not not wear masks, yet I definitely take precautions not to contract what is left of the virus whether it was pandemic or post pandemic. A fool I am not! The healthcare settings really need help. Help the staff by telling them what you need and want, respectfully. In return, give those workers some needed help in accurate information like news, CDC news, or suggestions with respect. At this point, many of us could use some nice words and some respect. – Getting over the pandemic.

    Unfortunately pandemics are very long term and slow developing, so “getting over them” only prolongs them and continues the suffering. The American death toll from this is already nearly equal to 400 (!) 9-11 terrorist attacks, with that number increasing by a multiple of 9-11 terrorist attacks every month even with less data collection, 4 years in. And then there’s Long COVID with 2-4M+ Americans out of work from it and increasing owing to multiple repeated infections. As much as we would all like to ignore it (no one wants it to go away more than I do), we can’t in good conscience do so. Should we go back to 2020? Of course not. But “living with COVID” means accepting and adjusting to the reality, not pretending it’s not a problem or is just like any other infectious disease. Would Americans accept recurrent 9-11 terrorist attacks? Of course not. Neither should we accept the current situation.

    Pandemics are often very long term and slow developing events, especially airborne contagious pandemics such as this one. When contagious and in a high-mobility society such as ours, acting like they’re over only prolongs them further. And this one has taken and continues to take American lives in large numbers (a million plus to date and many thousands per year) as well as causing immune damage in most and disability (Long COVID) in many including me. The trend is disturbingly towards immunocompromised like me having to potentially risk my life to go to a hospital. I can exercise the “individual choice” to wear a good mask but hundreds of unmasked or unmasked/sick is a tall order for one mask to overcome, and it shouldn’t be that way. Let’s remember that this is about human life including me, not just human comfort or convenience.

    Other opinions welcome; I think for this pandemic to truly be over and in good conscience fully maskless we need the following (could literally write volumes on the details of “how”):
    1) Vaccines that materially stop transmission and are adaptable to late-stage mutations, possibly nasal vaccines
    2) Engage OSHA additionally to mandate and fund ventilation and indoor air quality, which needs to be front and center in the absence of masks, everywhere really but especially in healthcare, schools, airports, etc. That will help with many things in addition to COVID as well. We as a nation missed a golden opportunity to do this in fall 2021 when we knew COVID transmission was primarily airborne, as this would have judicially succeeded where the attempted vaccine mandate failed. (To wit, the vaccine mandate turned many in the population hostile to safety in general.)
    3) Care accessible to all, including ASAP resumption of the PHE until these other criteria are met — essentially the “social justice” argument.
    4) Understanding, treatments, and mitigations for Long COVID and a slowdown in the number of Long COVID cases.
    5) Casualties and seasonality that are similar to the flu. (In early 2024 COVID-19 is still a long way away from that.)
    6) For this and future pandemics, a legal framework that treats reckless behavior w.r.t. infectious diseases in a similar fashion as reckless behavior causing other types of harm. (This deserves its own post and maybe even its own book, as there are reasonable precedents both in the USA and in Europe, but no pat solution yet.)

    Pandemics last as long as they fit the definition of a pandemic. We are still in a pandemic for Sars-Cov-2. What we do about the pandemic is another thing entirely. But we are still in a pandemic since there is uncontrolled spread and forward transmission in numerous locations. The US has had 6 weeks (going on 7) of more than 2000 people/week dying of Covid. And that’s just what is being counted under a severely restricted definition and extremely reduced testing. So yes, we are still in a pandemic. By contrast, about 826 people in the US die from car accidents per week. So YES, we are still in a pandemic. You don’t LIKE masking, that’s fine. Say that. Say that it is uncomfortable and you don’t want to wear one. That can be true. Say that being comfortable is more important stopping forward transmission because that is your value statement. But do not say we are not still in a pandemic because we are and people are still dying and getting long-term disability.

    Pandemics will only go away and not return when the majority of Americans get the available vaccinations. Until then Covid will continue mutating changing etc..
    Example: Mumps and Measles had been in our vocabulary for years. Schools required the vaccines. In the past years school systems got lax and parents decided they didn’t want the vaccines. We had several regional out breaks.

    The dynamic nature of healthcare guidelines, akin to the iterative process in reflects a commitment to staying abreast of evolving scientific insights. Updating the CDC guidelines on isolation precautions in response to contemporary scientific understanding is crucial for optimizing infection control in clinical settings. This approach, reminiscent of the continual improvement ethos in leading educational institutions, ensures that healthcare practices align with the latest knowledge, ultimately enhancing patient safety and well-being.

    Respirators are those that totally prevent inhalation of the atmosphere around the individual. Surgical mask, KN95, & N95 do not do this. These may reduce the level of inhalation of a contaminate but that is all. And what is the harm of continually breathing back in the very bodily contaminates which are meant to be exhaled. Mask mandate need to fit the specific situation and not an overall sense of protection for all personnel nor circumstance nor area. Filtered fresh air introduced by properly maintained and operated HVAC is needed. For the documentation showing N95 are beneficial, there is an opposing view indicating otherwise. Wearing N95 is a crapshoot.

    With an airborne disease such as COVID-19, mitigation arguments are inherently probabilistic and statistics/data science is just as important as medical science in making population-level decisions. Nothing pharma or NPI is truly 100% — the vaxes are not 100% (especially not w.r.t. transmission and with rapid immunity decay), masks regardless of type are not 100%, though the xx94s and xx95s are pretty good and much better than surgical masks, and ventilation is not 100%. However, all of these are very far away from 0%, including high-quality masks and respirators, so when implemented consistently in numbers, the effect on the overall community health outcome is significant. Healthcare settings are much higher risk than many other places, and given the poor transmission mitigations available from vaxes alone, we cannot afford to concede a “0%” anywhere else especially knowing that we won’t get a “100%” anywhere, and distancing/isolating is no longer in vogue so any deviation from 100% gets “multiplied” by a large number and becomes significant enough to cause harm.

