Sustained jumps in cases and hospitalizations fueled by the hyper-infectious BA.5 subvariant pushed Los Angeles County into the high COVID-19 community level Thursday, a shift that could trigger a new public indoor mask mandate by the end of this month unless conditions improve.
Health officials have long said the county was inching closer to the metrics for a new mask measure, and those warnings are now closer than ever as the latest COVID-19 wave continues to wash over the region.
Should L.A. County remain in the high COVID-19 community level, which is defined by the U.S. Centers for Disease Control and Prevention, for the next two Thursdays, a new masking order would be issued with a likely effective date of July 29.
But if L.A. County falls back to the medium level during either of the next two weeks, the clock would reset, pushing the earliest date for any new mask order into August.
A renewed mandate would apply indoors for those ages 2 and older at a familiar host of establishments and venues — including shared office space, manufacturing and retail settings, event spaces, restaurants and bars, educational settings and children’s programs, county Public Health Director Barbara Ferrer told the Board of Supervisors earlier this week.
Importantly, though, masks would “not be required for those using outdoor spaces, because the risk of transmission in an outdoor space is significantly lower than it is indoors,” she added Tuesday.
Patrons also would be able to take off their masks indoors when actively eating or drinking.
The CDC’s COVID-19 community level is a three-tier measurement of coronavirus transmission and hospital impact. For counties in the worst category on that scale, high, the CDC recommends indoor public masking.
Being in the high community level means L.A. County has observed at least 10 new weekly coronavirus-positive hospitalizations for every 100,000 residents. The latest rate was 10.5 new weekly hospitalizations for every 100,000 residents, according to the county Department of Public Health.
That’s up from a rate of 8.4 the previous week, according to the county. (Last week’s combined rate for L.A. and Orange counties, which was published by the CDC, was 9.7.)
L.A. County hasn’t been in the high community level since late February.
As of Wednesday, 1,202 coronavirus-positive patients were hospitalized countywide — more than double the total recorded a month ago.
And the rate of rise has steepened, with the daily patient census swelling 52% since the end of June.
Fueling this renewed stream of hospitalizations is stubbornly high transmission driven by highly infectious Omicron subvariants, chief among them BA.5. Los Angeles County has averaged about 6,400 coronavirus cases a day over the last week — its highest rate since early February.
The number of weekly reported COVID-19 deaths has also doubled over the last month, from 50 to roughly 100.
“When faced with rising cases, hospitalizations and deaths, we are advantaged if we use all available mitigation measures at our disposal to best protect ourselves and those most vulnerable,” Ferrer said.
Officials say BA.5, thought to be the dominant version of the coronavirus circulating nationwide, is not only more contagious than prior versions but also has increased the risk of reinfection — perhaps just weeks after an earlier case.
According to federal estimates, BA.5 accounted for 65% of the nation’s coronavirus cases over the weeklong period ending Saturday, an astonishing climb from a month ago, when it made up 17% of cases.
There are still a number of settings where masking remains mandatory, including healthcare and long-term care facilities, emergency shelters, cooling centers, jails and prisons, and at worksites experiencing a coronavirus outbreak. L.A. County, unlike the state as a whole, also requires face coverings when aboard public transit or in indoor transportation hubs such as airports.
However, should the county move ahead with a wider indoor mask mandate, it will do so alone. No other California counties currently have public indoor mask mandates, although the state Department of Public Health strongly recommends — but does not require — the practice.
As a result, some have questioned the wisdom of L.A. County’s approach, as well as whether there’d be widespread compliance with new rules. The only other county that reinstituted indoor masking during this latest wave, Alameda, rescinded the order three weeks later, and the efficacy of that short-lived mandate has been called into question.
Some experts, though, have noted that Alameda County’s mask mandate was the only time a lone county in the San Francisco Bay Area has issued a mask order without other major counties doing so as well. As a result, the order received significantly less attention in the region, affecting just 1.6 million residents among 7.7 million who live in the Bay Area.
By contrast, an order from L.A. County would instantly affect 10 million residents, give or take the roughly 600,000 residents of Long Beach and Pasadena. Those two cities have their own public health departments and can decide independently whether to align with the county’s rules.
Ferrer pointed to studies suggesting universal masking orders have been effective at reducing viral transmission.
One, published in February in the journal Health Affairs, said that of more than 400 U.S. counties, those with mask mandates between March and October 2020 had coronavirus case rates 35% lower than those without.
A second, published in March by the CDC, said school districts in Arkansas with universal mask requirements from August to October 2021 had a 23% lower coronavirus case incidence than districts without a mask order.
And another CDC publication from February said consistent use of a high-quality face covering — such as an N95 or KN95 respirator — in indoor public settings was associated with 83% lower odds of testing positive for the coronavirus, compared with those who didn’t wear a mask.
“For many, this will feel like a step backwards,” Ferrer said Tuesday of the potential masking order. “It may be more useful to recognize that we have a very rich toolkit that we can use to cope with the uncertainty of the trajectory of this pandemic. All of the tools we have can help us get through the different challenges. When transmission is very high, universal indoor masking makes a lot of sense because it helps us reduce risk.”
This wouldn’t be the first time L.A. County has acted alone. A year ago — on July 17, 2021 — the county reissued a universal mask mandate in response to the Delta variant, which lasted through March 4. A number of other California counties followed L.A. County’s lead in the subsequent weeks.
Local health officials in other parts of the state have not indicated they’re considering a new mask order, and some have said they don’t anticipate implementing new orders more stringent than those required by the state.
