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Holiday travel with Covid, RSV and flu means it’s time to bring back mask mandates

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Going into the holiday season last year, rising Covid-19 cases overwhelmed hospitals. This year, hospitals are overwhelmed by a combination of Covid, respiratory syncytial virus (RSV) and flu. Along with RSV, the record number of flu cases that children’s hospitals are approaching capacity is a worrying signal that the current flu season will be the worst in years. Children’s hospitals are facing a particularly acute crisis requested President Joe Biden will declare a state of emergency to provide more resources to respond to the current spikes.

This “triple epidemic” of flu, Covid and RSV reminds us that even when the pandemic is over, the threat of seasonal respiratory viruses remains. Fortunately, our toolkit for dealing with them is similar to what only works to suppress Covid, starting with the most basic and flexible level of protection: masking. When and where respiratory viruses emerge, mask mandates must be reinstated.

It is difficult for people to get adequate, high-quality information about risk and apply it in a society that has returned to pre-pandemic standards.

Masks work and, crucially, they don’t have to work perfectly to have a positive impact. A recent research found that Boston school districts that had lifted the mandates had an average of 45 more Covid cases per 1,000 students and staff than those with mandates. Other there is some evidence that masks are also effective against the flu some scientists suggest that widespread masking during the first two years of the pandemic contributed to the all-time low flu numbers and RSV observed in those years.

RSVa respiratory disease that causes cold symptoms and can be especially serious in young children and the elderly, spreads through the air like Covid but also through contact on surfaces. This means that RSV — for which a vaccine is still being made developed – can be mitigated by both wearing a mask and washing hands.

In a typical yearRSV causes up to 80,000 hospitalizations and 300 deaths in children under age 5, and up to 10,000 deaths and 120,000 hospitalizations in adults age 65 and older. As with the flu and now with Covid, individual ill effects are rare relative to the number of cases, but more spread and more infections means more people are experiencing serious consequences. Even as the pandemic eases, an average of 300 people still die from Covid each day. Unvaccinated people are six times the risk of death based on recent databut many people who are dying now are also being vaccinated.

Unfortunately, with mask mandates and public health coverage fading and complacency or resignation taking hold, the public’s voluntary adherence to healthy behaviors such as wearing masks and getting booster shots decreases, as businesses continue roll back sick leave and remote work policies.

Hospitals remain overwhelmed by the chronic strain of recent years and personnel problems. While children’s hospitals have been hardest hit, the entire system is struggling first aid guard time have increased. Masking may not prevent all infections, but preventing infections helps ease the burden.

Mask mandates not only prevent the spread of disease, but also have useful psychological benefits. It is difficult for people to get adequate, high-quality information about risk and apply it in a society that has returned to pre-pandemic standards. Promoting mask-wearing through official messages (ideally supported by free distribution of high-quality masks such as N-95s) removes the responsibility for individuals to find out “what is safe”.

Even if governments do not apply broad mandates, institutions and events can apply their own. The Supreme Court recently ruled that the Transportation Security Administration did have the authority to mandate masks. Show studies that when two people mask it is more effective than one person masking alone, and a mandate avoids the awkwardness of having to ask people to mask or reveal a high-risk condition.

Coming from our Covid experience, disease mitigation should be an ongoing practice that can be turned on as needed rather than a switch that is turned on or off completely. We should always encourage mask wearing during fall and winter seasons (since these respiratory viruses tend to transmit more efficiently in colder weather due to changes in humidity and how much time people spend indoors) and in crowded places such as public transport and supermarkets.

Behaviors such as washing hands (esp relevant to RSV) and staying at home when sick should also be promoted, alongside policies that enable people to do so. Seventeen states and countless cities have already mandated paid sick leave in one form or another; the federal government should follow suit. These policies have the potential to facilitate a cultural and behavioral change in how we approach disease and public health, even in “silent” years.

Understanding that viruses will continue to be a threat reduces the “Covid is over” mentality and further pressures Congress to fund mitigation actions in a sustainable manner. Currently the Covid response is threatened because Congress has not agreed on a spending package. As a result, Covid vaccinations may not be free next year, and the development of the New Generation of intranasal Covid vaccines in the US could suffer without more funding.

This partisan deadlock and congressional passivity also translates into anemic attempts to mandate clean air standards, even though proper ventilation can limit the spread of airborne pathogens. The White House is promoting such effortsbut without strict building codes and funding for renovations, such upgrades remain at the discretion of individual building owners.

We are all tired – of the pandemic and its attendant disruptions to our lives, of taking mitigation measures and of being sick. But we cannot remain complacent as our health systems are once again put to the test. And even when this challenge is over, we will have to accommodate future peaks. The pandemic has taught us that community transmission of respiratory disease can increase rapidly and unpredictably. Fortunately, it has also taught us how to take action to mitigate their dangers.f

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