    I am sure that most people who commented here never worked x12 hr shifts in n95 respirators. It is physically and emotionally exhausting, it causes headaches and decreased concentration till the end of the shift. Skin irritation is the problem as well. Hourly breaks should be allowed. Who will provide such breaks for overworked nurses in understaffed facilities? More errors and pt harms will happen if nurses are tired. Many healthcare workers will be forced to leave, because they won’t be able to handle this stress physically and emotionally. It feels like you are in never ending pandemic. Please consider that healthcare workers are a human beings too, not just robots , before implementing n95 for all healthcare settings all the time. We can put all healthcare workers in hazmat suits for even better protection from everything, but for what price? There are mountains of disposable masks in the trash by the hospitals every day. There gonna be even bigger mountains with every-day n95 use. How good is this for our environment?

    Agree that a mechanism needs to be provided for “mask breaks”.

    Maybe this can be mandated in a way that Big Health hires enough (i.e., pays enough) for adequate staffing, else face criminal and civil penalties that are enforced.

    Agree that a mechanism should be provided to allow periodic “mask breaks” for healthcare workers. There are ways to do this that would minimize the danger to patients and other healthcare workers, and possible solution paths are both “medical/science” (example: super-ventilated indoor, or outdoor, break areas) and “economic/legal/capitalism” (examples: expansions of Fair Labor Laws; economic/legal incentives and disincentives for Big Health behavior) in nature. Would like to open the floor to those affected to propose actionable ideas — my taxonomy takes too much ink ; ).

    I wear an n95 mask all day in my job as a dental hygienist. The only time I remove it is at lunch time(I sat in a separate room from coworkers through mid 2023) and at the end of day when changing to leave and am usually alone. I average wearing 9 hours per work day.
    I do not experience physical or emotional distress wearing the n95 masks. They do not cause me to have headaches, changes in concentration levels or additional fatigue. These masks have also not caused me or my coworkers to have skin issues. I do have indentation marks at the end of the day that resolve in a short time.
    I find it is the people who were resistant to wearing n95s from the start that make claims of distress from the masks. Simply mentally accepting the need to wear one when appropriate goes a long way in adapting to them.
    There is no indication in the draft that healthcare workers will be made to wear n95 masks all the time in all settings under normal circumstances. As a healthcare provider you should be willing to take the steps needed to protect your patient’s health and that of your coworkers and yourself.

    Those who need to wear N95 respirators in a physically demanding activity for more than a few hours each day normally should be using a Powered Air Purifying Respirator (PAPR). The CDC however should be focused on a more proactive testing and response to international movement of infectious diseases and pandemics, e.g. look how Japan, South Korea, Taiwan, and Vietnam responded to Covid19 in the Winter Spring of 2020. The USA does not have the production capacity to make N95 mask for everyone. Imported KN95 masks were more affordable and accessible than N95 masks. Any virus like Covid19 that latches on to a universal receptor like an ACE2 receptor has the potential to be a general viral infection causing Multiple Infection Syndrome if the infection incubation period is extended. Any virus that attacks the immune cytokine receptor like the NRP1 receptor is going to delay immune response and could cause a Cytokine Storm Syndrome.

    I totally agree that medical personnel are overworked and aren’t even given the necessary bathroom breaks. We absolutely need improve that. They should be given the breaks that they need so that they are not working exhausted and tired and not up to good performance so that patients get the correct and proper care that they need. And yes, masking takes a little bit extra effort — I know because I have been wearing a mask (usually an n95, sometimes a surgical mask) for entire work days since this start in 2020, so I am living that. (Not a health care worker. I don’t care to catch Sars-CoV-2 and I certainly don’t want to forward transmit Covid to someone who might get really sick or die from it because that is my value system.) But I do get breaks during the day where I go out to my car and get a snack. So YES, we NEED our personnel to get the proper BREAKS that they need. But also, they should still be wearing respirators so that they don’t catch anything themselves (because they will, and some will die from it and some will get Long Covid or some other disability and they shouldn’t have to be burdened like that and have their lives go off the rails) and because their patients shouldn’t have to catch something (so they don’t die from it or get Long Covid and have their lives go off the rails).
    So time to STEP UP, CDC. Do your work, even though it is unpopular. Prevent some disease. Control some disease. Or else change your name and stop pretending you are doing something you are not.

    CDC, please do the right thing, morally and ethically. Potentially fatal and disabling, and extremely transmissible viruses don’t care whether they infect inside or outside of a healthcare facility, or merely thrive in one. Even if universal masking in healthcare helps by a percentage, every human life is worth saving. And it is well documented that COVID-19 has taken millions of lives globally and 1M-plus-plus in the USA, many of them preventably, and continues to be #1 among contagious diseases on an annual basis. I have had disabling Long COVID for over a year, it is not fun and it is not just like the flu.

    90+% of the preceding posts already explain well the scientific rationale for the argument that high-quality universal masking, just like gloves, should be a permanent feature of healthcare infection control safety, as well as an urgent protection need during the ongoing COVID-19 pandemic.

    An aspect of harm that I have not seen addressed here is that reduced aerosol safety in healthcare has impacts well beyond healthcare facilities, as BSL-3 pathogens such as COVID-19, which has caused many millions of global deaths (7 to 36M depending on source and estimation method) and a million-plus and counting in the USA, are then circulated into a community that has largely abandoned NPIs, both culturally and legally. The virus doesn’t care whether it infects inside a healthcare facility or not, even if it originally thrived in a healthcare facility.

    My own family and neighbors have been affected by this. Not only does immunocompromised spouse have disabling Long COVID, but neighbor (only 67yo) caught COVID-19 and 4 days later, on Christmas Day, they had to pull the ventilator from her because they couldn’t do anything. And this was not 2020, but 2023!

    I will also say that the risks associated with current healthcare aerosol safety norms have delayed and impacted presently needed (non-COVID and non-emergency) healthcare and dental care for many including my own family and some of the other posters here, as we feel the harm-weighted risk of COVID-19 infection is now greater than the equivalent risk of postponing the other healthcare. Millions of other Americans, those with immune issues including many with multiple COVID reinfections already at greater risk for Long COVID and with Long COVID already, are in the same predicament. This cannot be good for public health overall.

