L.A. County goes it alone in push for new coronavirus mask rules, igniting familiar debate

Sustained growth in coronavirus-positive hospitalizations has Los Angeles County on the brink of a new public indoor mask mandate, a move officials say could help curb still-widespread transmission, but it has raised some concerns among business groups and sparked questions about its necessity.

Though the count remains well below the peaks of earlier surges, hospitalizations have swelled. In L.A. County, 1,299 coronavirus-positive patients were hospitalized as of Monday — up 60% since the start of the month. The story is much the same in intensive care units, where the latest daily census, 137, is far below the highs of previous waves but has increased almost 51% since July 1.

Although they’re not as high as during the peak of previous waves, the current number of coronavirus-positive patients in ICUs is roughly the same as when L.A. County last implemented an indoor mask mandate, on July 17, 2021. On that date, there were 134 coronavirus-positive patients in intensive care units.

Deaths have dramatically increased, too, but still remain far below the last wave. Over the last month, weekly COVID-19 death rates in L.A. County have roughly doubled.

The decision L.A. County public health officials have had to grapple with is whether to implement a mask mandate, and at what point to do so.

There are a significant number of people who have become infected but are not falling severely ill and ICUs are less crowded than in previous waves. The availability of vaccines and treatments and changes with the virus itself are also helping.

But the soaring rate of both cases and coronavirus-positive hospitalizations is worrying local public health officials.

In parts of California, infections may have reached levels higher than the initial Omicron wave, based on data emerging from coronavirus levels in wastewater. In Los Angeles County, some emergency rooms and community clinics are growing increasingly strapped, the number of nursing homes seeing significant outbreaks have dramatically increased and more workplaces are seeing clusters of cases.

And L.A. County health officials are quite concerned about the notable increase in weekly deaths, a pattern that has not been seen in other parts of the state.

The point of a mask mandate is to prevent significant harm to public health, local officials say, following significant warning signs in L.A. County, which has a large number of vulnerable, lower-income people.

Here is what we know:

Wastewater data suggest many at-home tests showing infections aren’t being recorded in officially reported coronavirus case counts.

Where does L.A. County stand?

L.A. County on Thursday reported 10.5 new coronavirus-positive hospitalizations for every 100,000 residents — enough to land the nation’s most populous county in the high COVID-19 community level defined by the U.S. Centers for Disease Control and Prevention.

Should it remain in that category for the next two Thursdays, a new masking order would be issued with an effective date of July 29.

However, if the county moves 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.

At the end of June, roughly 20% of coronavirus-positive patients at L.A. County’s four public hospitals were being treated for COVID-19 illnesses. At all hospitals — public and private — about 42% of coronavirus-positive patients are being seen for a COVID-19 illness. Statewide, the share is about 50%.

New data show the county’s coronavirus case rate continues to rise. It is now averaging about 6,900 coronavirus cases a day, nearly double the peak rate from last summer’s Delta surge and 27% higher than the previous week.

On a per capita basis, L.A. County’s case rate is 476 cases a week for every 100,000 residents.

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

COVID-19 deaths across L.A. County have increased significantly in the last month, from about 50 a week to between 88 and 100. That’s the first significant increase since the end of the winter Omicron wave. During the peak of that surge, weekly deaths topped 500.

California is recording about 21,000 coronavirus cases a day, up 16% from the prior week. On a per capita basis, the state is reporting 368 cases a week for every 100,000 residents and roughly 255 COVID-19 deaths per week.

Most Californians live in counties with a high COVID-19 community level, in which the CDC recommends universal masking in indoor public spaces.

What would a new mandate look like?

A renewed masking rule would apply indoors for those 2 and older at numerous venues — including shared office space, manufacturing and retail settings, event spaces, restaurants and bars, gyms and yoga studios, educational settings and children’s programs.

Masks would not be required for those using outdoor spaces, as the risk of transmission in those settings is significantly lower.

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

Though the county still has not pulled the trigger on a mandate, health officials have strongly recommended the practice for months — and continue to do so.

Ferrer said the period ahead of the potential issuance of a mandate 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.”

Many who become infected are not falling seriously ill. While hospitalizations are rising, patients are generally less sick, and intensive care units are less crowded than in previous surges.

What are the concerns?

Some have questioned the wisdom of L.A. County’s approach, as well as whether there’d be widespread compliance with any new masking rules.

Maria Salinas, president and chief executive of the Los Angeles Area Chamber of Commerce, and Jessica Lall, president and chief executive of the Central City Assn., a downtown business group, sent a letter to Ferrer last week expressing concerns.

Requiring masks, they wrote, “puts employees in the increasingly challenging position of enforcing a mandate that many customers no longer wish to — or are unwilling to — comply with.”

“L.A.’s restaurants, retail stores, museums, amusement parks, sports centers and so many other establishments are working every day to recover from the pandemic, all while facing workforce shortages, supply chain challenges and more,” they wrote. “Businesses should not be expected to enforce a mask mandate in addition to these ongoing constraints. Businesses cannot shoulder this burden of compliance alone as they have been required to do so in the past.”

If L.A. County does mandate indoor public masking, and no other counties follow suit, “residents and visitors may choose to take their spending power to businesses in other parts of Southern California, which would only harm our local economy,” they wrote.

As California grapples with another summertime coronavirus wave, will L.A. County prove to be ahead of the curve or, as some critics maintain, behind the times?

No other California counties currently have public indoor mask mandates. The state Department of Public Health strongly recommends — but does not require — the practice.

The only other county that reinstituted indoor masking during this latest wave, Alameda, rescinded it 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.

This content was originally published here.