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Masks are back — at least at some healthcare facilities. Should yours do the same?

A winter wave of COVID-19 and flu wave prompted some hospitals to reinstate mask mandates for patients, staff, and visitors. Most notably, masks are now required in all 11 of New York City's public hospitals and all Johns Hopkins Medicine locations in Maryland.

Some healthcare facilities in California, Illinois, Massachusetts, and North Carolina have also shifted to universal masking. When making the decision to put masks back on, staying up to date on Centers for Disease Control and Prevention (CDC) data — namely COVID hospital admission trends — can help guide your choice, said Syra Madad, a doctor of health science and an infectious disease epidemiologist with NYC Health + Hospitals.

Rising community transmission of respiratory viruses including COVID, respiratory syncytial virus (RSV), and influenza was behind NYC's decision, Madad said. Universal masking could help in reducing hospital-contracted diseases, like COVID, along with offering additional protection for the most vulnerable, high-risk individuals, she said.

The University of Maryland Medical System reinstated mask requirements at its facilities in December. Heightened respiratory virus cases at its urgent care centers, rising respiratory virus diagnoses among its healthcare workers, and a notable increase in COVID-19 wastewater levels all went into the decision, according to Surbhi Leekha, MD, medical director for infection prevention at the University of Maryland Medical System, Baltimore, Maryland.

"This is a vulnerable population that can suffer serious consequences from respiratory viral infections that may be no more than a cold or minor illness for others," Leekha said. "Requiring masking for everyone who may have contact with our patients during periods when the circulation of these viruses is high takes guesswork out of the equation."

All three respiratory viruses — RSV, COVID, and influenza — were considered when making the decision to reinstate mask requirements vs early in the pandemic when COVID-19 case numbers were often the focal point.

"The pandemic has helped bring masking into the mainstream as a recognized measure that can be employed more broadly in healthcare settings during the respiratory viral season," said Leekha, an epidemiology and public health professor at the University of Maryland School of Medicine, Baltimore, Maryland.

While the latest COVID wave seems to have stalled — positive tests, hospitalizations, and deaths from COVID fell in the past week — the metrics remain high. The same is true for flu, which remains elevated across most of the country, according to the CDC.

"Using this information is a powerful way to make data-driven policies — whether you're a small clinic or a large hospital — on when to reinstate mask wearing," Madad said.

Looking at patient demographics can also help you decide if mask requirements are right for your office, according to Leana Wen, MD, an emergency doctor and public health professor at George Washington University, Washington, DC.

"If many patients are elderly, immunocompromised, and/or with chronic medical conditions, it would make sense to require masks in areas with these patients," Wen said. Individuals at risk for severe COVID should also be guided to wear a properly fitted mask, such as an N-95.

Since the beginning of the pandemic, there's been an elevated number of COVID-19 hospitalizations during winter months, with unmasked, indoor gatherings playing a large role in the uptick, Wen said. But despite this increase, "they [hospitalization numbers] are nowhere near where they were in 2021 and 2022, which illustrates the remarkable effectiveness of vaccines and antiviral treatment."

Remembering to emphasize healthy habits to your patients — such as washing your hands and disinfecting high-touch surfaces both at work and home — can also be paramount in curbing disease transmission, said Tucker Woods, DO, chair of the emergency department and associate medical director of Lenox Health Greenwich Village, New York City.

"Germs can be spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth," Woods said as a reminder.

Madad noted that COVID and the flu have not peaked yet, and RSV is continuing to spread throughout communities across the country.

"We're still in for more weeks of elevated viral activity," she said. "It's not too late to stay up to date with your vaccinations, whether it's your annual flu shot, the updated COVID vaccine, or the new RSV vaccine and therapeutics for those eligible."