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Surge in Hospital-Onset Respiratory Viral Infections Linked With Easing of Masking and Testing Policies
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Key Takeaways
- Hospital-onset respiratory viral infections surged by 25% after stopping universal masking and testing, highlighting their preventive role.
- RSV is a leading cause of severe respiratory infections in adults, with significant hospitalization rates among those aged 65 and older.
Reduced hospital masking and testing policies increased rates of hospital-onset respiratory infections, including RSV.
In findings published in JAMA Network Open, researchers announced a surge in hospital-onset respiratory viral infections—including respiratory syncytial virus (RSV)—following a decrease in universal masking and SARS-CoV-2 testing upon admission.1
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"When our health care system stopped universal admission testing and masking there was, after adjustment, a 25% increase in hospital-onset respiratory viral infections, which includes COVID, flu, and respiratory syncytial virus, compared to before," said Theodore Pak, MD, PhD, of Massachusetts General Hospital in Boston, in a news release.2
RSV is reported to be the leading cause of acute respiratory tract infections among adults, leading to severe outcomes among high-risk individuals. An estimated 159,000 hospitalizations due to RSV infection occur each year in the US among adults aged 65 years and older.3,4
According to the CDC, RSV is a highly contagious virus that spreads through droplets, direct contact, contaminated surfaces, and dried secretions. The use of masks, physical distancing, and testing helps reduce the spread of RSV, along with other respiratory viruses.5 This was a universal practice in hospital settings during and after the COVID-19 pandemic, although most hospitals have recently stopped masking requirements and limited testing for SAR-CoV-2, which led to testing for other viruses.1
Researchers conducted a cohort study that analyzed the incidence of hospital-onset SARS-CoV-2, influenza, and RSV in 10 hospitals in the Mass General Brigham hospital system that ended masking and testing requirements in May 2023, before restarting mask requirements for health care providers in January 2024. The masking requirement was updated for staff following a winter respiratory viral surge in the 2024 season.1
"This sort of gave us a natural opportunity to look at a before-and-after then in terms of rates of hospital-onset COVID, adjusting for all the other things that we could in this kind of study,” said Pak, in an interview with MedPage Today.2
The study evaluated patients admitted to the 10 hospitals between November 6, 2020, and March 21, 2024. They examined data in 4 time periods: pre-Omicron variant with universal testing and masking, Omicron with universal testing and masking, Omicron without universal testing and masking, and Omicron after restarting masking for health care providers only. During the study period, a total of 641,483 admissions were included, with 30,071 community-onset and 2075 hospital-onset SARS-CoV-2, influenza, and RSV infections.1,2
The results found that when universal testing was in place, SARS-CoV-2 tests upon admission were collected for 386,257 of 415,541 admissions (92.9%), compared with 39,765 of 149,712 admissions (26.5%) after stopping universal testing.1,2
An unadjusted analysis showed that the mean weekly ratio between hospital-onset and community-onset infections increased from 2.9% before Omicron dominance to 7.6% during Omicron dominance (95% CI, 6.0%-9.1%). After universal masking and testing ended, the ratio increased to 15.5% (95% CI, 13.6%-17.4%), before decreasing to 8.0% (95% CI, 5.0%-11.0%) after masking for health care providers.1,2
“This is a helpful trend to look at because it suggests that these interventions, when you stop them, are associated with increases in hospital-onset respiratory viruses, and then when you restart them, they're associated with a decrease," Pak said, in the interview.2
Further results demonstrated a 25% increase in hospital-onset respiratory infections compared with the preceding Omicron-dominant period (rate ratio [RR], 1.25; 95% CI, 1.02-1.53). However, the study authors noted a 33% decrease following masking among health care providers (RR, 0.67; 95% CI, 0.52-0.85).1,2
"We know how to prevent the spread of SARS-CoV-2," she added. "When there is increased spread of SARS-CoV-2 in our communities, physicians and healthcare facilities would be wise to implement policies requiring masking of providers and/or testing of all patients seeking care,” Pak said, in the interview.2
REFERENCES
1. Testing and Masking Policies and Hospital-Onset Respiratory Viral Infections. JAMA Network Open. News release. November 27, 2024. Accessed December 5, 2024. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2827170?resultClick=3.
2. Want to Limit Respiratory Virus Infections? Mask and Test in Hospitals. MedPage Today. News release. November 27, 2024. Accessed December 5, 2024. https://www.medpagetoday.com/infectiousdisease/rsv/113155.
3. Hospitalization Following Outpatient Diagnosis of Respiratory Syncytial Virus in Adults. JAMA Network Open. News release. November 19, 2024. Accessed December 5, 2024. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2826359?resultClick=1.
4. One in 20 Adults With RSV Hospitalized, Study Shows. Medpage Today. News release. November 19, 2024. Accessed December 5, 2024, 2024. https://www.medpagetoday.com/infectiousdisease/rsv/112999?xid=nl_mpt_DHE_2024-11-19&mh=6d2b5f4f91352444bdf817a9c17750bc&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily%20Headlines%20Evening%20-%20Randomized%202024-11-19&utm_term=NL_Daily_DHE_dual-gmail-definition.
5. How RSV Spreads. CDC. News release. August 30, 2024. Accessed December 5, 2024. https://www.cdc.gov/rsv/causes/index.html#:~:text=RSV%20transmission,face%20before%20washing%20your%20hands.
