Nearly every adult ICU bed in Oregon is occupied, driven by an uptick in respiratory viruses. Portland-area hospitals are operating at a “crisis” level for the first time since the coronavirus pandemic began. The dire picture has prompted state health officials to implore people to slap their masks on, once again, to protect against a triple threat of covid, flu and RSV as people travel and gather indoors this holiday season.
But like nearly every community confronting a third pandemic winter, the entreaty is just that - a plea. Not a mandate. Health officials in a state that was among the last to end an indoor mask requirement in March now characterize mandates as a distraction. Instead, they are counting on Americans to voluntarily don one of the most effective tools for avoiding sickness.
Mandates “have been extremely politicized, polarized and divisive,” said Rachael Banks, director of the Oregon Health Authority’s public health division. “We’re really trying to focus on the behavior and not getting caught in the crossfire of that particular mandate.”
Officials in New York and Los Angeles are also strongly recommending people cover their faces, without new requirements for anyone to actually do so. New York Mayor Eric Adams (D), who has resisted bringing back mask mandates, put on a mask Tuesday as he urged others to do the same.
A community college on Long Island attempted to issue a mask mandate this month but has since pulled back. Just a handful of public institutions are reimposing such mandates, including the Philadelphia school system, Passaic schools in New Jersey, the State University of New York at Purchase and Oakland, Calif., for government buildings.
The hesitancy follows years of politically generated controversy surrounding mask mandates, with Republicans in several states gutting powers to implement them. Health officials even in heavily Democratic areas say mandates are harder to justify with the widespread availability of vaccines and antivirals that help keep the infected out of hospitals. Nor are hospitals clamoring for mask mandates as they did during earlier stages of the pandemic.
Interviews with three dozen residents, workers and business owners across the United States show that Americans remain deeply divided on masking, with many unaware of the recent burden respiratory infections have put on hospitals.
Kevin Lauinger, owner of a coffee shop in Bend, Ore., that earned a reputation as a refuge for anti-maskers because of its defiance of earlier mask mandates, said he believes the mix of respiratory viruses is a feature of a normal society and is unmoved by health officials’ recommendations to mask.
“When you’re not dealing with mandates and are not dealing with government officials checking up on you, you can just run your business,” said Lauinger, unmasked at the pickup counter along with three employees and a half-dozen customers. “People get sick. It’s a natural part of being part of a community.”
Others say they don’t feel the urgency to mask without a mandate.
As a swarm of unmasked high school students descended upon a food court across town, Mitchell Lamer, who works at a seafood counter, said the messaging around masking is unclear, in stark contrast to the multiple text messages from pharmacies to stay up to date on his flu and coronavirus vaccine shots. Without government mandates, the 23-year-old said it’s up to individuals to manage their own health. And it’s just easier to follow the status quo.
“Masks are recommended but not required. For me, I’m like, ‘What does that mean?’” said Lamer, who sometimes masks while attending community college in Bend. “I’m just trying to go to class.”
Only 3 in 10 Americans say they consistently wear masks when leaving the house, according to an Axios-Ipsos poll published in early December, the lowest rate since spring 2020. But 65 percent also said they would probably wear masks again if coronavirus cases rise in their communities.
The Centers for Disease Control and Prevention has touted masks as one of the best ways to avoid respiratory illness but stopped short of advocating for mandates.
“You didn’t see a lot of people walking around with masks in a bad flu season pre-pandemic, and as you know, not everyone is amenable to wearing a mask,” CDC Director Rochelle Walensky recently told The Washington Post.
The CDC’s new covid warning system emphasizes hospital admissions over positive tests for the coronavirus, a shift that acknowledges the pandemic as less deadly given widespread immunity from vaccines and previous infections. Those living in counties with a high number of covid cases in hospitals - about 9 percent of all counties this week - are urged to wear masks indoors. But those recommendations do not take into account the strain on hospitals from respiratory syncytial virus (RSV) and flu, which experts say declined drastically in 2020 because of masking and other covid containment measures.
Barbara Ferrer, director of the Los Angeles County Department of Public Health, said she may reimpose an indoor mask mandate if more than 10 percent of hospital beds are occupied by covid patients. That measure is now about 7 percent. Mandates should be tied to coronavirus hospitalizations rather than influenza and RSV because covid has a higher mortality rate, she said, noting that masking remains a prudent way to avoid respiratory infections.
“We might want to get comfortable with masks the way people in other countries are comfortable with masks,” Ferrer said. “They don’t see it as an imposition. They see it as something to be used when there’s lots of respiratory illness circulating, mostly in the winter.”
Masks are still required in some indoor settings elsewhere in the world, including South Korea, Taiwan and parts of Europe.
