With two states updating their guidelines this week as parts of the U.S. confront what has been described a “quad-emic,” mandatory masking in some circumstances has returned in eight states.

Duke Health in North Carolina and Mass General Brigham in Massachusetts this week updated masking and visitor guidelines. The two additions now bring the total to eight states that are requiring or strongly encouraging masking indoors following Wisconsin, California, Illinois, Indiana, New Jersey, and New York.

A quadruple threat of viral infections — including flu, COVID-19, RSV, and norovirus — is sweeping the nation, fueling hospitalizations, mask mandates, and heightened public health concerns, the Daily Mail reported.

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