Mask-wearing was new and controversial during the rise of COVID-19, but infectious disease experts are urging Minnesotans to use the practice again against an old enemy of influenza.
Michael Osterholm frequently criticized mask wearing during the pandemic because people were using inferior masks and wearing them ineffectively under their noses and loosely over their mouths. But the director of the University of Minnesota’s Center for Infectious Disease Research and Policy (CIDRAP) wore high-quality N95 masks to lectures across Europe this fall and stressed that the right masks, worn right, can make a difference this winter .
“I’m a loyal N95 user and I fit it appropriately to the face and not under my nose. And I think that’s what we’re talking about,” he said. “Many of them [mask-wearing] Recommendations are so general that the public has no idea what you are talking about.”
Minnesota experts are encouraging effective mask-wearing during the holidays — particularly by and near those at increased risk of serious illnesses — as respiratory viruses have become widespread at this time of year.
“It’s never a bad thing not to spread your germs to other people, so we use them widely in healthcare,” said Dr. Will Nicholson, President of the Minnesota Medical Association. He is also vice president of medical affairs for M Health Fairview’s East Metro hospitals, which this fall treated patients in emergency room waiting rooms for overcrowding.
Due to the early start of the influenza and RSV season, the conditions are already set for an increase in infections. Minnesota on Wednesday reported an additional 241 flu-related hospitalizations in the week ended Nov. 19 — bringing the total to 713 so far. Even during a tougher 2017-2018 flu season, Minnesota didn’t reach that number by Christmas.
Respiratory viruses have stretched hospital capacity in Minnesota, especially with RSV sending infants and some older children to children’s hospitals. So far in November, more than 8,000 inpatient beds have been occupied for six days – a record for Minnesota’s hospital capacity. The state as of November 15 was reduced to two available pediatric intensive care beds.
Leading Minnesota pediatricians held a news conference Monday to try to ease the pressure by advising parents on when – and when not – to take sick children to crowded emergency rooms. In general, ER travel is warranted for a sick child suffering from dehydration, difficulty breathing, or a fever of 100.4 degrees lasting more than four days. But they also found that mask wearing and prevention can reduce disease in the first place.
Wearing masks in public was an oddity in the US, rarely seen in airports before COVID-19. Interest surged early in the pandemic, leading to shortages of elastic, cloth, and especially high-profile N95 masks. Minnesota imposed a mandate in the summer of 2020 after supplies stabilized, and during the winter nearly 90% of residents polled wore them most or all of the time in public places.
The corresponding flu season has historically been mild, and doctors believe mask-wearing and social distancing played a part. Minnesota has reported just 35 flu-related hospitalizations this season, compared with 2,000 to 6,000 in a typical season. Mask wear rates fell below 60% the following winter – after the mandate was lifted – but flu-related hospital admissions remained lower than usual at 901 for the 2021-2022 season.
Mask wearing declined in 2022 as COVID-19 risks declined; The latest estimates put the mask-wearing rate in Minnesota at around 5%.
The spread of the coronavirus that causes COVID-19 has been low but steady throughout Minnesota throughout the fall, according to sewage monitoring for the virus at 40 treatment plants across the state. The state’s COVID-19 death toll has reached 13,663, but the risk is focused on seniors, according to Minnesota’s weekly situation update. Of 131 COVID-19 deaths in Minnesota since October 30, 120 have involved seniors.
Fatigue over masks and political opposition to the controversial mandate prompted a rapid decline, but people should use protection now that there is additional evidence they protect against the flu and other viruses, said Dr. Mark Sannes, infectious disease expert at Bloomington-based HealthPartners.
“Although we are not wearing masks for COVID purposes, we have a flu spike that we could interrupt by incorporating masks into our everyday lives when we are out in public,” he said. “I think this could be a tool that we use intermittently and turn on and off at times like this in the future.”
Osterholm said he was struck by the amount of ineffective mask wearing under the nose and mouth, even at a time when people are not required to wear them. He urged people to stock up on healthier supplies and use N95 or similar masks of a high standard.
Early federal estimates of the pandemic suggested that an unmasked person would transmit an infectious dose of the coronavirus to a face-to-face contact within 15 minutes. Osterholm’s CIDRAP has made estimates based on industry data and suggested that cloth or surgical masks would only delay transmission by another 5 to 15 minutes in this scenario.
An N95 would still protect someone from unmasked, infected close contact for an hour or two, depending on suitability. According to CIDRAP estimates, it would take 25 hours for an infectious dose to be transmitted between two close contacts, both wearing fitness-tested N95s.
Wearing masks could prove to be an extra precaution against a prolonged and severe flu season, or maybe just an early one. Fears of a difficult season originated in Australia, where there was an early surge in sick children but this quickly dissipated. Other parts of the southern hemisphere did not report severe flu seasons.
Minnesota’s RSV and flu-related hospitalizations were unusually high for the fall last week, but both represented slight declines from the previous week.
Health officials stressed that masks work best in combination with other strategies, including hand washing, social distancing, staying home when ill and recommended vaccinations.