Mask mandates make a return - along with controversy

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Two months after the Centers for Disease Control and Prevention said vaccinated individuals didn't need to wear masks in most settings, a growing number of experts are warning it's time to put them back on.

First, there was Los Angeles County, where the rising menace posed by the delta variant of the coronavirus prompted health officials to reimpose a mask mandate. Then, Bay Area health officers on Friday recommended that residents of seven counties and the city of Berkeley, Calif., resume wearing masks indoors. Mask mandates are being discussed, too, in coronavirus hot spots such as Arkansas and Missouri, where cases have sharply increased in recent weeks and many residents remain unvaccinated.

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"Universal masking indoors is a way of taking care of each other while we get more people vaccinated," said Barbara Ferrer, director of the Los Angeles County Department of Public Health, which last week moved to reinstate an indoor mask mandate. "It really doesn't disrupt any business practices. It allows us to remain fully open - while we acknowledge that the delta variant [is] spreading like wildfire here."

And the nation's current and former surgeon generals warned the nation should brace for a broader return to mask-wearing.

"We need to prepare the public for what could be, again, a return to some of these mitigation measures," former surgeon general Jerome Adams told Indianapolis TV station WISH-TV on Sunday, highlighting a resurgence of the virus across the Midwest. Adams, an appointee of former president Donald Trump, called on the CDC to "hit the reset button" and once again recommend widespread mask-wearing as coronavirus cases spike.

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But the growing calls to reinstate mask mandates - echoed by the American Academy of Pediatrics, which Monday called for everyone over the age of 2 to wear masks, regardless of vaccination status - renewed a cultural and health flash point a year and a half after the virus landed in the United States.

"We need to be reopening our state, not reimposing unnecessary restrictions," Kevin Faulconer, the Republican former San Diego mayor now running for California governor, wrote on Twitter last week. The Los Angeles County sheriff last week said he would refuse to enforce the local masking mandate, and Republicans nationally took aim at existing protections.

"In a free county people will evaluate their personal risk factors and are smart enough to ultimately make medical decisions like wearing a mask themselves," Sen. Rand Paul, R-Ky., said in a statement last week, introducing legislation that would ban mask mandates on planes and public transportation.

The daily average of confirmed U.S. coronavirus cases has risen in the past month, from 11,855 on June 19 to more than 34,000 on Monday, according to The Washington Post's seven-day average of coronavirus cases. Experts on coronavirus transmission say masks remain a crucial tool to protect tens of millions of unvaccinated Americans - and even vaccinated people, with growing evidence of breakthrough infections in some fully immunized adults, although health officials have said most people who have died or been hospitalized with covid-19 in recent weeks were unvaccinated.

"The best protection everybody has is masks," said Kimberly Prather, a professor at the University of California, San Diego who has studied airborne virus transmission and said she "absolutely" supports the resumption of indoor mask mandates. Prather said she has also grown wary of going without a mask in some settings outside, warning that the delta variant is hyper-transmissable.

"While delta numbers are going up - and if I'm in a crowded outdoor location with lots of people yelling - I would be wearing a mask," Prather said.

But many Americans say they have stopped wearing face coverings, and experts acknowledge it will be difficult to persuade them to resume.

"I think people will be disappointed that folks were having some hope and seeing the light at the end of the tunnel - and this would be a suggestion that we're taking a step back," said Marcus Plescia, chief medical officer at the Association of State and Territorial Health Officials.

Just 55% of respondents to an Axios/Ipsos poll in late June said they were wearing masks "sometimes" or "at all times" in public, down from 68% who said the same in early June and nearly 90% in February, March and early April.

Plescia said he supports the resumption of local mask mandates, given the rise in cases and the growing evidence about the threat of the delta variant.

"You know, recovery from just about anything comes in cycles - things get better, and they get worse, and they get better, and they get worse. It's rare that it's linear. And I think that's what's going on here," Plescia said.

Some physicians who embraced mask mandates last year said they're concerned the moment has passed.

Former Louisiana health commissioner Rebekah Gee, who is CEO of Health Care Services for LSU Health, wrote last year that she favored the use of mask mandates to protect public health. But "at this point, I'm not convinced that requiring masks in every aspect of society is effective," Gee said Monday, warning that many Americans had tuned out public health officials' calls to wear masks and take other steps to guard against the coronavirus.

Gee instead said she favors targeted mask requirements, such as mandating use in close quarters or when interacting with vulnerable populations such as children younger than 12, who have yet to get vaccinated. Gee also said she supports private-sector requirements for masks.

"The point now is how do you save lives and get people on the team of science, the team of truth?" Gee said. "Forcing people to do things is not the best way to get them to agree with you."

The CDC on May 13 initially moved to relax its mask guidance, saying vaccinated Americans could go without masks in many cases. Federal officials also suggested the move would provide an incentive for unvaccinated Americans to get immunized.

But the CDC's recommendation did not appear to spur a growth in vaccinations.

In a Kaiser Family Foundation survey of unvaccinated Americans following the CDC's recommendation, 85% of respondents said the agency's new guidance did not affect their decision to get vaccinated. The pace of vaccinations has steadily declined from about 2 million shots per day in mid-May to fewer than 550,000 shots a day. Health officials' goal of ensuring that at least 70% of adults receive one shot of vaccine, which President Joe Biden initially targeted for July 4, is unlikely to be reached before Aug. 10, according to The Post's projections.

Federal officials have defended the CDC's earlier decision. In a Washington Post Live interview Monday, National Institutes of Health Director Francis Collins said the CDC's recommendations for fully vaccinated people to remove their masks were issued before the delta variant began broadly circulating - and before it was clear how much hesitancy would exist in some parts of the country.

"I know people are tired of masks, but it's not so awful to consider having to put a cloth mask on your face when you're inside if it's going to potentially stop what is, right now, looking like a pretty significant surge of infections, especially in places where vaccination rates are low," Collins said.

Surgeon General Vivek Murthy said the federal government supports local mask mandates in places where cases are surging or many residents are unvaccinated.

"It's very reasonable for counties to take more mitigation measures, like the mask rules that you see coming out in L.A.," Murthy said Sunday on ABC's "This Week." "I anticipate that will happen in other parts of the country, too."

The latest debate over masks comes after months of battle over their benefits, including a now-retracted study in JAMA Pediatrics that claimed masks could harm children by forcing them to breathe high carbon dioxide levels. The study was retracted Friday amid "numerous scientific issues," the journal's editors wrote.

"The science is settled that masks do work, though mask performance can vary widely," said Linsey Marr, a Virginia Tech engineer who has studied airborne-disease transmission. "The kind of studies that are trying to just debunk masks, so far they've all been shown to be completely flawed."

Meanwhile, society continues to steadily reopen, as businesses and entertainment venues increasingly welcome back customers. The Transportation Security Administration said it tracked 2.23 million travelers through its checkpoints Sunday, the highest number of travelers since the onset of the pandemic last year, and movie theater chains have reported millions of patrons this month after a year when cinemas often sat empty.

The highest-rated television program in recent weeks has been the National Basketball Association Finals, featuring thousands of often mask-free fans crowding indoor arenas in Phoenix and Milwaukee to cheer on the teams - a visual that induced complicated emotions in at least one expert.

"I cringe every time I see it," said Shad Marvasti, a family medicine physician and director of Public Health and Prevention at the University of Arizona College of Medicine at Phoenix, who added he's rooting for Phoenix to win the NBA finals - but wishes fans were required to wear masks. "You can't leave this one to the honor system. It just doesn't work that way."

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The Washington Post's Frances Stead Sellers and Emily Guskin contributed to this report.

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