With the rise of COVID-19 metrics across the Bay Area, the familiar sight of weathered stickers in shop windows urging mask-wearing and social distancing may now regain relevance. But the landscape has shifted since the emergence of the coronavirus — and with it our understanding of its transmission and treatment.
Vaccines, medications and a sensible risk assessment have allowed most Americans to navigate daily life alongside the virus. Still, more than three years after the anxious imposition of shelter-in-place orders, apprehensions linger about the return of mandates and other social precautions, fanned by online claims of impending lockdowns.
Over the past month, California’s COVID-19 hospitalizations have risen by nearly 80%, jumping from a daily average of 210 admissions to 374, and the state’s test positivity rate from lab tests has reached 14%. Bay Area wastewater samples continue to show an upward trajectory.
“There is more COVID around than there was last month,” said Dr. Bob Wachter, chair of medicine at UCSF. “It’s still not anything like what we saw with the omicron or delta surge, but it’s a meaningful increase in the risk of getting infected.”
National metrics reflect local trends. COVID hospitalizations across the U.S. rose by 87% in the month ending Aug. 18, with more than 2,152 daily admissions, according to the most recent data from the Centers for Disease Control and Prevention. Deaths attributed to COVID-19 also rose 70% compared with the previous month.
The emergence of new immune-evasive coronavirus variants including EG.5 and BA.2.86 has added to the uncertainty.
Yet the return of sweeping government orders is highly unlikely. State and local health authorities now advocate instead for personal risk evaluation as COVID-19 moves toward becoming an endemic illness.
“The current upward trend is a cause for concern, but it’s not a crisis,” said Dr. Matt Willis, public health officer for Marin County.
Mask mandates are unlikely to return
While some local schools and businesses have reinstated temporary mask mandates due to late-summer COVID outbreaks, it is far from a universal trend. Bay Area health departments, in alignment with the state, recommend but don’t require individuals, especially those most at risk of disease, to wear high-quality N95 or KN95 face coverings in crowded spaces, such as stores, offices or medical facilities.
“A community-wide mask mandate will never come back,” said Dr. Peter-Chin Hong, an infectious diseases expert with UCSF. “But you might see it in selective settings like hospitals, nursing homes, or prisons because those are vulnerable populations.”
Willis said Marin County health officials are “strongly considering” requiring masks in acute care hospitals and skilled nursing facilities, within patient care areas from November through March. “This is the interval we anticipate flu, RSV, and COVID will be active at the same time,” he said.
But Willis emphasized, “We do not plan to issue any mandates or orders for the general public related to COVID-19.”
Most government mandates, including the CDC’s 2021 order for mask usage on public transportation, were invalidated by federal judges. Legal experts suggest that even if reinstated, such mandates would probably be challenged and blocked in lower courts, with the Supreme Court ultimately upholding the decisions.
“The case for mandates is less strong than it was, in my view, since there is so much population immunity — from vaccines, infections, and often both — and individuals can choose to wear masks if they want to lower their risk,” Wachter said.
Wachter noted that despite the overall rise, hospitalizations are still extremely low. UCSF Health had 21 COVID patients in its hospital as of Thursday compared with nearly 200 at the height of the omicron wave.
Besides, the CDC’s authority to impose national mandates is limited, with enforcement falling under state jurisdiction.
“They don’t even have the power to do the kinds of things that are being suggested,” said Lawrence Gostin, a professor of global health law at Georgetown University specializing in constitutional law.
The state’s health department recommends masking around others if a person has respiratory symptoms, has had significant exposure to someone who tested positive for the coronavirus, and for those infected with the virus. Local health jurisdictions and businesses retain the right to impose masking requirements based on community conditions.
In Southern California, Los Angeles County Public Health officials announced Thursday that confirmed coronavirus infections had “doubled over the past few weeks.” But Dr. Barbara Ferrer, the agency’s director, said even though the publicly reported numbers represent an undercount of the true caseload, there was no need to panic.
“I’m never going to say there’s not going to be a time when we all need to put our masks back on,” she said. “I am going to say we certainly don’t all need to put our masks back on now. We are at a place where people make their own assessment.”
Dr. Karen Smith, Sonoma County’s interim health officer, said that masking remains an important tool for preventing the spread of the virus, “especially for people who are more vulnerable to severe infection including those with underlying health conditions, people who are immunocompromised, and everyone over 50 years of age.”
Lockdowns this fall are implausible
The specter of pandemic-era lockdowns this fall is also unfounded, despite false claims circulating on social media.
Former President Donald Trump, who oversaw the nationwide closure of schools and businesses during his term in office, fueled the speculation via a flurry of social media posts Wednesday boasting, “We will not comply.” He added that, if reelected, he would cut federal funding to schools, airlines and public transportation agencies that impose mandates to curb the spread of the virus.
Benjamin Haynes, a spokesperson for the CDC, said that reports of upcoming lockdowns are “utterly false.”
In addition, the suggestion there could be a timeline in advance of such restrictions is “exceptionally implausible,” said Sherry Glied, dean of New York University’s Robert F. Wagner Graduate School of Public Service, who specializes in health policy reform.
In the Bay Area, Willis noted, “We do not foresee any public health action to close schools or businesses, or any form of stay-at-home order.”
With a better understanding of how the virus strikes — through airborne transmission, particularly in crowded indoor settings — making rules at a societal level would have little practical impact.
“If there was a large surge in hospitalizations and hospital capacity was being stressed, it would be reasonable to consider broader mandates,” Wachter said. “But there would be an enormous amount of public pushback and so I’d reserve mandates for a time, which I hope won’t happen, where we really have no choice but to hit the circuit breaker.”
The Associated Press contributed to this report.
Reach Aidin Vaziri: avaziri@sfchronicle.com