    This does not even count Long COVID which IMO is the real long-term threat with wide-ranging consequences, and the chance of Long COVID escalates with each re-infection from acute COVID. (For three infections it is something like 40%.) Lower aerosol safety standards may well lead us to an increase in the permanently disabled population (already 2-4M+ Americans estimated out of work from Long COVID, and with re-infections currently raging unchecked this number will surely increase). This cannot be good for public health or the US economy, and we still have a chance to slow it down right now with safe practices and hopefully also with public messaging, cogent explanations with enforcement teeth.

    Furthermore, COVID-19 remains by far the #1 contagious cause of death (cancer, heart disease, etc are umbrella descriptions of many diseases and are not contagious), still a multiple higher than that of the flu according to CDC’s own numbers for 2023, and that doesn’t even account for Long COVID which is not officially tracked. And more Americans have “officially” died to date from COVID-19 (1.15M+), than American deaths in all wars and school incidents combined over the last 100 years (<<1M), including the worst that almost anyone currently alive has seen directly causing American deaths.

    These are real American human lives and families affected. Is wearing a mask in healthcare really worse than this, even if it only helps by a percentage? And on a probabilistic basis, our current approach to aerosol safety in healthcare will not improve the situation. Please do the right thing, morally and ethically, please.

    Please require medical personnel and patients to wear masks when they are interacting.

    Any COVID infection may result in death; with any infection, there is always a high chance of debilitating Long COVID.

    Infectious COVID particles are most effectively transmitted from person to person through the air.

    A recent study concluded that the latest vaccine is only about 60% effective in preventing infection with the current most common COVID variant, JN.1. Older vaccinations and immunity from previous COVID infections had little effect on the rate of new infections of JN.1.

    JN.1 has possibly the highest R (infection ability) value of any know pathogen.

    Positive test results after an JN.1 infection may be delayed 2-3 days, decreasing the effectiveness of informal home COVID testing.

    In a medical situation, social distancing is not usually possible. Outdoor medical appointments rarely occur, and ventilation in older medical facilities is often poor.

    Masks are thus our only remaining realistic defense against medical facility COVID infection. Studies have shown repeatedly that well-fitted masks are effective in reducing the rate and severity of COVID infections.

    I was recently directed to a medical facility waiting room to await a simple vaccination. An obviously symptomatic patient in the waiting room told a nurse she was sick. The nurse asked if she had tested for COVID and the patient replied that she had not. The nurse mumbled something about going to check but never came back.

    After waiting with the sick person 15 minutes past my appointment time for a total of 30 minutes, a nurse appeared to administer my vaccination, directing me to a chair next to an open doorway about five feet from the sick person.

    The building was crowded with patients and medical office employees. I was the only person wearing a mask.

    Now my doctor at this medical facility refuses to renew my blood pressure medicine until I come in for a physical and blood tests. I assess my risk of harm from contracting COVID in such a dangerous medical situation to be greater than my risk from going without blood pressure medicine. When this was explained to my doctor, she offered no solution or compromise. So I will be going without my medicine.

    When it comes to COVID, the judgment of individuals is often flawed. Firm rules established by rational experts are the only solution. Universally required masks in medical facilities is one firm rule which should be established.

    Thank you for your consideration.

    Thank you for not accepting the inadequate draft from the inadequately- staffed HICPAC.

    Many people are unable to wear a mask (e.g., infants, people with some medical devices), so it is ALL THE MORE IMPORTANT that everyone in healthcare settings who is able to wear a NIOSH-approved respirator mask do so at all times.

    It is important to distinguish between NIOSH-approved respirators which protect against airborne infection and surgical or procedure masks which do not provide the same level of protection. (As the CDC is aware: https://www.cdc.gov/niosh/npptl/pdfs/infographic-n-95-508.pdf)

    Moreover, since many airborne illnesses are transmittable while the infected person is asymptomatic, it is important that the requirement for respirator mask use be in place at all times and in all healthcare settings.

    We should not be waiting until AFTER more providers, patients, and other staff and visitors become ill: the CDC should be preventing diseases, especially when there is such a simple and obvious way to do so.

    Keep it simple. N95 or better respirators in healthcare settings. Always. For everyone.

    Fit-tested respirators should be standard equipment for healthcare workers, and N95 respirators can be made available for patients or visitors who do not have their own.

    Please help make healthcare safe for those who need it! All of us will at some time.

    Thank you for sending this back. However, it is urgent that the current members of HICPAC be replaced. They contumaciously ignored public and expert commentary, and are not experts.

    My partner was infected with Covid-19 by doctors wearing “surgical” or “procedure” masks. Twice. We can prove this was where she was infected. This happened despite explicitly requesting a safe environment. This is unacceptable.

    The ONLY acceptable guidelines will require N95, equivalent (FFP2), or better (N99, P100) respirator masks with source control for ALL healthcare workers at ALL times. PERIOD. This is effective. Anything less is malpractice.

    Hello, Thank you for considering a revision to current SARS-CoV-2 measures. I am very worried about the lack of masking in public spaces, especially in medical offices and pharmacies. I’ve recently noticed more and more people coughing as I visited my doctor. Almost the entire lobby was loud with sharp coughs in between the normal sounds. It is difficult to say if all of these cases are covid, though it seems clear that a number of them are experiencing illness at an alarming amount. I can not imagine the sheer volume of medical staff, patients and especially at risk immunocompromised folks about to be exposed this winter.

    Therefore I call that the CDC carefully considers revising the current protocol to acknowledge that a lax view on masking is not beneficial for wellbeing of americans.

    This is a big step. Thank god. No one should have to consider getting sick in their effort to get well by accessing healthcare. We take steps to reduce harm in other ways in both healthcare and other settings; the world has changed and we must either change with it in step, or die from failing to do so.

    I am a nurse who used to work in the operating room before I was disabled by long Covid. The use of N95 masks are crucial to prevent the transmission of pathogenic and/or disabling viruses, such as Covid and HPV. There are more than a dozen carcinogenic strains of HPV, which is commonly encountered through surgical smoke in the operating room, posing a risk to health care workers. Exposure to viruses, of course, isn’t limited to the OR, but it’s illustrative of the necessity of masking.

