Masks - Evidence for the ongoing use of masks in the healthcare setting

What are the best options for prevention and protection against influenza and other respiratory diseases in health practices?

While influenza vaccination is considered as the gold standard of protection, there is strong and consistent scientific evidence proving that masks and respirators are effective in reducing the risk of transmission of influenza (1).

The effectiveness of surgical masks and respirators has been the centre of research attention for decades. Face masks and respirators work in two ways: By protecting and by preventing. They protect the wearer from becoming infected and prevent the wearer from spreading their infection to others by acting as a barrier (1, 2). This is not only relevant for the transmission of Covid-19, but also of influenza and other respiratory viruses (3).

If telehealth is not an option, cohorting of symptomatic patients during a respiratory clinic timeslot also minimises the interaction between infected and non-infected patients and may be assist the patient workflow of the practice.

Other measures such as promoting cough etiquette and hand hygiene incl. nudging these activities are also considered as effective.

What about mask mandates?

Evidence from the Covid-19 pandemic has proven that non-pharmaceutical infection control strategies like mask mandates are effective (1).

Currently NSW Health requires masks to be worn when visiting NSW hospitals (4), and their use is also strongly recommended in other non-hospital setting such as general practices and medical centres. Airborne precautions including protection with N95 respirators and eye protection/face shields are recommended based on assessment of risk of when providing care for patients exhibiting acute respiratory tract infection incl. suspected or confirmed COVID-19 patients (5).

Masks can effectively improve epidemic control if their use has a high uptake (1), e.g., when all staff and patients are required to use masks and/or respirators, especially during peak times for respiratory diseases transmission when the healthcare setting is a high-risk area with infectious patients encountering healthy patients and clinicians and their staff.

Practice owners are allowed to make wearing a mask a condition of entry to their premises. It is recommended to communicate this to patients in advance and have processes in place for patients who cannot wear a mask, e.g., children, or who cannot communicate with clinicians wearing a mask.

What is the current forecast for this year’s influenza season?

In contrast to pre-pandemic Australian flu seasons that usually peaked in August (6), the 2022 flu season kicked off early in April and peaked in mid-June (6).

Similarly, the current 2023 influenza season has also started early, and as of mid-June 2023 the rate of patients presenting to a GP with influenza like illness (ILI) symptoms per 1000 consultations was already above average, indicating a severe influenza season if this trend continues (6).

While it is still too early to accurately determine the severity of this influenza season, data on hospitalisations and deaths due to confirmed influenza will be utilized to measure the severity as the season further progresses (6).

References:

1. R Macintyre, AA Chughtai, D Fishman, T Greenhalgh. Yes, masks reduce the risk of spreading COVID, despite a review saying they don’t. UNSW Sydney, 07.02.2023 Yes, masks reduce the risk of spreading COVID, despite a review saying they don’t (unsw.edu.au)
2. R Macintyre, AA Chughtai. A rapid systematic review of the efficacy of face masks and respirators against coronaviruses and other respiratory transmissible viruses for the community, healthcare workers and sick patients. International Journal of Nursing Studies, Vol. 108, 2020. https://www.sciencedirect.com/science/article/pii/S0020748920301139?via%3Dihub
3. MJ Trent, A Moa, R Macintyre. Opinion “I’ll be back”: Australia’s experience of flu in 2022. BMJ, 2022. “I’ll be back”: Australia’s experience of flu in 2022 | The BMJ
4. NSW Government. Guidance on wearing face masks. 26.05.2023. Guidance on wearing face masks | NSW Government
5. NSW Government, Clinical Excellence Commission. Respiratory Protection program manual. Version 1.2, 27.10.2022. Respiratory Protection Program - Clinical Excellence Commission (nsw.gov.au)
6. Australian Government, Department of Health and Aged Care. Australian Influenza Surveillance Report No. 05 - 29 May to 11 June 2023. aisr-fortnightly-report-no-5-29-may-to-11-june-2023_0.docx (live.com)