Indoor masking in public settings could return to Los Angeles County in a week as circulation of the hyper-infectious BA.5 omicron subvariant continues to push coronavirus case counts higher and sends increasing numbers of people to the hospital.
The possible return of a mask mandate — a move only L.A. County is contemplating — is the latest flashpoint in the long-running pandemic.
Proponents say the move is an effective and low-impact way to help stymie soaring coronavirus transmission.
L.A. County — the nation’s most populous — is like no other county in California. With its higher rate of poverty and overcrowded housing, it has been hit harder than most other parts of the state.
“Of all the tools we have used in this pandemic to counter the spread of COVID, indoor masking is one of the simplest, and turns out to be very effective, tools that we have that can counter rapid spread of this virus,” county Public Health Director Barbara Ferrer said Thursday.
Still, critics are questioning the need for a new mask order. There is less fear of the illness than a year ago, and thanks in part to vaccinations and anti-COVID drugs, many who test positive are not reporting severe illness. In addition, hospitals and intensive care units are nowhere nearly as strained as during previous surges.
Businesses have voiced concerns, worried that workers will have to enforce a mask rule many no longer want to follow and that the order could cause shoppers to spend money elsewhere.
A renewed mandate would apply indoors for anyone age 2 or older at a host of establishments and venues, including shared office space, manufacturing and retail settings, event spaces, restaurants and bars, gyms and yoga studios, educational settings and children’s programs.
L.A. County officials long ago set the criteria for this health order revision — saying they would reissue a mask mandate should the region move into the high COVID-19 community level, as defined by the U.S. Centers for Disease Control and Prevention, and remain there for two consecutive weeks.
To be in that category, a county must record elevated levels of coronavirus spread as well as at least 10 new coronavirus-positive hospitalizations for every 100,000 residents. L.A. County exceeded that threshold last week and did so again Thursday, recording 11.4 cases for 100,000 people.
Unless that hospitalization rate drops below 10 next week, a new mask order will go into effect July 29.
Countywide, 1,329 coronavirus-positive patients were hospitalized as of Wednesday — a 34% increase from two weeks ago.
By comparison, the statewide patient count has climbed 23% over that period, to 4,762.
In both L.A. County and California as a whole, hospitalizations remain well below those during prior peaks. And officials note a significant share of those patients — about 58% in L.A. County — are not receiving treatment for COVID-19 but incidentally tested positive on admission for other reasons.
That the patient count, while rising, has remained relatively low in the face of high transmission is a testament to how the pandemic has changed.
L.A. County is reporting about 6,700 new cases a day, nearly double the peak from last summer’s delta surge. But most of those getting infected now are not falling seriously ill, a trend that officials and experts credit to robust vaccine coverage and ready availability of treatments.
According to data released by the CDC, 50 of 58 California counties are in the high COVID-19 community level. The latest to enter for the first time since the beginning of June are Riverside, San Bernardino, Colusa and Modoc counties.
In all, 98.5% of Californians — or 38.6 million people — live in counties in the high COVID-19 community level.
The nature of the virus itself has also changed. The omicron subvariants fueling this latest spike are hyper-infectious but tend to cause less severe illness. At the peak of the delta surge, for instance, about 5.6% of coronavirus cases in L.A. County required hospitalization. That share was only about 1.2% for the initial omicron wave that struck last fall and winter.
During an internal town hall last week that was posted online, Los Angeles County-USC Medical Center Chief Medical Officer Dr. Brad Spellberg said around 90% of the hospital’s coronavirus-positive patients were admitted for other issues.
“Virtually none of them go to the ICU — and when they do go to the ICU, it is not for pneumonia. They are not intubated,” he said, citing other issues such as electrolyte abnormalities.
He added, “A lot of people have bad colds, is what we’re seeing.”
Some have pointed to this disconnect as evidence against imposing a new mask mandate. If hospitals aren’t anywhere close to being overwhelmed, what’s the justification?
“For two years straight, Californians wore masks inside. They got vaccinated at high rates. Many got boosted. The rates of severe disease are so decoupled from hospitalizations, and that’s so obvious to the public,” said Dr. Monica Gandhi, an infectious-diseases expert at UC San Francisco.
But officials at both the L.A. County Department of Public Health and the Department of Health Services, which has oversight of County-USC, say the surest way to shore up hospitals is to tamp down transmission. And wearing high-quality, well-fitting masks, they say, remains one of the least-disruptive interventions at the public’s disposal.
“While we are not currently experiencing an increase in ICU admissions at (County-USC), we are seeing a significant increase in the number of infections among our patients, staff and the communities we serve,” officials with the Department of Health Services wrote in a statement this week. “Rising rates of infection are extremely concerning, as the more people who become infected, the greater the probability that ICU admissions for COVID-19 will rise in the future.”
And while mask orders have been off the books for months, many officials have continually urged the use of face coverings in indoor public places. The California Department of Public Health strongly recommends the practice.
As anyone who’s out and about can attest, though, many Californians are not heeding that call. That’s led some to question who exactly would enforce a new L.A. County order and what sort of compliance can be expected.
“L.A.’s restaurants, retail stores, museums, amusement parks, sports centers and so many other establishments are working every day to recover from the pandemic, all while facing workforce shortages, supply chain challenges and more,” Maria Salinas, president and CEO of the Los Angeles Area Chamber of Commerce, and Jessica Lall, president and CEO of the Central City Assn., a downtown business group, wrote in a letter to Ferrer last week. “Businesses should not be expected to enforce a mask mandate in addition to these ongoing constraints. Businesses cannot shoulder this burden of compliance alone as they have been required to do so in the past.”