Several studies have found that mask mandates can be effective, including an analysis showing that counties without school mask requirements had higher pediatric covid rates after the start of the 2021 school year than those who did. But challenges remain in implementing mandates because businesses often do not enforce them and many people do not comply.
“We see there is very strong evidence that masks reduce covid transmission and masking together is far more effective than masking alone,” said Julia Raifman, an assistant professor at Boston University’s School of Public Health who tracks state covid policies. “But masks were sort of turned into a symbol of divisiveness.”
When Nassau Community College on Long Island attempted to reinstate a mask mandate this month, it faced immediate blowback from the county’s top elected official. Nassau County Executive Bruce Blakeman, a Republican, insisted there is little value in mandating masks. The college quickly reversed course and recommended masks instead.
Blakeman said he has no problem with a recommendation but said a mandate would go too far when other public places are not requiring masks.
“For most people, there’s covid fatigue and they want to move on,” Blakeman said in an interview. “I’m not against masks. I’m against mandating masks.” The college’s media office would not make administrators available for an interview on the decision to rescind the mask mandate.
Masked students interviewed on campus last week said they wanted to protect themselves and their families ahead of the holidays, but lamented that many of their classmates would not mask unless compelled.
“They will wear masks again if they are told to,” said Quinn Pabon, an 18-year-old mortuary science student who estimated that about 60 percent of his classmates regularly wear masks.
Philadelphia public schools plan to require masks for 10 days after students return from winter break, making it the largest school system to reinstate a mask mandate - albeit temporarily. In April, following an uptick of an omicron subvariant, the city had scrapped one of the country’s only indoor mask mandates at the time, just four days after it took effect. Health Commissioner Cheryl Bettigole recently told the Philadelphia Inquirer that mask mandates in businesses are no longer necessary because the city has a high rate of mask-wearing.
Without mandates, front-line worker face heightened exposure to the barrage of winter viruses.
Maria Johanna Nieto, a 54-year-old beauty salon owner in Omaha, offers masks at the door but stopped requiring them several months ago after customers grew annoyed since the county had long lifted its indoor mask mandate. Nieto has yet to contract covid, which she credits to masking. She said she’s wary of how few people mask nowadays, especially when clients come in with a cough.
“We ask them if they’ve been tested, but everybody lies and says yes,” Nieto said. “Nobody is going to say no.”
Daisy Alvarez, a 19-year-old waitress at a Mexican restaurant that doubles as a nightclub in Omaha, said masks should be the norm again as covid cases rise in winter.
“I’m scared again, scared to be around people, scared to work,” Alvarez said. “It’s a constant worry in my head.”
In a food hall in Nashville’s Broadway district, a haven for live music and tourism, Deuane Saengmingpaeng was the only employee across 30 eateries wearing a mask on a recent weeknight.
The 33-year-old Thai restaurant manager said she masks because she has observed many people coughing and sneezing. She said she would like Nashville’s mask mandate revived, but state lawmakers passed legislation in 2021 severely restricting local government’s ability to do so.
“There have been a lot of people getting sick, and they are out and about,” Saengmingpaeng said. “Even if it’s small, it could be something severe for other people.”
Parents are also making their own decisions on masking as children’s hospitals have struggled to care for children afflicted with respiratory viruses.
At a barber shop in rural Liberty Hill, Tex., LaJoy Amthor said she would not patronize businesses that require masks as her 11-year-old son received a faux hawk. She said her children hated wearing masks at school earlier in the pandemic because they would get headaches.
“We’re back to normal,” said Amthor, 44, as Christmas tunes hummed in the background. “If it makes you feel comfortable, then you should [wear masks]. If you don’t want to wear them, then that’s absolutely your personal choice.”
But Ashley Stevens, a mother of four immunocompromised children who lives in Killeen, Tex., said masking should not be regarded as just a personal choice.
Her home-schooled children, ages 4 to 17, have managed to avoid getting sick this fall, she said, because they are masked in stores as well as at their weekly doctor appointments. Her husband, a produce manager at a grocery store, wears a mask to work, but most of his customers do not. Stevens said her family would feel safer with a city mask mandate, which Texas Gov. Greg Abbottt (R) and state lawmakers have been attempting to ban.
“By wearing a mask, you’re protecting somebody’s child. You’re protecting somebody’s mom, somebody’s dad, somebody’s sibling,” Stevens said. “That, to me, is bigger than anything else.”
Nirappil reported from Washington, Rogers from Bend, Ore., Kjeldsen from Texas and Aguilar from Omaha. Ranya Song in Nashville, Kristen Hartke in New York and Emily Guskin also contributed to this report.