Faced with rising coronavirus cases and growing concerns about the Omicron variant, California is ordering a statewide mask mandate for indoor public spaces to go into effect on Wednesday.
The move comes as coronavirus case rates in California have risen by almost 50% in the last 2½ weeks, and COVID-19 hospitalizations are up by nearly 15%. County health officials across the state say they suspect they may be seeing the start of a winter jump in coronavirus cases.
The U.S. Centers for Disease Control and Prevention ranks California as having a high level of transmission of the coronavirus, the worst tier in the federal agency’s four-tier scale.
“This is a critical time where we have a tool that we know has worked and can work,” Dr. Mark Ghaly, California’s health and human services secretary, said Monday. “We are proactively putting this tool of universal indoor masking in public settings in place to ensure we get through a time of joy and hope — without a darker cloud of concern and despair.”
The order will affect roughly half the state’s population, including San Diego and Orange counties, the Inland Empire, and swaths of the Central Valley and rural Northern California. The statewide indoor mask mandate order will last a month, expiring on Jan. 15.
A number of California counties — including Los Angeles, Ventura and Sacramento — and most of the San Francisco Bay Area already have their own indoor mask mandates that were implemented in the summer and have no end dates.
The state is also recommending that travelers who return to or visit the state get tested within three to five days of their arrival.
California’s announcement came on the same day New York enacted its own statewide mask requirement in indoor public spaces, excepting only settings where everyone inside must be vaccinated. Officials in Britain have also reordered an expansion of indoor mask mandates.
The new mask orders arrive as the Omicron variant — discovered only last month — has spread rapidly around the globe. Britain has recorded its first death of someone infected with the Omicron variant.
“Omicron will almost certainly overtake Delta and cause new waves of infection globally,” Dr. Tom Frieden, a former CDC director, tweeted. While there has been some optimism that Omicron may cause less severe illness, “this will take time to figure out,” Frieden wrote.
Troublingly, studies of household members find that Omicron poses more than double the risk of coronavirus transmission compared with Delta, Frieden said. In Britain, officials expect new Omicron cases to become equal to that of Delta sometime in mid-December, with Omicron cases doubling every two to three days, Frieden said.
“Make no mistake, Omicron has the potential to induce an enormous number of infections worldwide and even if severe COVID is one-tenth that of Delta or preceding variants, in absolute numbers it could lead to a major toll of hospitalizations or deaths,” Dr. Eric Topol, director of the Scripps Research Translational Institute in La Jolla, wrote in a blog post.
“Similarly, we should not underestimate Omicron’s impact on long COVID. The propagation of a large number of infections, even among vaccinated individuals, for whom there is expected to be some ill-defined lower risk and severity of long COVID, is a lingering and serious concern,” Topol wrote.
There continues to be concern about a potential reduction in the effectiveness of COVID-19 immunizations against symptomatic illness resulting from Omicron. Early data suggest effectiveness against symptomatic illness for the two-shot Pfizer vaccine falls to 35%, but rises to 75% following a booster shot. Still, this is not as good as the vaccine effectiveness against Delta, which was 95% following the booster, according to Topol.
Scientists suspect that vaccinations and boosters will still provide significant protection against severe illness, however.
In addition, many states have been struggling with a winter COVID-19 surge due to the still-dominant Delta variant. “We see other states in the United States struggle with overwhelmed hospitals and a high number of cases,” Ghaly said.
With the more recent coronavirus variants, data suggest that if people do become severely sick, they become sicker sooner, Ghaly said. “So the impact on hospitals might be quicker,” he said.
Also, there is no discussion that stay-at-home orders will return again this winter, Ghaly said, so hospitals will in some ways face some challenges that they didn’t last year.
Ghaly said he’s concerned that hospital capacity is still pressed and challenged, particularly in San Bernardino and Riverside counties, across the Central Valley and in the eastern Sierra and the rural north. A number of hospitals throughout the state are busier than usual for this time of year, where staff are still exhausted from battling a nearly 2-year-old historic pandemic, and there’s still plenty of pent-up demand for healthcare needs that were postponed during earlier parts of the pandemic.
