(The Hill) — The Centers for Disease Control and Prevention no longer recommends universal masking in health care settings, unless the facilities are in areas of high COVID-19 transmission.

The agency quietly issued the updates as part of an overhaul to its infection control guidance for health workers published late Friday afternoon. It marks a major departure from the agency’s previous recommendation for universal masking.

“Updates were made to reflect the high levels of vaccine-and infection-induced immunity and the availability of effective treatments and prevention tools,” the CDC’s new guidance says.

Now, the CDC says facilities in regions without high transmission can “choose not to require” all doctors, patients, and visitors to mask. Transmission is different from the community levels CDC uses to guide non-healthcare settings.

Community transmission refers to measures of the presence and spread of SARS-CoV-2, CDC said. 

“It is the metric currently recommended to guide select practices in healthcare settings to allow for earlier intervention, before there is strain on the healthcare system and to better protect the individuals seeking care in these settings,” CDC said.

Right now, about 73% of the US is experiencing “high” rates of transmission. 

Community levels “place an emphasis on measures of the impact of COVID-19 in terms of hospitalizations and healthcare system strain, while accounting for transmission in the community,” CDC said. 

Only 7% of counties are considered high risk, while nearly 62% of counties are considered low.

In addition, the new guidance includes a list of exceptions when people might choose to mask, compared to the previous guidance that included exceptions when masking was not recommended. 

Even if masking is not universally required, if a provider works in a part of the facility experiencing a COVID-19 outbreak, or if they care for immunocompromised patients, they should wear a mask. 

When transmission levels are high, masking is recommended for everyone in a healthcare setting when they are in areas of the healthcare facility where they could encounter patients. 

Providers can choose not to wear masks when they are in “well-defined areas” that are restricted from patient access, like staff meeting rooms.

Public health experts said the updates will make it so fewer people in hospitals and nursing homes wear masks, putting patients and providers at risk.

Megan Ranney, dean of the Brown University School of Public Health, tweeted that the new guidance could result in places with substantial transmission unmasking sick patients who haven’t yet been tested for COVID-19, right next to the elderly, chemo patients, people with pulmonary disorders, and vulnerable pregnant women.

“This nuanced have your cake and eat it too approach hasn’t worked A SINGLE TIME throughout the pandemic. People hear “no more masks!” tweeted Jerome Adams, who served as surgeon general during the Trump administration.