Updated CDC Mask Guidance for Healthcare Workers

September 20, 2023

A draft of expected CDC guidance recommends that healthcare workers wear surgical masks when treating patients with endemic respiratory infections, like flu. This most recent draft “controversially concluded that N95 face masks are equivalent to looser, surgical face masks.” For now, the newest guidelines won’t apply to SARS-CoV-2, the virus that causes Covid-19. Still, some health providers and workplace health and safety experts are concerned. 

JORDAN BARAB; jbarab@gmail.com, @jbarab
    Barab was the OSHA Deputy Assistant Secretary from 2009 to 2017. He writes Confined Space, a newsletter about workplace safety and labor. 

The newest recommendations hinge on studies that find “no difference in infection rates among health providers who wear N95 masks versus surgical masks in the clinic”––directly contradicting the CDC’s own 2022 report, which indicated that N95s do significantly cut the risk of transmission. 

Barab told the Institute for Public Accuracy: “I can’t understand what difference the endemicity [of a virus] makes. Endemicity has nothing to do with seriousness or the type of spread. Determining what type of respiratory protection [healthcare workers] wear should be determined by how the pathogen or virus is transmitted and the seriousness of it. 

“It’s very clear that Covid-19 is not just transmitted through droplets that fall to the ground, but [also] through aerosolized transmission, which persist in the air for longer and can travel further distances. In that case, a loose-fitting surgical [mask] isn’t as effective.”

If the CDC’s new draft goes into effect, it also may be in conflict with guidelines from the Occupational Health and Safety Administration (OSHA). OSHA “can mandate whatever it wants to mandate,” Barab said, “and that takes precedence over CDC recommendations. The trouble is that the two agencies shouldn’t really require different things, and they need to figure that out. The CDC is seen as the agency with more expertise, so they tend to win out.”

Many states also have their own OSHA offices. Those states “are able to issue their own standards as long as they are at least as effective as federal OSHA standards.” In California, for example, the state’s OSHA “can require N95s even if the CDC isn’t recommending them.” Though there is no legal issue there, the varying recommendations are problematic because they create further confusion for the public. 

There is an “industrial hierarchy of controls, which [defines] which types of controls are most effective and should be employed first,” Barab said. Engineering controls (such as improving ventilation) and administrative controls (such as implementing isolation rooms for infectious people) are high in the hierarchy. “At the bottom of the hierarchy is personal protective equipment like N95 respirators. Those are not as effective [as higher controls] because they require people to do something, rather than being passive controls. To the extent that you focus too much on the bottom of the hierarchy and are ignoring ventilation, it’s a distraction. And that’s a problem with HICPAC [the Healthcare Infection Control Advisory Committee, which released the newest guidelines]. They are ignoring the whole area of ventilation.”