‘We may be the last maskers’: COVID cases are rising. Here’s why health experts are masking indoors

While much of the world has moved on from the COVID-19 pandemic, Santa Clara County Public Health Officer Dr. Sara Cody and her colleagues still wear protective masks to work and in other crowded indoor settings. And if you’ve noticed a lot of people you know coming down with COVID lately, you’ll understand why.

Thrust into the national spotlight three years ago as an early voice of caution and protective orders as the then-deadly COVID pandemic took hold, Cody admits she and her public health colleagues stand out now among the mostly unmasked masses. But with cases rising again, and her own recent bout with the disease still in mind, she urges others to consider masking indoors.

“Every single one of us masks every day, because we look at the data,” Cody said. “We may be the last maskers, but that’s what we do. I’d highly recommend people going to indoor gatherings with a lot of people mask. The chances you’d be exposed are very high.”

Signs of the virus are on the rise, with the California Department of Public Health’s most recent statewide 7-day average percentage of positive tests at 7.6%, more than twice this year’s 3.4% low on May 5 and higher than July 2021. Bay Area counties have seen positivity rates double from June to July, to 4.9% in Santa Clara, 7.7% in San  Mateo, 8.7% in Contra Costa and 8.8% in Alameda.

The various COVID-19 states of emergency in California, the U.S. and World Health Organization all folded between late February and early May. And there’s no indication any of those states of emergency and the restrictions and mandates that accompanied them will return. But that doesn’t mean the virus has vanished.

“We’re in a place in the pandemic where we’re mostly providing information and asking the public to make their own decisions,” Cody said. “Unfortunately, with the narrative that the emergency is over, the public has heard that COVID is over and it’s not around anymore, and that’s not true. The truth is we know COVID is still circulating, and you can still get sick and miss a lot of work and miss a lot of school.”

Tracking the virus’ activity isn’t as precise as at the height of the pandemic when there was widespread testing with results reported to health officials who updated case counts daily. But hospitals still test for the virus and report results to state and federal authorities who update counts weekly. And wastewater sampling also provides a gauge of community virus levels.

What do those signals show?

Wastewater monitoring shows virus levels steadily rising to a medium level in San Jose. In Palo Alto, where Cody lives, it’s already jumped to the high level.

The U.S. Centers for Disease Control and Prevention reported a 14% increase in COVID-19 hospitalization rates nationally in the three weeks through July 22, and a 13% increase in California. Although hospitalization rates remain low for more than 99 percent of the country, including all the Bay Area counties, they’re no longer falling either, said CDC spokesman Scott Pauley.

He said the U.S. has seen COVID-19 infections rise during the last three summers, so it’s not surprising to see an uptick after a long period of declining rates.

“I know right now three people with COVID, and there were times during the pandemic when I didn’t know anybody with COVID,” said Dr. John Swartzberg, clinical professor emeritus of infectious diseases and vaccinology at UC Berkeley’s School of Public Health.

Genomic surveillance, Pauley said, shows the rising infections are caused by variants closely related to the omicron strains circulating since December 2021. The Food and Drug Administration in June ordered vaccine makers to use the omicron XBB and XBB.1.5 strains to create a booster shot for this fall.

Swartzberg says that’s good news for us. Many people by now already have been infected with some version of the omicron variant that first appeared in December 2021. And while vaccines’ ability to stave off infection wanes quickly, they still provide good protection from severe illness, proven by low hospitalization rates compared to the early years of the pandemic.

“We know the beast we’re dealing with right now,” Swartzberg said.

For now the CDC advises that people stay up to date on COVID-19 vaccination, isolate themselves if they have or think they have the virus and avoid others who have or might have it. And the CDC says “people may choose to wear a mask at any time.”

The virus has even outfoxed Bay Area health experts who’d managed to avoid it at the height of the pandemic, such as Dr. Bob Wachter, the UC-San Francisco medical department chair, whose advice on avoiding COVID is followed by hundreds of thousands on social media.

Wachter has since recovered, but he doesn’t know how he got infected. He’d received a COVID vaccine booster in April, hadn’t seen COVID patients, wears an KN-95 mask on planes and in crowded rooms but dines indoors without. He called it a “cautionary tale” that “COVID continues to be worth avoiding if you can.”

The virus also found Cody, back in late February. Despite her masking habit, she said she removed her mask for a social event and was sick with COVID 48 hours later. She says she won’t chance it again.

“I thought I needed to take the risk, so I did so knowingly, and I was miserable,” Cody said. “But, yeah, masks work.”

Swartzberg said the start of school in a couple of weeks likely will see more cases of COVID and other respiratory illnesses and that people should follow precautions according to their risk tolerance, including for lingering “long COVID.”

“If you’re in a higher risk group for a bad outcome,” he said, “given there’s a lot of virus circulating now, you probably want to be a little more careful.”