Return of the Mask? COVID, RSV, Flu Renew Calls to Cover Up

Dec. 9, 2022 – For those of you anxiously waiting to see if the spread of respiratory illnesses in the United States will be as bad as some experts predict, you might wonder if we’re going back to recommendations to wear face masks again.

Actually, health officials have already started. Along with recommending that everyone traveling on planes, trains, buses, and other public transportation wear masks, the CDC also recommends Americans in communities with high COVID-19 numbers again wear a mask indoors in public spaces.

This is welcome news for some people – many of whom say they never stopped wearing masks.

Natalie, a 36-year-old mother of three children who runs a small business in Arizona, is among them. 

“I continue to mask because, for me and my family at least, it’s a simple measure that helps protect us and others,” she says. 

She’s listened to doctors, epidemiologists, and virologists who say that catching COVID-19 multiple times increases the risk of having long-term health complications. “I don’t want that for my family, and I don’t want to do that to anyone else, either,” she says.

Natalie’s positive attitude doesn’t mean it will be easy to get everyone back in the mask-wearing habit, many experts say.

“We started to see the unfortunate and expected rise of COVID-19 cases and hospitalizations nationally after the Thanksgiving holiday,” CDC Director Rochelle Walensky, MD, said during a media briefing this week. “This rise in cases and hospitalizations is especially worrisome as we move into the winter months when more people are assembling indoors … and as we approach the holiday season where many are gathering with loved ones across multiple generations.”

In addition to staying up to date on vaccinations, Walensky said the CDC encourages everyone “to wear a high-quality, well-fitting mask to prevent the spread of respiratory illnesses.” This is especially true, she said, for the 5% of the population “currently living in counties with high COVID-19 community levels.” 

For example, five neighboring counties in New York – Nassau, Suffolk, Queens, Kings (Brooklyn), and Bronx – report enough COVID-19 cases to meet the indoor masking criteria. These high-level areas and others are indicated in orange on the CDC COVID Data Tracker map of the United States. 

Priya Nori, MD, an infectious disease specialist in the Bronx, one of the affected counties, says she has been seeing a steady increase in COVID-19 cases in the past couple of months, including after Thanksgiving. 

“But there has certainly been a shift in how ill our patients are presenting,” says Nori, an associate professor of medicine and orthopedic surgery at the Albert Einstein College of Medicine. 

Overall, COVID-19 is less severe, she says, with most patients having upper respiratory illness and not the more concerning lower respiratory tract symptoms. Nor are they seeing patients with a need for oxygen, major blood clots, or strokes. 

“This is definitely a different ball game.”

Nori adds an important caveat: “We still are very much concerned about the population we consider to be moderately to severely immunocompromised. For those folks, I don’t want to share a blanket statement that the illness is very mild.” 

She emphasizes that masks and other precautions remain essential for the immunocompromised, people over 65, and anyone else at a higher risk for severe outcomes of COVID-19.

The CDC continues to recommend masking for anyone who may be immunocompromised or at increased risk of severe disease, Walensky said. 

 ‘So Over Covid’

“Complacency is our enemy. That is my biggest fear – that people are so desensitized and feeling that it is the norm,” New York Gov. Kathy Hochul said during a recent update on winter health preparedness, including COVID-19, the flu, and respiratory syncytial virus (RSV). “Yes, it is become our norm, but it does not have to be the norm that everybody gets sick. That’s what we’re trying to fight against.”

Bruce Farber, MD, chief of public health and epidemiology for Northwell Health in Manhasset, NY – within Nassau County – is likewise concerned. “It appears very unlikely that New Yorkers are going to start wearing masks again unless rates skyrocket,” he says. 

Nori agrees that complacency remains a challenge. “I don’t think that New Yorkers are any different from the rest of Americans or the rest of the world, in that they’ve had now many multiple waves of COVID go through their communities, they’ve been ill at least once themselves, and they are pretty experienced at this point with the pandemic.” 

A potentially high level of “mask fatigue” means people are perhaps less likely to adhere to these community-level recommendations from the CDC, Nori says. People are “just so over COVID.”

A Ferocious Start to Flu Season

“That being said, there are so many good reasons for wearing a mask right now, the least of which is influenza,” Nori says. “We skipped multiple flu seasons through the pandemic … and this season is attacking early and intensely.”

“In my opinion, especially with the numbers that I’m seeing in terms of positive tests locally, I do feel that flu is really the one to watch for this winter,” she says. “Definitely the message is to keep your eye on flu this season because it’s coming with ferocity.”

Walensky pointed out that flu cases “continue to be the highest we have seen at this time of year in a decade, demonstrating the significantly earlier flu season we are experiencing.”

Farber agrees that the flu should be taken seriously. “The flu has the potential to cause over 50,000 deaths this year. It is a very good reason to get vaccinated and to wear masks in crowded areas.”

‘Not a Forever Situation’

The flu can lead to severe illness, disability, and death. “For that reason, I advise patients and I advise colleagues that masking continues to be the way to go, especially for the next couple of weeks,” Nori says. “If we can remain disciplined about that for the next couple weeks, I think we’ll have a much better holiday season and be much better prepared to get through the winter.”

“It’s not a forever situation,” she says. “There will be a day where we can dial this back again.”

Masks are “going to be super important to help us get safely through the winter until the spring,” Nori says. “And then we can all celebrate if flu and COVID are coming down again at that point, which I think they will.” 

RSV is also particularly worrisome at the moment. The virus is infecting so many young children that it continues to challenge the capacity of children’s hospitals nationwide. It’s also infecting many people over age 65 as well. Adding to the concern: There is no approved vaccine against RSV, although several are in development. 

What About the Worried Well?

The CDC recommendations are just that – recommendations. “One need not wait for CDC action in order to put a mask on,” Walensky said.

The New York state commissioner of health agrees. “What I want to say is that people should feel free to wear a mask. Everybody can make the decision to wear masks, and I want people to be aware of the settings in which mask wearing would be wise,” Mary T. Bassett, MD, said during the governor’s news briefing.

She emphasized these are recommendations, not mandates. “We’ve gone through a period where people are tired of being told what to do, but we in public health are now emphasizing that people can make decisions on their own and make decisions to be protected,” Bassett said.

“The people that are testing negative for flu, COVID, and RSV should be very glad, but understand those aren’t the only respiratory infections that are out there,” Walensky said. “People can still have regular colds.”

“But all these things we talked about – masking, washing your hands, covering your cough, and staying home when you’re sick – all those things can keep down the spread of all these respiratory infections,” and they’re important, Walensky said. “You know, it’s that time of year.”