    There are so many papers in the scientific literature that provide evidence that N95’s are superior in preventing transmission of aerosolized viruses, such as HPV and Covid. There’s also evidence of Covid transmission through the eyes, so at least in a health care setting, it’s recommended to wear protective eye wear, glasses, or goggles. Here are just a few papers providing support for the use of N95’s:


    HVAC systems in health care settings should also be upgraded and tested to reduce virus particles in the air. Remember how we thought that you could have a “smoking section” in a restaurant? The same principle applies to Covid. So many patients have been infected with Covid during their hospital stays. Hospitals should be where people go to receive health care, not to become more ill or permanently disabled. Hospitals aren’t keeping good track of Covid infections in patient populations anymore, so their current numbers are likely inaccurate/underestimates.

    I want to echo everyone here who has said we need N95 or better precautions in all healthcare settings, due to the high circulating levels of the BSL-3 pathogen, SARS-CoV2. As someone at high risk of COVID and long COVID, I want to be able to access healthcare without incurring a severe risk of disability when doing so.

    Hospitals and all other care facilities in the wealthiest nation on earth should strive to halt disease transmission in their spaces. This is not complicated. Everyone in these spaces should be wearing a KN95 mask and every space needs HEPA air filtration and CO2 monitors to validate that the airflow is sufficient. I am a 55 year-old mom of 3 and I have seen more than enough sickness in my life, I don’t understand why repeated mass infection has become acceptable, and cannot believe I need to come here to say this.

    Covid-19 is an airborne virus.

    All airborne viruses are classified in laboratories with designations such as BSL-3 and above. It is imperative that we follow analogous protocols outside the laboratory, especially when these viruses are present in our environment. This includes the use of PAPRs (Powered Air Purifying Respirators), Respirators, and N95 masks, in that order of preference.

    Given the extended incubation periods observed with Covid-19, everyone within a healthcare facility, or any facility where disease transmission is possible, should be considered a potential carrier. This approach is critical for controlling the spread.

    To further strengthen our defenses, there should be a push for more affordable, high-quality PCR tests for home use. This way, healthcare workers can self-test before coming to work. Ideally, such testing should either be a mandatory requirement or should be conducted routinely at the workplace.

    Additionally, the implementation of HEPA filtration systems with high Clean Air Delivery Rates (CADR) must be made mandatory in all healthcare facilities. Such measures are crucial for maintaining a safe environment for both healthcare workers and patients

    I am an RN, one of my duties is Covid Contact Tracing. Healthcare workers were forced to take 3 Covid vaccine during the pandemic. We are forced to continue Contact Tracing after sick pay benefits have been removed, masking had been removed, and barriers have been removed. However we provide direct care unprotected every day.
    You know Covid exposures are happening everywhere, everyday.
    Employees show up everyday sick with Covid exposing their coworkers and patients.
    Now with the new updated 2024 guidelines and new covid variants there will most like be another surge in Covid exposures. I implore you to reinstate masking 😷, Covid pay for Healthcare workers to allow them to stay home while they are ill for at least the 5 mandatory days.
    It’s obvious Covid is not going away any time soon. It’s obvious there are protective measures that do slow and decrease risk of exposures. We can’t control public behavior. However something must be done to protect our Healthcare Employees since OSHA regulations have not changed or reviewed to concur with State regulations.
    Frustrated 😠 not taking care of Healthcare workers leaving the industry due to bad guidelines not providing protection for US.
    Stop the political grand standing 🧍‍♀️

    I applaud the CDC for taking a second look at the HIPAC recommendations. I encourage the CDC to appoint the proper number of members to the committee as required by law and constitute it with experts from across the country with a diverse skill set. This committee should include experts in aerosol science , industrial hygiene, environmental air control, as well as experts on chronic diseases, such as Long-Covid. These experts should not only come from diverse backgrounds but have diverging points of view that lend to vigorous debate. The committee currently has two members, including the chair, (20% of the committee) who have, at the very least, demonstrated a pre-bias to the outcome as evidenced in their June 2023 published article in Annals of Internal Medicine. Worse, they have used this platform to further a fringe, ill-advised opinion and stance, not firmly rooted in science, that is not shared by a large portion of their peers. These two individuals should be replaced in order to restore public confidence in the eventual codification of the recommendations.

    As a health care leader, I implore you to ensure hospitals are safe for all. Our system knows we are actively infecting colleagues and patients and will not do anything different unless the CDC requires it. Please use the science and require n95 masks in all health care spaces at all times. Add air cleaning requirements and hold hospitals accountable for hospital associated COVID infections.

    Agree, our most vulnerable populations ie: transplant and cancer patients deserve care free from the risk of contracting COVID. Not all healthcare facilities have private rooms and these new guidelines need to be carefully reviewed to protect ALL patients. We know this is an airborne virus yet to change it to be the same as flu and RSV which are droplet viruses is dangerous. Will you also be changing the guidelines for measles and chickenpox? They are airborne viruses as well. Airborne and droplet are NOT the same.

    Hello, I strongly urge you to require N95 masks for all healthcare workers in any setting. There are many people who are extremely vulnerable, with asthma and chronic illnesses, congestive heart failure, heart disease, cancer, kidney disease, and more. Every time someone goes to the doctor, they are put at an unfair risk, and so the choice between go, and get the care you need, with a risk of Covid or RSV or flu or other respiratory viruses, or don’t go and get the car you need. It’s appalling that people could become ill, possibly seriously ill, just from visiting a doctor.
    Please in instate a permanent mask mandate for all healthcare settings.

    Healthcare workers should be required to mask at all times. Patients entering healthcare facilities should also be required to mask, with masks provided. These masks should meet minimum filtration guidelines such that they are not simply performative, which means they should likely be at least NIOSH approved N95 respirators. N95 respirators should be viewed similar to hand washing guidelines and equipment sterilization – i.e. the bare minimum. We need to make healthcare facilities safe for all to access and reduce disease spread in areas that both healthy, those with chronic illnesses, and actively sick people need to congregate. Masks are a bare minimum and an easy update for the CDC. This should be permanent policy.
    Healthcare facilities should also be required to invest in improved air filtration, Far UVC, and ventilation such that a sufficient number of clean ACH is achieved in all locations. We are capable of dramatically reducing all airborne transmissions with these steps. Other than cost, there is no reason not to invest in protecting healthcare workers and patients. Let’s treat indoor air quality with the same rigor we have for water quality or food contamination.