The evidence is there that masks make a difference, Ghaly said. The coronavirus is airborne and can also spread silently from infected, asymptomatic people.
“Even a 10% increase in indoor masking can reduce case transmission significantly,” Ghaly said. “Wearing a mask is going to be one of the most important things to help us get through this period of uncertainty.”
Ghaly acknowledged that there may be people across the state who will not comply with an indoor mask mandate.
“We hope that those are few and far between,” Ghaly said. “In some places, the enforcement is going to be stronger than others.”
But Ghaly expressed hope that some communities will decide to follow the new rules for just the next month.
The mask policy “can have a real impact on case transmission and help preserve our hospital system, and save lives,” Ghaly said.
At least 10 studies cited by the CDC recently have confirmed the benefit of masks, and “each analysis demonstrated that, following directives for universal masking, new infections fell significantly,” the state Department of Public Health said in a statement.
State public health officials credited a universal masking requirement in indoor settings in California’s K-12 schools as being effective in helping to keep schools open even as other states nationwide have been forced to temporarily halt in-person instruction due to outbreaks. “California accounts for roughly 12% of all U.S. students, but only 1% of COVID-19 related school closures,” state officials said in the statement.
For parts of California, the new mask order will result in dramatic changes in day-to-day life if the rule is widely followed. Places like Orange, Riverside, San Bernardino and San Diego counties haven’t had an indoor mask order since June 15, when the last statewide mask order ended.
Residents in areas that partially eased local mask rules will also notice a difference. San Francisco on Monday said it will no longer allow people at indoor gyms or offices to be maskless, even if everyone inside is fully vaccinated.
But in places like L.A. and Ventura counties, the state’s latest rules essentially echo the existing local mask orders, and won’t result in changes.
Under the new order to go in effect on Wednesday, California is also tightening rules related to entering large indoor events. Existing rules require patrons age 3 and older of indoor events of 1,000 or more people to show proof of full vaccination or the results of a recent negative test.
For patrons who choose to show a recent negative test, existing rules allow them to show a test as much as 72 hours old; the new rules require patrons to show a more recent test — within two days if it’s a PCR test or one day if it’s a rapid antigen test.
Health officials in Los Angeles and Orange counties warned in recent days that it is possible that hospitals will be strained again this winter with COVID-19 patients.
Dr. Regina Chinsio-Kwong, a deputy health officer for Orange County, said even without factoring in Omicron, Orange County will need to brace itself for the possibility of a COVID-19 surge.
“Unfortunately, yes, our hospitals are having to relook at their surge plans with the staffing shortages that they have been experiencing to brace themselves again for a very, very busy winter,” Chinsio-Kwong said Friday.
It still remains possible that too many cases of COVID-19 could make it harder for heart attack patients to get a hospital bed, leaving them at greater risk of dying or suffering severe illness “because they’re not able to get the care they need as quickly as they need it,” Chinsio-Kwong said.
In Los Angeles County, growing vaccination rates have made an impact on reducing the burden on hospitals; during last year’s surges, 15% to 20% of coronavirus cases led to hospitalizations, but for this summer’s Delta surge, about 5% to 6% of cases led to hospitalizations. That “really reflects the power of those vaccines,” Los Angeles County Public Health Director Barbara Ferrer said recently.
“But we worry about a strain on the hospital care system. We have a really noted ongoing staffing shortage issue at many of our hospitals,” Ferrer said.
A number of healthcare workers have decided to leave the workforce, exhausted by the pandemic and disillusioned by anti-vaccination sentiment.
“So while I don’t anticipate us being hit anywhere near as hard as we were hit last winter, it’s all relative,” Ferrer said. “And our job is to really do our very best to make sure people know what they can do to try and avoid getting a serious illness associated with COVID.”
California is approaching a statewide COVID-19 death toll of 75,000. The national death total is nearing 800,000.
People exempted from the state’s indoor mask requirement include those younger than 2; people with medical or mental health conditions that prevents wearing a mask, including those for whom wearing a mask could obstruct breathing or who are unconscious; and people who are hearing impaired or are communicating with someone hearing impaired, where the ability to see the mouth is needed to communicate.