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L.A. County on verge of indoor mask mandate as deaths, hospitalizations rise

Some commuters wear masks at Union Station on Tuesday in Los Angeles.
California is suffering through another intense coronavirus wave, fueled by the stunning proliferation of the BA.5 subvariant.
(Irfan Khan / Los Angeles Times)

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 an effective date of July 29.

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.

However, given continued increases in cases — and the potential for a corresponding rise in hospitalizations over the weeks to come — “at this point, it’s much more likely that we will stay in ‘high’ for these two weeks,” said county Public Health Director Barbara Ferrer.

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“With the high rates of transmission fueling the increased risks, sensible safety precautions that can slow down the spread of the virus are warranted, and that includes universal indoor masking,” she said Thursday.

A renewed mandate would apply indoors for those 2 and older at a familiar 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.

Importantly, though, masks would not be required for those using outdoor spaces, as the risk of transmission in those settings is significantly lower than it is indoors.

Patrons also would be able to take off their masks indoors when actively eating or drinking.

Though the county is still a few weeks away from possibly mandating indoor masking, health officials have strongly recommended the practice for months — and continue to do so.

“We are not closing anything down. We are not asking people not to gather with the people they love. We are not asking you to forgo activities you love,” Ferrer said. “We’re asking you to take a sensible step when there’s this much transmission, with a highly transmissible variant, to go ahead and put back on a well-fitting, high-filtration mask when you’re indoors around others. And I think that’s the prudent thing to do.”

Weekly COVID-19 deaths doubled in Los Angeles County over the last month, to 100 from 50 a week.

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.)

Los Angeles County hasn’t been in the high community level since late February.

Compared with its ancestors, the latest Omicron subvariant, BA.5, may have an enhanced ability to create a numerous copies of the coronavirus once it gets into human cells.

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 100.

Weekly COVID-19 deaths doubled in Los Angeles County over the last month, to 100 from 50 a week.

Officials say BA.5, thought to be the dominant version of the coronavirus circulating nationwide, is not only more contagious than previous 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.

“Many people feel like the risk is a lot lower right now, and there’s no need to worry. We’re saying there is need to worry,” Ferrer said. “This variant is, as everybody has noted, highly infectious, easily transmitted from person to person. We need an additional layer of protection, and this is the additional layer.”

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.

Taking preventative measures is especially important now as BA.4 and especially BA.5 can reinfect even those who recently contracted an earlier Omicron subvariant.

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.

The latest maps and charts on the spread of COVID-19 in Los Angeles County, including cases, deaths, closures and restrictions.

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 report, published by the CDC in 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.

Ferrer acknowledged that, for many, reinstituting an indoor mask order “will feel like a step backward” and that for others it will “feel unnecessary because of the availability of powerful vaccines and therapeutics.”

“The reality is that because we’re living with a mutating SARS-CoV-2 virus, there remains uncertainty around the trajectory of this pandemic,” she said. “The best way to manage the uncertainty, and to reduce morbidity and mortality, is to remain open to using both the sophisticated tools we now have — our tests, our vaccines, our therapeutics — and the non-pharmaceutical strategies, masking ventilation and distancing, to layer on protections to respond to the conditions at hand.”

Ferrer said the next two weeks will be spent reaching out to businesses “so that they’re clear about their need to both supply those masks for all of their employees, make sure that their employees are masked appropriately indoors, and to do their best to message to their customers.”

This wouldn’t be the first time Los Angeles 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.

L.A. County health officials plan to lift the mask order once the county dips back into the medium COVID-19 community level for two consecutive weeks.


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