Face mask mandates make a comeback in eight US states amid fears of quad-demic

Face mask mandates appear to be making a quiet comeback in hospitals across the US, amid growing concerns about what experts are calling a “quad-emic.”

Four viral infections – flu, Covid, the common cold virus RSV and norovirus – are on the rise, reaching around 15 million cases and 30,000 deaths so far this winter.

In response to the outbreak, Duke Health in North Carolina and Mass General Brigham in Massachusetts both updated their mask and visitor guidelines this week.

It means hospitals in at least eight states require or strongly insist on wearing masks indoors, including Wisconsin, California, Illinois, Indiana, New Jersey and New York.

The move comes amid growing fears of a viral outbreak in China that has reportedly overwhelmed hospitals in the northern provinces.

Mass General, which treats 2.5 million patients, consists of 12 hospitals and clinics across Massachusetts and leaders have raised the respiratory virus activity status to “high” for most facilities.

Now doctors and hospital staff are required to wear masks in patient areas and patients and visitors are ‘strongly encouraged’ to wear a face mask, although it is not mandatory.

In North Carolina, Duke Health hospitals and clinics stated, “Due to increased respiratory illness in our communities, we are updating our visitation restrictions after consulting with our infectious disease and infection prevention experts.”

With dozens of locations across the state and surrounding areas, Duke Health now “strongly” recommends masking in patient areas, and masking is required in “select patient care areas based on their medical conditions.”

In addition, unit visitor guidelines have been updated, introducing some restrictions and a requirement for full PPE for the most vulnerable patients.

In other parts of the country, a spokesperson for Wisconsin’s Aurora Health Care system — which treats 1.2 million patients a year — said confirmed to local outlet WISN12, it will institute a mask mandate for patients and other people in “congregate areas, such as patient rooms,” starting next week.

New Jersey’s largest hospital system, RWJBarnabas Health — which treats 3 million patients a year — has also reinstated its mask mandate.

The guidelines posted online stated that ‘all visitors are expected to wear a face mask and ‘maintain physical distancing’.

It added: ‘We will provide you with a new mask for source control or may ask you to replace your own mask with a hospital-supplied mask.’

In San Francisco, everyone who works in skilled nursing facilities is required to wear a mask. In Alameda, San Mateo, Contra Costa and Napa counties, as well as the city of Berkeley, healthcare workers and staff in certain health care facilities are required to wear masks in patient areas.

In San Mateo, the mandate also applies to visitors.

In Illinois, the OSF HealthCare Network, which has 10 locations across the state, is requiring all employees, patients and visitors to wear masks and is temporarily limiting visiting hours and reimbursements.

In addition, Rush University’s health care system, which includes two medical centers and one hospital, also began requiring face masks for staff and visitors.

In Indiana, Union Health has also asked people to wear face masks and limit visiting hours, citing increases in flu, Covid and RSV cases.

Patients experiencing respiratory symptoms “must wear a mask upon presentation at any Union Health facility,” including about three dozen locations in Indiana.

In New York, State Health Commissioner Dr. James McDonald said last month that flu is prevalent across the state and that health care workers who have not received a flu vaccine this year will be required to wear masks in certain health care settings.

According to the CDC, the level of respiratory disease activity in the US is “high” and in most states it is “high” or “very high.”

The virus with the highest level is Covid-19. Flu and RSV are at ‘moderate levels’.

However, the number of emergency room visits for flu and RSV is ‘very high’ and increasing, while the number of visits is ‘low’ but increasing for Covid-19.

Cases of flu and RSV reached new highs this season, with 19 percent and 13 percent of samples testing positive for those viruses in the week ending December 28, respectively.

About seven percent of tests were positive for Covid.

The CDC estimates that between October 1, 2024 and December 14, there have been 1.2 million RSV visits, 60,000 hospitalizations, and 3,100 deaths.

For Covid, estimates are 4.9 million cases, 1.1 million visits, 130,000 hospitalizations and 15,000 deaths.

And for the flu, estimates are 9.3 million cases, 4.2 million visits, 140,000 hospitalizations and 13,000 deaths in the same period.

For the week ending December 28 – the latest available – 1.2 percent of hospital visits were for Covid-19, up from less than one percent a month earlier.

RSV accounted for one percent, up from 0.6 percent a month earlier, and flu visits accounted for 5.2 percent of visits – a sharp increase from just one percent in the week ending November 30.

Hospital admissions are also required for all respiratory viruses. The number of hospital admissions rose to two percent for Covid and RSV and to four percent for flu at the end of December.

The number of deaths has increased slightly, but is less than one percent of the total mortality rate.

Data shows that cases of norovirus – also known as stomach flu – for this time of year are at the highest level since 2012.

State health officials reported 91 outbreaks of norovirus — considered a group of two or more cases arising from a common source — during the week of Dec. 5, up from 69 the week before.

In 2021, there were only two outbreaks in the same week.

Current data are not comprehensive and the number of cases is likely higher than reported. The CDC does not report individual cases because the infection usually goes away on its own within a few days and is not diagnosed by a doctor and goes unreported.

Just over a dozen states participate in the CDC’s national disease surveillance system.

Overall, norovirus is estimated to infect about 21 million Americans each year, sending about 2 million of them to doctors’ offices or emergency care. Every year, approximately 465,000 people go to the emergency department with the virus and 900 people die.