    Universal masking in ALL healthcare, please!
    My infant is too young to mask and I’m terrified of them catching germs anytime we need medical care.

    What about the Hippocratic Oath???!!!!

    There should be disciplinary actions taken against staff members that are not following the hospitals rules especially the department heads. It is beyond obnoxious that healthcare workers would behave this way. As a dental hygienist I have been wearing masks at work for decades and have never had a real problem with wearing them. Before Covid we wore them during patient care. During the initial Covid outbreak we wore n95 masks at all times in the office. Sadly many in dentistry have ended all day masking and went back to just surgical masks(or worse, exam masks) for patient care. I continue to wear an n95 at all times.

    Yes there should be required masks in healthcare facilities. I also think the vaccine should be mandatory for all healthcare workers. I have long covid and I’m scared to go out anywhere because no one wears a mask

    We have just experienced the second highest peak in wastewater levels for the entire COVID pandemic and it just baffles me how we keep taking regressive steps when it comes to the mitigation of pathogen transmission in healthcare facilities. By now, it should be clear to those who follow the science that COVID is airborne, can be transmitted asymptomatically regardless of vaccination status, is more than just a respiratory illness given the ability to cause multisystem organ damage (1 in 10 COVID infections lead to Long COVID), and will not cease to circulate at high levels for most of the year until more efforts are made to curb transmission.

    Given all this, I find it alarming that healthcare facilities, the very institutions we as a society entrust our health and well-being to, have been dragging their feet in acknowledging the value of masking and air filtration. It is still a pity that many still think surgical masks are better than N95/K95 masks, or more alarmingly, that it is ok to treat patients maskless altogether. It really should not be the case that a patient goes to a healthcare facility to treat one illness and comes out contracting another (perhaps more debilitating) illness. That makes zero sense. The reality is this: If healthcare facilities do not set the right example of properly mitigating pathogen tramission, no one else will. Change needs to come from these places first before having any shot at any real progress in society as a whole.

    One last thing for the CDC: please model proper behavior yourselves. It was an embarrassment that your own conference became a super-spreader last year and it is quite horrific that the CDC director keeps posting photos of going maskless at events without acknowledging whether any precautions were taken beforehand. Please separate the politics from public health, please. You are devaluing the very same things you advise people of with contradictory, and frankly headscratching, behaviors.

    N95 masks have been shown to reduce the spread of infectious disease in hospitals. It is incredibly frustrating to be a parent of a medically vulnerable small child and told that her hospital providers are not required to mask. Parents want masks in hospitals to protect their small children.

    This clear, reasoned post and the letter from Dr. Kallen to HICPAC are so heartening. Respiratory protection should no longer be controversial, given what is known about SARS-CoV-2. May the CDC persevere in crafting cogent new guidelines.

    Thank you for reconsidering. COVID is airborne. We are in the second highest wave of the pandemic largely because of the loosening of precautions in healthcare settings. Every nosocomial infection is an unacceptable failure. No one seeking healthcare should be worried about coming out in worse health. Healthcare workers should have the best protections from all airborne pathogens year-round, permanently.

    Thank you for reconsidering. COVID is airborne. We are in the second highest wave of the pandemic largely because of the loosening of precautions in healthcare settings. Every nosocomial infection is an unacceptable failure. No one seeking healthcare should be worried about coming out in worse health. Healthcare workers should have the best protections from all airborne pathogens year-round, permanently.

    4 years into the ongoing SARS-COV2 pandemic, amidst its second highest wave as documented by wastewater signals — where asymptomatic individuals are transmitting a disease that has undeniable negative downstream impact on the brain/vasculature/vital organs and where rapidly waning vaccines do not provide immunity — that air cleaning technologies and use of N-95 masks in all health care settings (hospitals, outpatient facilities, pharmacies, etc) are not required is stunning, given the volumes of research proving beyond any doubt their effectiveness.

    HICPAC/CDC must make healthcare safe for patients and health care providers by requiring respirator use in every healthcare setting. The lessons of Ignaz Semmelweis and John Snow should be foremost in the minds of those charged with responsibility of protecting the health of the public.

    Thank you for confirming that COVID-19 is airborne, that respirator masks (such as N95) offer significantly better protection that surgical. Agree on the need to clarify that long COVID also be taken into consideration when assessing threat level and precautions for pathogens. I’m confused a bit by your uses if the phrase “short distances”, as we know that Covid can spread over long distances and through ventilation systems, and I couldn’t quite understand if that’s what you are saying here, but yes that long distance and through ventilation systems spread needs to be considered and accounted for in this control of infectious disease update. Universal N95 is necessary in healthcare spaces that share ventilation because if long distance spread, long Covid as well as acute Covid risks, a high number of at higher risk people in both general population as well as (and especially in) hospital population, high infectiousness, high prevalence, and presymptomatic spread. Also I’m glad HICPAC will be expanding its membership to include a more diverse knowledge-base, hoping this includes industrial hygienists and people outside of hospital admin. roles to get a more balanced viewpoint.

    High quality masks should be recommended in all public settings and absolutely required in healthcare! Universal masking and clean air policies will help every single person, especially the clinically vulnerable who have been excluded from healthcare and public life for over 4 years now. These policies need to follow the science.

    The decision to not mask and to not use proper respirators appears either willful ignorance or malfeasance. Are these guidelines made with public health in mind or merely a way for corporations to scapegoat liability despite the low costs required to use n95s and adequate ventilation? Are corporations the new citizens and the citizens their new fodder? 30 million Americans disabled by this virus in one way or another and this is the response? Are my children next? This is horrific.

