San Francisco Chronicle - (Sunday)
Gradual easing likely in state’s mask mandate
When the day finally arrives that denizens of the Bay Area can tear off their masks and safely breathe one another’s unfiltered air, it won’t be accompanied by cheers and the tossing of face coverings into the streets.
That’s what happened in San Francisco in November 1918 during the influenza pandemic, and the celebrations turned out to be fatally premature. Barely a month later, the city was buried under a fresh wave of illness and death.
Lifting California’s mask mandate may be the single most obvious sign that the coronavirus pandemic is nearly over. “It will be a moment of exhaling and saying the worst is behind us,” said Dr. Ori Tzvieli, deputy health officer for Contra Costa County. But that moment will also arrive with much more caution this century than last, he said.
At least a dozen states — mostly with Republican governors — already have lowered their collective guard and abandoned face coverings.
President Biden and national public health authorities have said that move is premature and begged them to reinstate their mandates as cases climb again across the country.
California has given no hint of letting up its mandate soon. It’s likely that the state mandate will remain for at least another couple of months, public health and infectious disease experts say. State leaders will probably wait until a large majority of the population has been vaccinated. They may wait until daily cases are in the dozens instead of thousands statewide, or for deaths to be near zero.
Even then, people like wedding planner Chanda Daniels may cling to their face coverings like snugfitting talismans.
“Honestly, I feel like I’m just going to wear a mask forever,” Daniels said with a laugh. She owns A Monique Affair in Oakland, and though clients are starting to call her with wedding plans again, she said she can’t imagine a time in the near — or far — future when she’ll want to be out in public without a face covering.
Though there will certainly come a day when the state health officer officially lifts California’s mandate, it will probably be a gradual rollback. Some restrictions may soften a bit before the full mandate is gone, while masks may be required under specific conditions for many more months after.
The state may start by telling people they don’t need to be quite so diligent when they’re outdoors — they can leave the mask in a pocket when they’re out for a run, for example. Or the state may allow those who are vaccinated to gather together maskless, as the Centers for Disease Control and Prevention has advised.
Alternately, the state or counties may decide to retain certain restrictions even after a general mandate is removed. They may require that people wear masks on public transit or other places where they’re crowded indoors and not everyone is vaccinated. Children may need to wear them in school when they return to classrooms in the fall.
“In 1918, they all threw their masks off in November and there were 1,800 more deaths after that” in San Francisco, said Dr. George Rutherford, a UCSF infectious disease expert. He thinks masks may remain in regular use, though perhaps not mandated, through the end of this year. “I don’t want to be the person who has to pull that trigger now. We have to ease our way out of this.”
Masks were among the last, and quickly became among the most controversial, tools used to battle the coronavirus in the United States. After a couple of months advising Americans to forgo masks because they were in short supply and should be saved for health care workers, authorities abruptly turned course. But that early messaging would haunt public health authorities throughout the pandemic, and in many parts of the country masks never caught on.
Sonoma County was the first in the Bay Area and among the first in the state to order residents to wear face coverings in public, on April 13. Other counties quickly followed, and the state order came in midJune.
California’s initial mask mandate required all residents to wear a face covering in public and workplace settings where there is a “high risk of exposure.” It was later updated to require people wear face coverings any time they were outside their homes and within 6 feet of others. Some counties are even more restrictive, requiring that people wear masks at all times outside their homes, whether others are around or not.
Over the past year, masks have become an enduring symbol of this pandemic: They are literally on everyone’s face any time they go out in public. They have hidden the friendly smiles of strangers and loved ones alike, but they’ve also been a profound source of comfort to many who would otherwise be afraid to leave their homes.
Though masks feel limiting and are an unwieldy burden at times, they have allowed the economy to continue humming at its sluggish pace. And as long as the masks stay firmly on faces, they will help the state slowly unfurl from the pandemic, infectious disease experts say.
