For many of us in the U.S., the COVID-19 pandemic fundamentally changed our relationship with face masks. And as the pandemic continues to evolve — and as new variants like BA.2 emerge — we can expect mask requirements to come and go as needed, experts said.
Masking still isn't necessary, even indoors, in more than 90% of the country, according to the latest estimates. And masks are no longer required on public transportation, including planes, as of Monday, when a federal judge ruled that the Centers for Disease Control and Prevention had overstepped its legal authority by imposing the mandate. (The CDC still recommends wearing a mask on public transit.)
But many states have seen cases rise in recent weeks largely due to BA.2, a subvariant of omicron. Philadelphia actually reinstated its indoor mask requirements, and some universities have, as well. Above all, as the rise of BA.2 makes clear, we should be prepared for the situation to change — and to put our masks back on when the time comes.
Should the BA.2 omicron subvariant change the way we think about masks?
In February, the Centers for Disease Control and Prevention announced it would be using a new metric — community COVID-19 levels — to direct its recommendations on masks and other precautions. That metric relies on hospitalization numbers and local case counts, but primarily the former, to determine whether masks are necessary at a given time.
"As we roll out vaccines and therapeutics, it is appropriate to change the goal metric from infections to hospitalizations and deaths," Dr. Megan Ranney, emergency medicine physician and associate dean for strategy and innovation at the Brown School of Public Health, told TODAY.
Shifting to metrics that include hospitalizations is "a reasonable change to make at this point," agreed Dr. Taison Bell, assistant professor of medicine in the divisions of infectious diseases and international health and pulmonary and critical care medicine at the University of Virginia.
But "cases will always matter," he told TODAY. That's because hospitalization numbers tend to lag behind cases, he explained, and you never want to rely on a single indicator — the more data the better.
When the new metric was introduced — before BA.2 began to really take over — much of the country had a low community COVID-19 level, meaning masks weren't necessary. But with cases rising and the new subvariant now the dominant strain in the U.S., masks may come back.
The recent uptick in cases due to BA.2 variant may lead to reintroducing mask mandates or might delay the lifting of mandates, “but I don’t think it’s fundamentally changing the way we think about this,” David Dowdy, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health, told TODAY.
“We shouldn't be lifting restrictions when cases are going up,” he said. "But the actual level of serious illness — hospitalizations — is still relatively low.”
A shift to more individual decision-making
The latest CDC recommendations and lack of mask mandate for public transit represent a shift from the kind of collective public health response many experts have pushed for since the beginning of the pandemic to one based more on individual risk and personal preferences.
"If you are someone who is older, unvaccinated or has a compromised immune system, you should be looking around at your local cases," Dowdy said. If cases are going up around you, it makes sense to start wearing masks again, especially in riskier situations, like large, indoor gatherings.
"I think those of us who don't fit into those (high-risk) categories also owe it to those people to be more cautious in those same sorts of settings," Dowdy added. Even if you don't have any of those risk factors, wearing a mask is "the considerate thing to do" when you're in a public place where you might encounter vulnerable people.
That's why Dr. Richard Besser, former acting director of the CDC, said he'd hoped the federal mask mandate for public transportation would be one of the last ones to go.
"The reason for that is that there are a lot of people who don’t have a choice when it comes to travel," he told TODAY's Savannah Guthrie Tuesday. "There are people who have disabilities, who have medical conditions that put them at greater risk, who are in situations where they are shoulder to shoulder with fellow passengers on a bus or on a train in a subway."
"(Immunocompromised) people can wear their own masks, but there’s some added protection when you’re that close for a long period of time if those people around you also have a mask," he added. "I would hope that people would respect those around them, and if there are people around you who are wearing masks, that you put yours on. It’s not a big thing to do."
The new CDC metrics don’t offer much specific guidance for people who are immunosuppressed or have other underlying conditions that put them at a higher risk for severe COVID-19 beyond telling them to ask their doctor. “There are still people that are very vulnerable despite doing everything that they can to try to protect themselves," Bell said. "They are the ones who feel the most lost in all this and the most left out."
You might be someone who is high risk, caring for or living with someone who is high risk, or someone who simply feels more comfortable with a mask on knowing it's helping to protect the people around you (who could have risk factors you don't know about). All of those are good reasons to keep masking even when CDC guidelines say you don't necessarily need to, the experts said.
But Bell said that, despite the new focus on individual decision-making, people have frequently been left to figure out their own personal level of risk throughout the pandemic. "But what's changed is that trying to determine that risk is not as easy as it was before," he said, because the use of at-home rapid testing likely undercounts many positive test results. That makes it more challenging to get an accurate picture of the COVID-19 data — and the level of risk — around you.
Expect masks to come back when cases rise in your area
Based on the new guidelines, it may no longer be necessary to wear masks in your area of the country. But that doesn't mean they're gone forever.
“What I suspect that we will see going forward is masks going on during surges and coming off when surges are gone,” Ranney said.
For instance, health officials in Philadelphia said this week that cases in the city had risen by more than 50% in 10 days. And therefore, according to the city’s own COVID-19 response metrics, it was time to implement mask requirements in all public indoor spaces.
And the CDC and Transportation Security Administration opted to keep the country's mask mandate in place on public transportation due to the rise in cases in the country and the spread of BA.2, which now accounts for more than 85% of all COVID-19 cases in the U.S.
But whether other local governments will go as far as implementing mask mandates during these moments isn’t clear yet. “I and other public health professionals would argue that mandates are critically important during moments of surges,” Ranney said.
Even without mandates, you can certainly choose to take more precautions yourself based on what's going around you. "If you're in a community where there's a small uptick in cases, hospitals are not to capacity but they're not in great shape, and there's not a lot of ability to give therapeutics," Bell said, "that might be a community where you want to be a little more cautious and try to do what you can."
He also noted that masks remain an especially important tool in high-risk situations, like on planes and other mass transit. "These are enclosed spaces," Bell said. "And not everyone who is traveling has had the opportunity to get vaccinated, including young children."
Some people may choose to keep wearing masks in the long term
There are plenty of COVID-related and non-COVID reasons some people might keep wearing masks in the future.
Many people who are at a high risk for severe COVID-19 probably will and should continue to wear a mask when in close contact with people outside their household, depending on the advice of their doctor. For others, masks have become an easy way to protect themselves from other circulating illnesses, including seasonal allergies and the flu.
Masking may also continue to be more of a priority in certain communities. "People from Black and brown communities have consistently wanted masking in indoor environments," Bell said. "And if you look at the data, you understand why: They're at the highest risk of having severe outcomes."
There are practical considerations, too. For instance, Ranney said her daughter is continuing to wear a mask because she's in a school play in a few weeks and doesn't want to get sick beforehand. And Bell's daughter wears a mask outdoors in cold weather even when he tells her she doesn't need to simply because it keeps her warm. "She calls it her face blanket," he said.
“Many people may choose to maintain these precautions long term for the sake of continuing to be healthy,” Ranney said.
Bell agreed: “I think it’ll be a part of the lingering effects of the pandemic, but for a good reason.”
If you're among those who want to keep masking in the absence of mandates, the experts TODAY spoke to emphasized the value of higher-quality masks; an N95 or KN95 respirator will be most helpful when it comes to one-way masking.
Ultimately, masks are just one tool we've come to rely on during the pandemic. They can be significantly helpful, but they aren't our only option. And vaccination is still the backbone of our efforts to reduce COVID-19, Ranney said.