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1. Experts say it’s not yet time to take off masks in the health care setting
Abstract: https://www.acpjournals.org/doi/10.7326/M23-1190
URL goes live when the embargo lifts
A new commentary from infectious disease experts at George Washington University School of Medicine and the National Institutes of Health (NIH) says for patient safety, masking should continue in health care settings. This message conflicts with a recent commentary from authors from 8 U.S. institutions suggesting that the time for universal masking is over. The commentary is published in Annals of Internal Medicine.
Masking has been a controversial mitigation strategy during the COVID-19 pandemic because high-quality evidence of efficacy is lacking and because the topic has become highly politicized. Regardless, real-world experience demonstrates the effectiveness of mask-wearing in clinical settings where data shows that transmission from patient-to-staff and staff-to-patent, when both are masked, is uncommon. Since health care personnel report being driven to show up for work even when they are ill themselves, the argument in support of mask-wearing becomes even more compelling.
Those without symptoms may also transmit respiratory viruses, particularly SARS-CoV-2. While the Omicron strain has been milder, infection could still cause severe or life-threatening disease or prolonged illness if transmitted to at-risk patients, such as the elderly or immunocompromised. With the still-looming risks, now does not seem the time to take off masks in the health care setting. Instead, the authors advocate strongly for continued mask use for infection prevention.
Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author David K. Henderson, MD, please email dhenderson@cc.nih.gov.
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2. Updated evidence suggests masks may reduce risk for SARS-CoV-2 infection in community and health care settings
A beneficial effect of N95 respirators in health care settings could not be ruled out
Abstract: https://www.acpjournals.org/doi/10.7326/M23-0570
Editorial: https://www.acpjournals.org/doi/10.7326/M23-1120
URL goes live when the embargo lifts
The final and major update to a rapid, living review of published evidence suggests that masks may be associated with a small reduction in risk for COVID-19 infection in community settings versus no mask use and both surgical masks and N95 respirators may be associated with similar infection risk in routine patient care settings. However, a beneficial effect of N95 respirators could not be ruled out in the health care setting. The review is published in Annals of Internal Medicine.
In June 2020, Annals published an initial living review of research on mask use which found insufficient evidence to determine effects of masks on COVID-19 infection. The initial review was followed by eight brief updates that found low to moderate strength evidence for an association between mask use and decreased risk for SARS-CoV-2 infection in community settings, but evidence on N95 versus surgical masks in health care settings and risk for COVID-19 infection remained insufficient. This 9th and final review is different because it includes enough evidence to be considered a major update.
Investigators from Oregon Health & Science University reviewed three randomized trials and 21 observational studies to update an evidence synthesis on N95, surgical, and cloth mask effectiveness in community and health care settings for preventing SARS-CoV-2 infection. The authors found that mask use may be associated with a small, reduced risk for COVID-19 infection versus no mask use in community settings. However, they note that that the interventions, settings, and populations included in the reviewed studies varied and adherence was suboptimal, which may have impacted outcomes. The authors note that trial and observational studies of surgical or N95 mask use compared with no mask were imprecise or limited, with evidence on other mask comparisons in health care settings remaining insufficient.
An accompanying editorial by Annals Editor-in-Chief Christine Laine, MD, MPH and Deputy Editor Stephanie Chang, MD, MPH provides important context for understanding why recent evidence reviews do not provide a definitive answer about the benefits of masking. Studies vary widely in what they are designed to determine, such as the effectiveness of masks at preventing viral penetration or the effectiveness of masking recommendations. Because these studies are conducted in the real world where infection risk-reduction strategies also vary, it may be difficult to determine the effectiveness of a single component of that strategy. And finally, the authors say we must be explicit in weighing benefits and harms. While some may consider any evidence of benefit sufficient to justify masking, others believe that inconvenience, discomfort, or communication impedance outweigh small benefits. To get to the truth about masking, the authors say it is imperative to design studies that fill information gaps, interpret the evidence accurately, and are honest about what we do and do not know.
Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author Roger Chou, MD, please contact Erik Robertson at robineri@ohsu.edu.
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3. Adding a single data point to COVID-19 reporting may more accurately convey the real-time burden of infection in health care settings
Abstract: https://www.acpjournals.org/doi/10.7326/M23-0618
URL goes live when the embargo lifts
In a new ‘Medicine and Public Issues,’ authors from Tufts Medical Center, Veterans Affairs Boston Healthcare System, Harvard Medical School and the Massachusetts Department of Public Health advocate for the inclusion of both the total number of COVID-19 hospitalizations daily and the number of inpatients who received dexamethasone at any point during their hospital stay. The authors emphasize that the addition of this data element is an easy and much-needed update to COVID-19 surveillance efforts that may help to more accurately convey the real-time burden of a rapidly changing infection in health care settings. The article is published in Annals of Internal Medicine.
On 10 January 2022, the Massachusetts Department of Public Health (MDPH) began requiring hospitals to expand surveillance to include reports of both the total number of COVID-19 hospitalizations daily and the number of inpatients who received dexamethasone at any point during their hospital stay. This requirement was added because dexamethasone administration had been shown to be highly correlated with disease severity and was sensitive to the changing epidemiology of new immune-evasive COVID-19 variants.
The authors highlight that the purpose of the ongoing requirement by the MDPH to report dexamethasone is not to minimize pandemic impacts, but to instead understand the ongoing burden of the pandemic in the setting of a changing landscape of population immunity and viral variants. The authors point to COVID-19 data collected from all 68 acute care hospitals in Massachusetts between January 2022 and January 2023, which show that the proportion of persons hospitalized for COVID-19 who received dexamethasone decreased from 49.6 to 33 percent. According to the authors, these data have been used to communicate risk and weigh community-level recommendations by health authorities. They also emphasize that their experience highlights the importance of ongoing review and reevaluation to maintain the utility and predictive value of public health surveillance definitions.
Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author Shira Doron, MD, MS, please email Jeremy Lechan at jlechan@tuftsmedicalcenter.org.
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Also new in this issue:
Gatekeepers of Extermination: SS Camp Physicians and Their Scope of Action
Nico Biermanns, MEd
History of Medicine
Abstract: https://www.acpjournals.org/doi/10.7326/M23-0362
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