“Masking is what’s allowing our sectors to reopen as we try to move through the tiers,” said Dr. Susan Philip, the San Francisco health officer, referring to California’s colorcoded reopening tiers. “By continuing to mask, we are keeping the transmission rate down so we can keep these businesses open and engage with workers safely.”
But ultimately there will come a time when masks are no longer deemed necessary. Public health officials haven’t yet said exactly what metrics they will be looking for to make that decision. But the first and most obvious probably will be vaccination rates, experts said.
State and county officials may wait to get rid of mask mandates at least until vaccine supply is at a point that anyone who wants to be vaccinated has had at least one dose. That’s a matter of equity and community protection, experts said: It’s not exactly fair to remove a mask mandate when so many people don’t have the option of protecting themselves in some other way. And lifting it just for the vaccinated would create a public health nightmare as far as enforcement.
Vaccines are set to open to all comers in California on April 15. It may take a few more weeks for supply to fully come online and for the early rush to subside so that everyone who wants one can get an appointment. Then another month or two will pass as all those people who waited patiently get their shots.
Dr. Monica Gandhi, an infectious disease expert at UCSF, said she expects that enough people will be vaccinated that a mandate could be lifted a couple of months after everyone is eligible for vaccines. Conveniently, that would be June 15: pretty much exactly one year from the state’s initial mask order.
“There’s a nice symmetry to that, right?” Gandhi said. “I think we should be able to lift mask mandates by the summer. Everyone who wants the vaccine will have had a chance to get a vaccine by then.”
But other experts said they would recommend more caution, and they expect that Bay Area public health officials may feel the same. Counties can keep local mask mandates or issue new ones if the state drops them before they feel ready.
Most experts say they would want to reach certain goals for people vaccinated as well as for people believed to have some immunity, either from vaccines or previous infection. They don’t, however, expect mandates to stay in place until the state reaches herd immunity, which would require getting children vaccinated too. Young children may not be approved to get the vaccines until late this year or early next.
But children aren’t believed to be major sources of disease transmission in this pandemic anyway. Once the state gets to a high level of vaccination among people ages 16 and older, that should dramatically curb cases and, most importantly, hospitalizations and deaths.
It’s possible that a mask mandate could be removed after 70% or more of adults have gotten their shots, which could be as early as June and almost certainly by midsummer. The main limiting factor would probably be vaccine hesitancy by then.
Still, other infectious disease experts said they’d prefer to retain mask mandates beyond just high vaccination rates. They’d like to see stable evidence that cases have dropped dramatically and that people aren’t getting seriously ill and dying very often — maybe numbers comparable to a typical flu season.
California doesn’t track influenza hospitalizations and deaths as closely as it does for COVID19. But the CDC estimates that roughly 6,000 people die of the flu in California each year, which works out to under 50 deaths a day during the season. California currently reports about 100 to 250 deaths a day from COVID19.
How low cases need to go is up for debate, but no one thinks California or anywhere in the U.S. will get to zero. Some infectious disease experts said they would like to see cases stabilize at under 200 a day. Other experts say they’d feel comfortable under 400 a day. California currently reports about 2,000 to 4,000 cases a day.
“It’s not just the number of daily cases, but how long the number of daily cases remains below a certain number and whether those numbers are decreasing,” said Dr. Lee Riley, an infectious disease expert at UC Berkeley. “If they’re still going up or down or staying in a plateau, a mask mandate should remain.”
As most Californians have come to appreciate, there are still potential snags — most notably, the troublesome coronavirus variants — that could prolong the pandemic and the time everyone must spend behind a mask. More infectious variants already are believed to be partially to blame for spikes in cases across Europe and in parts of the United States.
So far California seems to be pulling ahead in the race against variants, though. And that bodes well for a day in the nottoodistant future when people can put their masks away — not in the trash or recycling bin, though. It’d probably be best to keep them close at hand, just in case.
“Frankly, I don’t think I’m ever getting on an airplane again without a mask,” said Shannon Bennett, chief of science at the California Academy of Sciences. “Other cultures do it. And I now have a bunch of very fashionable, comfortable masks. I’m definitely going to embrace mask wearing.”