Amid an uptick of respiratory illness across Washington, some Spokane-area hospitals are considering a temporary return to a mask mandate for their staff, patients and visitors.

That mandate is already in place in hospitals on the other side of the state. MultiCare Health systems recently announced its hospitals in King, Pierce, Thurston and Kitsap counties began enforcing a mask mandate Wednesday. MultiCare Yakima Memorial Hospital in central Washington reintroduced a mask mandate several weeks ago.

The healthcare nonprofit also owns and operates Deaconess and Valley hospitals.

MultiCare spokesperson Kevin Maloney said the Inland Northwest is one of the only regions in Washington where MultiCare has not yet reintroduced a mask mandate. But he anticipates a change will be coming for Deaconess and Valley in the near future.

“We’re not quite there yet. But I do think that time will be coming soon,” Maloney said. “It’s not a matter of if but of when.”

These mask mandates are not being driven by COVID-19. Instead, the primary culprit is Respiratory Syncytial Virus, another infection that has similar symptoms to COVID and the flu.

In deciding whether to reinstate a mask mandate, MultiCare follows standards developed by the Northwest Healthcare Response Network, a coalition of health care providers and public health experts that helps these entities prepare for public health emergencies.

In an updated recommendation to its members about masking in September 2023, the Northwest Healthcare Response Network states hospitals should reintroduce a mask mandate if their hospital reaches any one of these three categories.

• More than 10 new COVID-19 hospital admissions per 100,000 residents in a given county
• Regional flu hospital visits exceed 1% of total hospital visits in a given facility
• Regional RSV hospital visits exceed 0.3% of total hospital visits in a given facility

Mandated masking would continue until all three pathogens are below these targets “for at least two weeks.”

According to Maloney, MultiCare hospitals in greater Spokane are not close to exceeding targets for either COVID-19 or the flu, but are close to the 0.3% threshold of RSV hospital admissions.

Maloney is unsure how close either Deaconess or Valley Hospital are to that target because the “population of our patients fluctuates on a daily basis,” to a degree that obtaining exact figures is difficult.

There was a spike of RSV cases in Deaconess’ ER in November, but that has “leveled off” in December, he said.

According to statewide data collected the last week of November through Saturday, approximately 0.6% of hospital admissions statewide are caused by RSV. That metric is highly concentrated among patients younger than 18 – for whom RSV accounts for 2.7% of all admissions over the same time period.

Spokane Regional Health District spokesperson Kelli Hawkins said Spokane County is “seeing the beginning of an increasing trend” of RSV transmission, but additional data is needed.

“Other counties in Washington, especially on the West Side, are seeing an increase in RSV and other respiratory viruses. Since the east side of the state typically lags in communicable disease trends, we should take precautions now to prevent similar increases in transmission of respiratory viruses,” Hawkins said.

While he does not know when a mask mandate could be implemented at MultiCare facilities in Spokane or what facilities would be impacted, Maloney said he expects masking rules in Deaconess and Valley hospitals to be a “little more firm” than those in Rockwood clinics.

If a mask mandate is implemented, MultiCare facilities will provide a single-use surgical mask to patients and visitors.

According to MultiCare Rockwood clinics’ Dr. Sarah d’Hulst, masking is “one of the best methods” to prevent transmission of RSV.

“A simple cough or a sneeze can spread it. A cough or a sneeze contains tiny infectious droplets that can land in a person’s mouth or eyes that can infect them. RSV can also live on hard surfaces like a countertop or desk for a prolonged period of time that can also help spread it,” she said. “Similar to other respiratory diseases, regular hand-washing with good coughing and sneezing etiquette while wearing a mask will help stop the spread.”

In addition to risks to patients, a potential mask mandate would be for the benefit of hospital staff, he added.

“With the worker shortages that everybody is experiencing, that just is magnified by caretakers themselves who are getting sick and having to call in,” Maloney said. “It’s important to remember that the caretakers are a part of the community as well.”

Providence Health is the other major health care system in Spokane – running Sacred Heart Medical Center, Holy Family Hospital and other health care clinics.

In a statement, Providence said there are “currently no changes to masking guidelines” at either Spokane or Stevens County Providence hospitals and clinics.

“We regularly review respiratory infection levels in the community. Providence may institute additional masking policies if we see high levels of respiratory viruses circulating in the community, such as influenza, RSV, and COVID-19,” reads the statement. “Providence encourages everyone to do what they can to stay safe and healthy, which includes getting vaccinated, staying home when you’re sick, and washing your hands often.”

What is RSV?

Like the flu and COVID-19, RSV is a viral disease and has similar symptoms of fever, coughing, wheezing, runny nose, shortness of breath and a decreased appetite.

These symptoms tend to be mild and resolve within one to two weeks without medical intervention, but the disease carries the risk for serious symptoms – especially among infants and the elderly.

According to the Centers for Disease Control and Prevention, RSV is the leading cause of infant hospitalization in the United States. Most children will have experienced an RSV infection before their first birthday, and RSV causes an estimated 58,000 to 80,000 hospitalizations in children younger than 5 each year.

If an individual develops severe complications from RSV, they are likely to develop an infection of the lungs or inflammation of the small airways in the lungs. RSV is the leading cause of these symptoms, pneumonia and bronchiolitis, among children younger than a year old.

Symptoms of the disease may be subtle among very small infants. These symptoms include irritability, decreased activity and breathing difficulties, according to the Spokane Regional Health District.

RSV can also present serious risk to older adults and adults who are immunocompromised. According to the CDC, approximately 60,000 to 160,000 adults in the United States are hospitalized with RSV each year and 6,000 to 10,000 of those patients die because of complications of the virus.

A vaccine for RSV was approved for the first time earlier this year by the FDA. The vaccine is currently approved only for pregnant women and those 60 and older.

Unlike COVID and the flu, some people may not have heard of RSV outside of information campaigns focused specifically on the parents of infants. According to Spokane Regional Health District epidemiologist Mark Springer, that’s because public health officials have not had access to the vaccine and other treatment options for it before this year.

“RSV has become a more prominent respiratory illness from a public health perspective because now we have more tools. And looking for this from a clinical perspective, it’s hard for providers to test for something or to look for something when they don’t have a treatment option. And we did not have that treatment option for RSV until now,” he said in an October interview.