    It is utterly deplorable that almost 5 years into a pandemic and this is still an ongoing issue. This isn’t a lack of education, people just don’t want to listen.
    It’s unacceptable that the CDC guidelines have become significantly less strict as the pandemic goes on. We are currently in the second largest surge of covid with 2 million cases per day. People should not be returning to work after 5 days, they should return back to work when they test NEGATIVE and the state mandated pay for that time should be implemented once again.
    Masks are incredibly important and should be worn by all participating members of society. This is an airborne virus, and risk of exposure is so high right now, that it is no longer safe to wear the basic surgical masks anymore, an N95 is.
    If we are going to remain open as is, business as usual, then EVERYONE needs to mask again.
    Masks should be required in all Healthcare facilities by patients and workers.
    People who handle food should also be masked because it’s just common sense.
    Clean air ventilation and filtration systems should be implemented in all closed air facilities such as schools, hospitals, airplanes, restaurants, concert venues, etc. in order to minimize exposure.
    Thank you to those of you who had public outcry and asked the CDC to revise these guidelines. Thank you to those of you who take this life threatening virus seriously because it is serious!
    Public health should come first, NOT the economy.

    Seeing as we are now approaching year 5 of a global pandemic, it is utterly unacceptable that masking has been thrown on the back burner and the CDC guidelines have become significantly less strict in order to accommodate our capitalistic society. There is still a life threatening virus in our midst and it’s not being taken seriously, even by the CDC themselves. With that being said, I appreciate that this draft is being revised because of public complaint. Thank you to those of you that are treating this as a vitally important cause for public health and safety, because it is!
    Masking should be required nationwide again, and clean air filtration and ventilation systems should be implemented in all closed air facilities (supermarkets, hospitals, schools, airplanes, concert venues, etc). If the nation is going to remain open, as is, then the people should be required to do everything they can to prevent the spread of infection.
    PCR tests should be readily available and accessible at a much lower price than they currently are and rapid tests should be free and accessible to all.
    Healthcare professionals and patients should absolutely be wearing N95 masks or better considering this is where our most vulnerable will be.
    People handling food should also mask to lessen the spread of the virus.
    Also, bringing back state mandated pay for 2 weeks while people recover should also come back.
    Basically, masking and updates to clean air filtration should be an incredibly high priority.

    Public health should come first, NOT the economy.

    Thank you for this post and for acknowledging the airborne spread of COVID-19/SARS-CoV-2. Please work with HICPAC to require respirators (N95 or better) in all healthcare settings—hospitals, inpatient and outpatient clinics, and pharmacies—for staff, patients, and visitors, regardless of vaccination status.

    Please make it clear through policy and public outreach that the CDC itself has classified COVID-19/SARS-CoV-2 as a biosafety level three pathogen, meaning it can cause serious and potentially lethal disease through inhalation. Please find a way to educate the public that COVID-19/SARS-CoV-2 is airborne and is one of the most contagious diseases humanity has ever had the misfortune to contend with.

    Clear and comprehensive masking requirements can go a long way toward helping us protect one another, especially in healthcare settings where vulnerable people must congregate and illness is by nature more concentrated and likely to spread. Another commenter in this thread said it well: “Respirators belong in healthcare across the board just like gloves do. HICPAC/CDC can avoid confusion and make healthcare safer by making it a blanket requirement.”

    This is year five of the pandemic, and we’re currently in the second largest wave of disease so far. Approximately 2,000 Americans are dying each week from COVID-19/SARS-CoV-2, and yet I’m seeing less masking than at any other stage in this continuing calamity. When I go to the doctor’s office or pharmacy or hospital, I’m often the only person wearing a mask. Even my doctors don’t mask anymore, never mind the scores of coughing patients. Masking with respirators should be as commonplace and indispensable to healthcare protocol as hand-washing. The CDC should be making it clear to the public that the best way to protect one another is to wear a respirator when sharing air with others.

    Experts know COVID-19/SARS-CoV-2 is airborne. Experts know it’s deadly. Experts know it’s not “just a cold or flu.” Experts recently testified to Congress that the disease has vascular, systemic components that can lead to chronic illness or death, even if the acute stage of the infection is mild or asymptomatic. It’s the CDC’s job to translate that expert knowledge to the public: to lead, to educate, to set the example for best practices in public health.

    Please inform people how to best protect one another. Please make policy that clearly flows from the fact that COVID-19/SARS-CoV-2 is airborne, that it wafts through and hangs in the air like invisible, odorless smoke, and that we spread it by breathing near one another. The policy flowing from those facts should require us all to protect one another from our breath by wearing respirators—a simple, inexpensive, and very effective defense.

    Two days ago, the CDC director posted a photo on Twitter of a CDC conference, showing 44 attendees smiling shoulder-to-shoulder. Only one was wearing a mask. Again, this is at the height of the second largest wave of disease in this pandemic so far. This is when 2,000 Americans are dying each week from COVID-19/SARS-CoV-2. For the CDC to set an example of gathering closely together unmasked in an indoor setting while thousands die from a rampantly circulating airborne disease is a dereliction of duty. And that was just a conference, voluntarily attended. To not require basic precautions to keep the air as disease-free as possible during an airborne pandemic in healthcare settings that host an unavoidable concentration of both illness and vulnerable people is even more egregious.

    You opened this blog post by saying, “The COVID-19 pandemic has forever changed the approach we take in healthcare settings to protect healthcare personnel, patients, and others from transmission of respiratory infections.” But from my vantage point, as a member of the public looking to the CDC for guidance throughout this pandemic, I haven’t seen many changes implemented in my day-to-day life as a patient, and the trend seems to be going in the wrong direction. Every time I access healthcare, I must weigh the risk of catching COVID-19/SARS-CoV-2 at the very facilities I frequent to address the other healthcare challenges I already face. More and more often, I’m the only one in a mask. I’m definitely the only one in a respirator/N95. I cannot put into words how disheartening and alarming that is as we enter year five of this ongoing crisis.

    Thank you for reconsidering! Many of us want masks and air filtration & ventilation in healthcare! *You* should want these things too! They help control the spread of disease!

    Agree that the guidelines need to be revised as a whole, not piecemeal. Healthcare workers need to be able to go to Appendix A and find out exactly what type of precautions are indicated for any disease condition, and this information should be available upon release of the updated guidelines, from the start.

