Mask rules are about to change, signaling the end of official oversight of our pandemic behavior.
But now it’s up to us, not health officials, to decide when masks are needed in most places. A very public act just turned personal. Participation in even the simplest social gatherings – from book clubs to bars – will demand a quick calculation of risk.
“That’s tricky to navigate,” said UC San Francisco infectious disease expert Dr. Peter Chin-Hong. “The approach is less of a sledgehammer – ‘everybody has to do the same thing’ – to one that’s more individual.”
California’s statewide mask order expires at midnight Wednesday, Feb. 15, so fully vaccinated people will no longer need to wear masks in most public indoor settings. The counties of Alameda, Contra Costa, Marin, Monterey, Napa, San Francisco, San Mateo, Santa Cruz, San Benito, Solano, Sonoma and the city of Berkeley also will lift universal mask requirements for vaccinated people.
Only Santa Clara County is continuing with its rule that residents wear masks in indoor public spaces, regardless of whether they’ve been vaccinated. That’s consistent with the guidance from the U.S. Centers for Disease Control and Prevention, which suggests masking in places with substantial COVID-19 transmission rates.
There are some places where rules aren’t changing, such as in nursing homes, health care facilities and on public transit. And masks are still required inside most public places for unvaccinated Californians.
While COVID-19 cases and hospitalizations are falling, the pandemic is far from over. A study published Friday by the Centers for Disease Control and Prevention found that booster shots of the Pfizer-BioNTech and Moderna vaccines lose substantial effectiveness at preventing outpatient visits after about four months — falling from 87% to 66%. But they still provided significant protection in keeping people out of the hospital.
“People should keep in mind that we still are in a surge,” said Dr. Anne Liu, clinical associate professor of medicine at Stanford Hospital and Clinics/Lucile Packard Children’s Hospital. “There is still quite a lot of COVID out there.”
Be patient, experts agreed. Even for the most cautious people, masking isn’t forever. The situation will continue to improve over the next several weeks as new infections decline – and supplies of treatments, such as antiviral drugs and monoclonal antibodies, start to climb.
But we’re not there yet. And everyone will reach a different decision, based on risk tolerance.
If you or your loved ones are at risk of severe illness, it’s not worth the chance to shed that mask indoors. Or perhaps you don’t want to miss work, school, a big social event or travel, experts say.
“If a financial provider becomes ill, or they’re providing multigenerational caregiving, getting sick has huge implications,” said UC Davis epidemiologist Dr. Lorena Garcia.
Where are you going? That matters, too.
“If people are packed in like sardines and there’s no ventilation, nobody has a mask on and they’re partying like it’s 1975, that’s a high-risk situation,” said UCSF epidemiologist Dr. George Rutherford. “If it’s 8 a.m. on Old Folks Morning at Trader Joe’s, then I’m probably OK without a mask on. But everybody’s going to look at me like I’m Attila The Hun.”
A combination of these two assessments – who you are and where you’re going – will help guide your decision. For advice, we turned to four experts: Drs. Liu, Garcia, Chin-Hong and Rutherford.
Who you are
- You’re healthy, younger than 65, “boosted” and can handle a week or so of feeling lousy and quarantining while your body beats back an infection. You have paid sick leave and you’re OK with illness, knowing that it’s highly unlikely you’ll be hospitalized. Your housemates are the same.
- This may feel especially important if your day-to-day work is greatly impaired by mask-wearing – for example, if you work with kids who have speech or hearing problems.
- You’re healthy, under 65 and boosted. Your housemates are the same. You have ready access to medical care. But getting sick and missing work – or a big upcoming social event or travel – would be a hardship.
- You’re over age 65 and boosted.
- You’re healthy, under 65 and boosted but live with someone who isn’t.
- You’re healthy, under 65 and boosted but live with someone who is too young to be vaccinated or is immunocompromised.
- You’re healthy and under 65 but you absolutely can’t skip work, a social event or travel.
- You’re at risk of getting serious disease because you have health issues that severely impair your immune system. Perhaps the vaccines didn’t boost your immune protection.
- You’re over age 65 and not boosted.
- You’re low income, so any medical costs would be stressful.
- You live in a rural community where you can’t get tests or prompt medical care if you need it.
Where are you going?
- Good ventilation.
- Small gathering, with little crowding and little mingling.
- The venue requires vaccination or negative test results.
- The community has low case counts. Think rural or suburban Contra Costa, San Mateo or Marin counties.
- Moderate ventilation.
- Medium-sized gathering, with some mingling.
- No vaccination or test requirement.
- The community has moderate case counts. Think higher-density Santa Clara or Alameda counties.
- Poor ventilation.
- Large gathering, with lots of mingling, singing or yelling.
- No vaccination or test requirement.
- The community has high case counts. Think San Joaquin Valley cities, such as Fresno.
“These are all really difficult decisions,” said Liu. “We live in a very confusing time.”
“I understand why people can’t keep a muscle flexed all the time,” she said. “We need to relax it once in a while so that we have the energy and fortitude to be able to do this again when another variant comes around. We are in this for the long haul.”