Los Angeles County public health authorities are urging unvaccinated and vaccinated people alike to don masks again inside restaurants, stores and other public indoor spaces because of the growing threat posed by the more contagious delta variant of the novel coronavirus.
The high-profile move by the county of 10 million marks an abrupt shift in tone after states and localities have dropped most mask mandates and social distancing requirements in recent weeks. The Centers for Disease Control and Prevention in mid-May rescinded almost all masking recommendations for fully vaccinated people.
But the Los Angeles County Department of Public Health cited a growing share of new cases linked to the delta variant, which was first detected during India's catastrophic surge of infections and has upended reopening plans across the globe, in "strongly recommending" a return to masking. Los Angeles dropped its mask mandate for vaccinated people with the rest of California on June 15, with limited exceptions for public transportation, hospitals and schools.
County health officials said 123 people were infected with the delta variant from June 4 to 18. Ten were fully vaccinated, and none of those people needed hospital care. Three people infected with delta were partially vaccinated, and 110 were not vaccinated; two people were hospitalized.
"Fully vaccinated people are well protected against serious illness and disease caused by variants of concern including the Delta variant," Barbara Ferrer, the county's public health director, said in a statement.
Los Angeles officials are also concerned by reports of some fully vaccinated people contracting cases of the delta variant in Israel and want to learn more about the variant and how it spreads.
"We want to make sure we understand that people who are fully vaccinated aren't getting infected in large portions or small portions in a way that allows them to unknowingly transmit to others," Los Angeles County Health Officer Muntu Davis said in an interview.
The World Health Organization on Friday urged fully vaccinated people to continue wearing masks in light of delta's rapid spread. Israel on Sunday reinstated an indoor mask mandate, which had been lifted two weeks ago, in response to a spike in delta cases, but it declined to adopt more stringent restrictions because of its high vaccination rate.
The CDC does not plan to change its guidance that allows fully vaccinated people to take off their masks in most settings.
"We are fortunate to have highly effective vaccines in this country that are widely available for those aged 12 and up," Kristen Nordlund, a CDC spokeswoman, said in a statement to The Washington Post. "People who are fully vaccinated are protected, including from the variants currently circulating in the country such as delta. That is not the case in every country where some of the vaccines they are using are not as effective as the ones we have here in the U.S."
CDC Director Rochelle Walensky reiterated that message in an appearance on NBC's "Today" show Wednesday morning. But she noted that some areas have low vaccination rates and "local policymakers need to make policies for their local environments"
Los Angeles appears to be an outlier in its call to resume masking. Pennsylvania and King County, Wash., which includes Seattle, on Tuesday dropped their mask mandates for the vaccinated.
Davis said Los Angeles County wanted to be especially careful because it has 4 million residents who are unvaccinated or too young to receive the shot. He stressed that officials are avoiding disruptions by not mandating masks or restoring restrictions on businesses.
"This is really, hopefully, a temporary recommendation as we learn more about what this virus is actually doing," Davis said. "This is one of the easier things to do. It doesn't disrupt your daily routine, it doesn't disrupt business, and it doesn't disrupt the economy. It's just a mask, but it's very helpful."
Los Angeles bears the scars of being the epicenter of the nation's devastating winter surge, eclipsing 200 deaths a day in January while ambulances and hospitals were forced to conserve oxygen.
Cases have since plummeted, daily fatalities now number in the single digits and nearly 60 percent of eligible residents have been fully vaccinated. Officials worry the delta variant will rapidly spread through the unvaccinated, noting that it made up half of the variants sequenced in Los Angeles County in the week ending June 12.
"It's just a small inconvenience for those who have been vaccinated to try to be good citizens by wearing masks indoors," said Robert Kim-Farley, an epidemiologist and professor at the UCLA Fielding School of Public Health. "Hopefully this can be a wake-up call for those who are still on the fence about getting vaccinated to become vaccinated so that we can all stop wearing masks."
But some experts say public health authorities who don't differentiate between the vaccinated and unvaccinated may end up dissuading holdouts from getting shots.
"You just told the unvaccinated, 'Yeah, get vaccinated, it's so scary, but of course, you'll still have to mask because it's so scary,' " said Monica Gandhi, professor of medicine at the University of California at San Francisco. "If I were an unvaccinated person who was debating whether to get vaccinated, I would think, 'Oh wow, there's no point, looks like the delta variant would break through the vaccine anyway.' "
Evidence shows the opposite: Nearly all serious British cases have been among the unvaccinated or partially vaccinated as the delta variant dominates new infections. The CDC says a growing body of evidence shows people who have been fully vaccinated with a Pfizer or Moderna mRNA vaccine are less likely to have asymptomatic cases or transmit them to others.
The juxtaposition of these developments showing the vaccines' effectiveness against the delta variant and the new mask guidance left some Los Angeles residents confused.
Ashley Pavone, 25, recently started to feel comfortable going out barefaced even though she was among the first in line to get vaccinated in February as a restaurant worker.
"I thought we were moving forward with this, and that's why I've been vaccinated for so long, so it's upsetting to think we'd have to now move backward. I wonder if there's any facts behind this or if it's just another rule," Pavone said after a maskless trip to a Vons supermarket in the Echo Park neighborhood of Los Angeles. "If masks are being used again, then people may not go out as much, and then we'd see our tips decrease."
Steve Morales said he still wears a mask while working his shifts as a Vons clerk, even though he's vaccinated and his workplace doesn't require it, because he's uneasy about what customers have been exposed to. Still, he has no interest in tangling with customers about masks.
"I don't give people my opinion about it; it's up to them," said Morales, 64.
Rhea Boyd, a pediatrician who has advocated for improved vaccine access for communities of color, said Los Angeles should be commended for working to prevent its residents from letting their guard down and laying the groundwork to restore restrictions if necessary to quell an explosion in delta cases.
"Los Angeles County didn't reinstate a mask mandate, they put out a recommendation. It's to prepare people to see something is different about the delta variant," Boyd said. "It may be hard to hear this because we all want to believe that what was such a traumatic year is all behind us, but the truth is, we are still very much confronting a pandemic."
The Washington Post's Lena H. Sun in Washington and Miranda C. Green in Los Angeles contributed to this report.
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