    There also needs to be clear guidance on what to do if AIIR is indicated (say for COVID), but actually isn’t available, as in most of the skilled nursing facilities across the nation. That is a big “disconnect” for a lot of healthcare workers.

    We need clear and universal requirements. My mother was just hospitalized and had to endure an ER with both known COVID positive patients who were unmasked and HCW who were inconsistently masked. They were triaging and testing suspected COVID cases in the waiting room. For our protection, we both wore elastomeric masks, and I stayed by her side for six hours because she is not well enough to mask on her own. I actively advocate for HCW to mask around my mother, but not everyone has an advocate who will fight on their behalf for their safety.

    The fact is that seniors are dying of hospital acquired infections and those of us who recognize our own risk and that of our loved ones are avoiding and delaying care because our hospitals and healthcare offices are extremely high risk and lack mitigations. The only ethical approach to delivering healthcare is to deliver it as safely as possible. This requires universal masking in all medical facilities, SNFs, senior facilities, home health environments, eye care, dental care, PT, hearing and speech practices, podiatry offices and pharmacies, regardless of vaccination status.

    HICPAC/CDC need to make accessing healthcare safer for all by requiring respirators for healthcare workers as well as universal masking for everyone in a healthcare setting. Also provide guidance for improved ventilation and clear and concise education about Covid, its infectiousness, its vascular nature, and the dangers of long covid.

    Thank you for considering a revision. Yes, N95 respirators should be recommended for all pathogens spread by air. Masking in healthcare is so important – critical for infection control and patient safety.

    I am so glad that the CDC will be including broader expertise on the HICPAC committee. As constituted at the time of the recent draft, it was entirely a single discipline of expertise. No wonder it rendered a draft that was unacceptable.

    At least 60% of infectious disease spread is caused by asymptomatic or pre-symptomatic carriers. Combine this with the fact that Sars2, Flu, Measles, and RSV are all transmitted by close range AND long range infectious aerosols (particles that hang and linger in the air for hours) and it’s incomprehensible that the standard of care recommended was not universal and consistent N95+ respirators for all health personnel and patients. You can’t wait until an infectious disease is suspected to use an N95 if more than half of carriers don’t yet show symptoms.

    Just as universal glove wearing and hand washing is the standard of care because of blood-borne diseases like Hepatitis C and HIV, clean air and fit tested N95+ respirator use should be the standard of care, at all times in all clinical settings.

    N95 respirators or better for all HCW, patients, staff, and employees in all patient and HCW settings to prevent airborne acquires infections for all. This should be standard precautions immediately. Update the 2007 universal precautions now. We will not accept “enhanced” diminished sub-standards of care that cause public, patient, and HCW harm.

    NIOSH approved N95 respirators (or better) should be required in all healthcare settings for airborne pathogens. Their use should not be left to voluntary choice, it should be compulsory.

    The CDC’s role is to protect public health and as such it should be upholding protections that are in the best interest of the health and safety of all (healthcare workers, patients and the general public).

    Lower quality masks in these settings is tantamount to not using gloves or sterile instruments when administering care. Thank you for reconsidering a dangerous downgrade in protections.

    The CDC is supposed to be the leader in public health. We’ve learned a lot over the past decade, especially over the past four years, about how to avoid infection and transmission — masking, ventilation, cleaning, isolation, etc. Why do these guidelines take us back to the “before times” when we now know how to protect patients and staff from airborne illness. I’ve learned to avoid healthcare now, and pray that I won’t need more serious care in the near future.

    The fact that mask use is not mandatory in American hospitals during SARS-CoV-2 surges like the one we are currently in, is insane. Other countries like Italy, Spain, facilities across Asia, and Australia, they all require masks to protect their citizens from the pandemic we are in. The CDC is failing Americans and it is a shameful thing to witness.

    The fact that mask use is not mandatory in American hospitals during SARS-CoV-2 surges like the one we are currently is, is insane. Other countries alike Italy, Spain, facilities across Asia, and Australia, they all require masks to protect their citizens from the pandemic we are in. The CDC is failing Americans and it is a shameful thing to witness.

    Fear of Public scrutiny and fear of voters and political leaders over basic masks is what’s killing people and our country. It’s time to take a stand for what’s right. If you’re scared to do the right thing, that’s a problem.
    To take politics out of the picture, Why not put this topic on the general ballot for people to vote upon. I do believe the majority of Americans want protection in our healthcare. I think enforcement of these rules and practices must be implemented. If the voters approve the changes, I believe enforcing it will be easier. Thx for opening this decussion .

    All hospitals should upgrade filtration to filter respiratory virus aerosols and droplets and mandate masking for patients and workers in healthcare spaces.

    N95 or better masks need to be required for ALL healthcare workers and patients in ALL healthcare settings. Safe access to healthcare is a right everyone deserves to have, including those who are at increased risk of death or severe illness from Covid-19 and other airborne pathogens. No one should be forced to risk an infection that could cause serious, permanent harm or death while obtaining healthcare services. The vulnerable are not expendable.

    Thank you for taking a step back to revise the guidelines! I believe masking (n95 or better) and clean air are especially important in healthcare settings, and I hope you agree.

    Thank you for considering making health care safer and more accessible for all of us! Respirators should be a requirement in all medical facilities, we should be able to receive care while not being exposed to deadly viruses and pathogens.

    High-quality, well-fitted respirators should be mandatory in any healthcare setting, especially hospitals. Surgical masks do not provide adequate protection since COVID-19 is airborne. People should not have to risk their lives and well-being to receive and provide essential healthcare. Nosocomial infections have always been an issue within the United States. Since the beginning of the ongoing pandemic, the severity of this issue has only grown. We should be doing everything in our power to make hospitals and other healthcare facilities as safe as possible for everyone. We also need to remember that COVID-19 is not the only disease that can cause harm. The flu, a common cold, and other infections can pose a serious threat to anyone, especially vulnerable populations (elderly, immunocompromised, disabled, cancer patients, etc.) Stop being cowards and do the right thing. COVID-19 is dangerous, stop the spread.

