What Infection Preventionists Must Do in Current Omicron Crisis

As hospitals in the United States buckle under the strain of Omicron, infection preventionists (IPs) once again find themselves scurrying to help their fellow health care professionals stay on the job in the face of the most infectious version of COVID-19 yet to be seen.

Saskia Popescu, PhD, MPH, MA, CIC, a member of Infection Control Today^®’s Editorial Advisory Board (EAB), suggests that IPs should continue what they usually do, but perhaps also “focus [more] on discussing work and non-work exposure risks and how people can be safe in both places. Also, PPE [personal protective equipment] fatigue is real and it’s helpful to identify options for people to take mask breaks (outside!) and hydrate.”

Those clutching for any sign of hope point to indications that Omicron presents with less severe symptoms and that it could burn itself out in a few weeks. Also, there’s hope that Omicron will lead to herd immunity and effectively end the pandemic.

Sharon Ward-Fore, MS, MT(ASCP), CIC, FAPIC, another ICT^® EAB member, holds out such hope. “IPs should also understand how Omicron may help bring us to some sort of herd immunity—hopefully—and know the positivity rate in their community,” says Ward-Fore. “They should remind health care professionals that they need to follow public health best practices even when they leave the health care facility. They should advocate masking, social distancing, vaccination and boosting.”

For her part, Linda Spaulding, RN-BC, CIC, CHEC, CHOP, another ICT^® EAB member, doubts that Omicron will lead to herd immunity. Spaulding recently wrote a Viewpoint for ICT^® in which she maintains that we’re not even halfway through the pandemic.

Spaulding noted that Anthony Fauci, MD, the director of the National Institute of Allergy and Infectious Diseases and President Joe Biden’s chief medical advisor, told CNN that the Omicron variant will “find just about everybody,” either through exposure or infection. Fauci added that most people will not get severely ill from Omicron, especially if they’ve been vaccinated and even more so if they’ve been vaccinated and have gotten a booster.

However, says Spaulding, while the US health care system may win the battle against Omicron, that doesn’t mean it will win the war against COVID-19, at least not in the foreseeable future.

“If the spike that we’re seeing now does decrease in the next few weeks, what’s the next fight going to be?” asks Spaulding. “Is it going to be Deltacrom or is it going to be something else? Why would the entire population getting one variant mean that we won’t face something that can be much worse? Why would we think it would stop?”

Meanwhile, IPs have their hands full. Yesterday, saw 747,267 new cases of COVID-19 (with the seven day rolling average up 34% from the previous week) and 1715 deaths (up 40% in the past week) in the US, according to the Johns Hopkins Coronavirus Resource Center. The number of people hospitalized with COVID-19 has more than doubled in 2 weeks to 151,000, according to the US Department of Health and Human Services.

Masking has been a hot topic this week, with the Centers for Disease Control (CDC) at first sending signals that it might recommend that in order to slow down Omicron the public needs to mask up with N95s or KN95s, rather than surgical or cloth masks, which some experts believe are useless against COVID-19. One of those experts is Leana Wen, MD, an emergency physician, professor of health policy and management at George Washington University and a medical analyst for CNN, who recently called cloth masks “little more than facial decorations.”

Rochelle Walensky, MD, said that the CDC doesn’t intend to recommend that Americans wear N95s or KN95s, but that the CDC does plan to update its website about masks to let people know all the options, the Hill reports. Despite that, 50 Democratic lawmakers are working on legislation that would send N95 masks to all Americans.

Kevin Kavanagh, MD, another ICT^® EAB member, says that “it is even more imperative for us to up our mask protection with the highly infectious Omicron variant. A high-quality mask which fits well is required."

The best option is the N95, says Kavanagh.

"Even if not formally fit tested its performance can still be high, if worn properly. One study by MacIntyre CR, et al. even observed in a randomized controlled trial (published in Influenza and Other Respiratory Viruses) that ‘there was no significant difference in outcomes between the N95 arms with and without fit testing’ and ‘non‐fit‐tested N95 respirators were significantly more protective than medical masks against CRI (chronic respiratory illnesses).’”

Spaulding says that the only way to get out of this pandemic is to “get back to basics and start wearing masks when we’re out and about.” However, people for the most part want to wear masks with ear loops, which are easier to put on and take off, as opposed to N95s and KN95s which have straps.

“They saying, ‘It will mess up my hair,’” says Spaulding. “People aren’t even trying to find masks. There are a lot of people who don’t even care about wearing masks.”

Ward-Fore says that “what IPs can do regarding masking is continue to follow the science of masking as an effective barrier to mitigate risk—not eliminate it. They should be well versed in the pros and cons of each type of mask. They should know how to don and doff each type safely. They should be providing real-time education and auditing of PPE and hand hygiene, since the expectation is you clean your hands after doffing PPE.”

Kavanagh says that all frontline workers and the public need to “be careful to make sure there is a good fit even if the mask is not formally fit tested. A mask placed over an N95 may hold the mask tighter to the face and assure an even tighter fit. This is important if the N95 is used repeatedly, and the elastic bands are beginning to stretch. Surgical masks will also offer some protection, but they are much harder to fit and require a second mask to hold them against the face.” 

Viewpoint: The dos and don’ts of masking

By Sharon Ward-Fore, MS, MT(ASCP), CIC, FAPIC

Here’s my opinion about masking.

For the public I’d rather see double masking with surgical type masks. The reasons are:

• they are now familiar with how to wear them correctly
• they are readily available
• most people seem to have figured out how to fit them to their face
• they tend to be replaced more often than cloth masks

KN95s, although more protective than cloth, are typically manufactured outside the USA so I am a bit suspect as to their quality. Also, the fit on most faces seems to be all over the place, which impacts their effectiveness. N95s should only be available for health care personnel. The reasons are:

• staff are fit tested to wear these masks
• staff are trained (hopefully) on proper donning and doffing of the mask as well as knowing it must be replaced if visibly soiled or wet
• they provide the greatest protection in a health care environment where the prevalence of COVID is probably higher than in outside environments
• staff are very familiar with this form of PPE

Cloth masks on their own have never been an option I would recommend unless it was at least 2 ply with the ability to add a filter and was laundered after each use. The reasons are:

• they are worn beyond a single use
• they are not laundered as frequently as needed
• some cannot be laundered adequately because they are "be-dazzled" or made from a material or design that is not conducive to laundering (but looks really fashionable or "cool")
• the fit sometimes cannot be adjusted to face size or shape so they either slip down or never adequately cover the nose