Face masks may return amid holiday ‘tripledemic’

With three highly contagious respiratory viruses sickening adults and children around the country and holiday gatherings just weeks away, public health officials are beginning to talk about face masks again.

While mask mandates are unlikely in most parts of the country, health experts are renewing recommendations to wear a high-quality medical mask on public transportation, in airports and on planes, while shopping and in other crowded public spaces.

What’s notable is that the mask recommendations this time aren’t just about avoiding the coronavirus. Masks are advised to protect against what is being called the “tripledemic” — a confluence of influenza, coronavirus and respiratory syncytial virus (RSV) that already is straining hospitals and forcing parents to miss work in record numbers.

As the country heads into its third pandemic winter, COVID-19 cases are on the rise, and the 2022-23 flu season is shaping up to be the worst in a decade — there have already been 4,500 deaths from flu, including 14 children, according to the Centers for Disease Control and Prevention.

With such a heavy burden of illness straining the health-care system, it may be hard to believe that something as simple as a face mask could make a meaningful difference. But health experts say a quality medical mask — such as an, KN95, or KF94 — remains a highly effective line of defense, especially when combined with vaccination, hand washing, better ventilation and avoiding crowds.

Why are we talking about masks again?

Rochelle Walensky, the CDC director, said earlier this week that the agency encourages everyone “to wear a high quality, well-fitting mask to help prevent the spread of respiratory illness,” particularly on public transportation and during airport travel. Masking is especially important in counties with high COVID-19 community levels, she said.

Walensky said that while the CDC’s mask guidance is “largely based” on the coronavirus, and not flu and RSV, “it is the case that the mask works against those as well.”

“If you have these other things circulating as well, and you want to protect yourself against other respiratory diseases, then the mask will help you,” she said.

Are mask mandates coming back?

Only a few communities are reconsidering mask mandates, especially if the CDC identifies them as having high levels of COVID. The most notable is Los Angeles County, which the CDC considers to have medium COVID levels, where cases are spiking and hospital admissions are rising. If the share of hospital beds used by coronavirus positive patients rises from 6.4 percent (as of Saturday) to 10 percent, that could trigger a new indoor mask mandate that could go into effect by early January, the Los Angeles Times has reported.

The CDC in February announced a new system of COVID community levels that would tie masking recommendations to metrics illustrating the strain of COVID on hospitals rather than the prevalence of infections. The system isn’t designed to track levels of other respiratory viruses.

When should I wear a mask?

Mask-wearing is a personal decision affected by your health risks and whether you spend time with a vulnerable person. It makes sense to wear a mask in crowded spaces where you don’t know the vaccination status of others, such as subways, buses, trains and planes.

Masking is a good idea in public places where you’re spending more than a few minutes — such as a grocery store, shopping mall or physician’s office. Some people may opt to wear a mask at work all the time — or only when gathering in small enclosed meeting rooms.

You should also wear a mask if you’re caring for a sick person or have respiratory symptoms, even if you test negative for the coronavirus.

Anyone who has cold or respiratory symptoms should not go to work or social events until the symptoms end.

What’s the evidence that masks work?

A study that looked at mask use in California found that people who reported always wearing a cloth mask in indoor public spaces last year were 56 percent less likely to test positive for the coronavirus compared with people who did not wear masks.

The protection grew to 66 percent for those who consistently wore surgical masks and to 83 percent for those wearing N95 or KN95 masks.

Most of the mask research is on reducing risk for the coronavirus, but the evidence suggests masks will also be effective at blocking other respiratory viruses, said Linsey Marr, a virus transmission expert and professor of civil and environmental engineering at Virginia Tech. Marr noted that masks work by trapping viral particles, and influenza and coronavirus are similar in size.