    Make healthcare settings safe. There is nothing but benefits if Thank you for reading my comment. All need to mask in healthcare. The cost of supplying masks (respirators), is negligible compared to paying triple time for traveling healthcare or overtime due to losing staffing from long term for covid disability or short term illness. Nevermind skipping the social, health and emotional benefits of a safe workplace and healthcare service. No one should come home sick with a new illness. We had bloodborne pathogen protocols why not aerosol?

    Thank you for taking this feedback seriously. We want real, science-based infection control against airborne pathogens at all times, not just when the hospitals are overflowing. No one should become more ill seeking care.

    As a senior, with multiple co-morbidities for adverse outcomes with airborne diseases, not least of which is SARSCov2.

    I am begging you for safe access to healthcare. I should be able to have access to my practitioners, ER, and hospitalizations without further harm from caregivers.
    What ever happened to first do no harm?
    My providers and facilities need to provide clean air, sanitation, and protection for their patients by wearing N95 masks, properly!

    These same providers, follow your guidance, yet you need to give it.
    Will I be regulated to being just another empty chair, over a few mitigation measures?
    Right now I have absolutely no choice, but to pray, this procedure, visit, care (ha ha) will not be the time, that cost me another disability or my life.
    Please require masks in healthcare and save our lives.

    Thank you for revisiting this dangerous policy. Expanding input to include aerosol scientists is critical. Masks should be standard throughout healthcare. N95 in setting where patient must unmask (dental care, surgery, infant/toddler care etc.).

    Healthcare workers and their patients deserve to be safe when providing and receiving care. It’s unacceptable that we would knowingly weaken guidelines that we know protect providers and patients. It’s important for the CDC to set the example.

    Thank you for reconsidering your policy. As our most vulnerable are still the most at-risk for adverse outcomes with a COVID infection, and our most vulnerable are the most likely to need to go to healthcare facilities most frequently, it is in their best interest that we do what we can to protect them. Masking and air purification/filtration are of utmost importance until we can find treatments for long covid and better vaccines to prevent covid. Requiring masking and air purification has shown to reduce work related illness which also can reduce employee absenteeism, which would help to reduce the strain on the healthcare profession. This is not only in the public’s best interest, but it’s also good business sense.

    CDC guidance should require all people working in public settings to wear a NIOSH approved N95 mask, and should provide them free to the public so they may also wear them to protect their health and the health of their community. The bare minimum would be to require healthcare professionals to wear N95 respirators instead of inferior surgical masks. This pandemic would have unfolded differently if our government had spent money and energy to educate the public about how to prevent catching an airborne pathogen, spent money to produce and give masks to the public for free, and spent the money required to install proper HEPA ventilation in buildings. I honestly am shocked that people have not begun filing class action lawsuits against the government for their inaction. It has affected millions and millions of people.

    Politics isn’t science. The Science is resoundingly clear that COVID is dangerous regardless of the severity of the acute infection and mandatory respirators/ventilation is the only defense against transmission, and politics is resoundingly clear that it wants you to ignore that. Please listen to the science.

    Clean air is essential in health care settings to mitigate the spread of pathogens. The updated draft must reflect this, emphasizing universal masking (N95 or better), along with air filtration and circulating outdoor air.

    Just like how clean water and gloves are used in medical settings, we should ensure healthcare workers, patients, and guests also have clean air and use well-fitted respirators (e.g., N95, KN95, KF-94) to protect everyone. We don’t have to live how we are now with patients seeking care and staff getting infected over and over. This is preventable. Less infection means better health outcomes for everyone! Hospital staff shortages will only get worse if more HCWs become unable to do their jobs effectively or leave due to the immense unnecessary stress from hospitals being overwhelmed (which is directly related to Covid and illnesses resultant from long term effects of Covid).

    I don’t need the government to tell me what to do or not do. We are educated people who can figure this out on our own.

    Great news. N95s should be the standard in healthcare going forward – it makes no sense to roll back everything we learned from the brief period where we had consistent masking.

    My wife, 67 years old, obese and diabetic, is recovering from Covid after
    having a rebound. I tested positive on 1/22, and I’m now taking Paxlovid.
    Should I continue to isolate since she has already had

    Hello, are companies required to keep any of their old Covid Policies on file? Our company amassed about a dozen or so Covid policies over the years with all but one (our most recent) being outdated/no longer relevant.
    Thank you!

    I feel that if health care workers have to wear a mask with patients, then when patients enter health care facilities ALL health care facilities, patients should also wear a mask as well.

    Disappointment describes that this DRAFT update is not an update of the whole Guidelines which is long past being overdue.
    Advancements in cleaning and disinfecting, how to utilize adjunct technology, additional aspects of caring for patients on precautions.
    What are they waiting for. It the job of whole guideline revision done instead of piece meal.

    This needs to be readable for the layperson – with clear FAQs about things average humans care about – such as

    -To mask or not? Why or why not?
    -Isolate or not? Why or why not?

    This is not digestible for the average American. It needs to be “translated” into layperson’s terms to better serve the public. This reads more like a scientific paper and has no way to skim through for key points. It needs to be revised to be tighter, clearer, and usable.

    Thank you for considering revising these guidelines!

    For the sake of public health (and the economy), please require masking in all healthcare settings.

    Masks do not help!!! If you want to wear one, wear it and protect yourself. I agree that if you are going to a healthcare facility and you are sick, you should wear one and I realize not all people are honest or will, but I believe if masks are provided the majority will. That was a big part for us because we are anti mask, going into my orthopedics office we weren’t permitted without a mask but yet they didn’t provide them. That was an issue

    how we end covid: by helping relieve stress on Coral with complex sound, affecting Climate Change and Air Quality. this is how we end covid.

    Incredible news! Respirators and clean air belong in healthcare, pharmacies, and outpatient care centers regardless of vaccination status.

    Respirators belong in healthcare across the board just like gloves do.

    HICPAC/CDC can avoid confusion and make healthcare safer by making it a blanket requirement.

    Agree! This is promising. Let’s make a lead forward in infection prevention, not backwards! You can do it CDC!

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Page last reviewed: February 23, 2024
Page last updated: February 23, 2024