Fitness centers are listed by experts as one of the higher risk places for COVID-19 transmission. FG Trade/Getty Images
Just when we almost seemed done with them, masks are back. At least in some places.
As COVID-19 case rates declined the past two months following a spike driven by the highly infectious Omicron variant in January, mask mandates began falling across the United States as well.
In recent weeks, however, new cases caused by a pair of new Omicron subvariants have some schools and communities in certain sections of the country reversing course.
The Centers for Disease Control and Prevention (CDC) last week extended its mask mandate on air, train, and other public transportation just days before the previous rule was set to expire. Masks on these forms of transportation were scheduled to be required until at least May 3, although a Florida judge struck down the mandate on April 18.
On April 11, the city of Philadelphia reinstated its indoor masking requirement after COVID-19 cases increased 50 percent in the span of fewer than two weeks.
In addition, as cases rose in the eastern United States, a number of colleges and universities also put their mask mandates back into force. These included American University, Johns Hopkins, Georgetown, Columbia, Rice, and the University of Connecticut.
“Given the increase in cases associated with the more highly transmissible BA.2 variant, many communities are recommending universal masking regardless of vaccination status when indoors in public settings,” David Souleles, MPH, the director of COVID-19 Response at the University of California Irvine, told Healthline.
The rise in cases caused by the new Omicron variants of COVID-19 — known as BA.2.12 and BA.2.12.1 — may or may not last. But experts say that masking — whether mandated or voluntarily — is likely to be with us for the foreseeable future.
Hospitals and other healthcare facilities, for example, are unlikely to drop the masking mandates that have been in place since the COVID-19 pandemic began.
Dr. Glenn Wortmann, the medical director of infection prevention at MedStar Health’s Institute of Quality and Safety, told Healthline that many institutions will continue to set their masking and physical distancing policies based on CDC’s estimates of COVID-19 positivity rates from community to community.
“When there’s not much transmission in the community you don’t need to mask, but when there is, you should,” he said.
What you need to consider
Individual health status and transmission risk should play leading roles in deciding whether or not to mask in places where masking isn’t required by law, Wortmann said.
“If you’re going into a nursing home or you’ve had a kidney transplant that has wrecked your immune system, then yes you should wear a mask,” he said. “If you’re 20 years old and in good health, probably not. It’s a situational decision.”
“As community levels rise from low to moderate, those who are immunocompromised or have higher risk medical conditions should consider wearing masks,” Dr. Tammy Lundstrom, an infectious disease specialist and chief medical officer at Trinity Health, told Healthline. “If there is a high community level, everyone should wear a mask in indoor settings. Even when community levels are low, some people may feel more comfortable continuing to wear a mask in crowded indoor settings.”
Wortmann said masking will continue to be particularly protective in crowded indoor settings.
“The more people there are in a crowd, the higher the chances that some of these people are carrying COVID,” he said.
Sharona Hoffmann, a professor of law and medical bioethics at Case Western Reserve University in Ohio, agrees there are still places where wearing a mask is a good idea.
“According to the CDC, people should continue to wear masks if they are in an area with high COVID-19 numbers or if they are in crowded indoor settings,” Hoffman told Healthline. “In addition, if you are vulnerable to serious illness from COVID or are visiting someone who is vulnerable, you should wear a mask. People are particularly vulnerable if they are elderly, immunocompromised, or have certain diseases such as asthma or heart disease.”
On the other hand, Wortmann said, there’s probably no need to wear a mask outdoors.
Places to be cautious
In a report issued in January, one group of experts said enclosed spaces with poor air circulation such as nightclubs and under-ventilated gyms are higher risk areas,
They also noted that activities such as exercising, shouting, or singing also increase the risk. The number of people and the length of time spent inside also matter.
Another report issued in January by a San Francisco neighborhood safety group listed the 10 riskiest places for catching COVID-19.
Bars, jails, and prisons were at the top of the list followed by nursing homes, indoor theaters, churches, restaurants, crowded outdoor theaters, and gyms.
A report published by Readers’ Digest in February listed bars, restaurants, gyms, and public transportation among the highest risk areas.
“In general, settings with fewer people and good ventilation are best,” said Wortmann. “For example, a smaller restaurant with outdoor seating would be safer than a crowded, indoor bar. The duration of exposure is also an important factor. A short trip to the supermarket is going to be safer than being in a crowded room for an hour.”
Masks are effective
Research has demonstrated that wearing a mask can reduce the odds of catching COVID-19, experts agree.
“COVID-19 spreads through droplets and particles released into the air when people speak, sing, cough, sneeze, or even breathe,” Hoffman explained. “Masks are consequently helpful in preventing people who wear them from spreading the disease or inhaling particles that are present in the room.”
“A high quality, properly fitting mask works to reduce the likelihood the wearer will transmit virus to others or become infected by others, even if others are not wearing a mask,” added Souleles. “A respirator, such as an N-95 mask, offers the best protection, [but the] CDC continues to recommend that you wear the most protective mask you can that fits well and that you will wear consistently. Good options to consider are N-95s, KN-95s, and surgical masks.”
“The least protective are cloth masks,” noted Lundstrom.
How you wear your mask also matters.
“All masks should fit snugly and cover the nose, mouth, and chin, with no gaps,” said Hoffman.
One silver lining of the latest COVID-19 uptick is that it has been accompanied by a lower rate of hospitalizations and deaths than previous spikes, perhaps because a large proportion of the U.S. population has either been immunized against the disease or recovered from a recent bout of COVID or both.
“As this plays out we may just have to accept this as part of life,” said Wortmann. “I like to wear a seatbelt when I drive, so if I can wear a mask and not get sick, it’s worth it to me.”
