Most of Washington’s indoor masking requirements are coming to an end — and the state’s newest “natural experiment” will begin.
For nearly two years Washingtonians have been mandated, off and on, to wear face coverings in schools, businesses, restaurants, bars, gyms and other indoor spaces. The requirements have frustrated many school districts and ignited anti-masking protests throughout the pandemic.
Now as coronavirus infection and hospitalization rates continue to fall, some questions remain about how to best transition back into maskless communities. Washington will end its statewide mask mandates for schools and other indoor settings by the end of Friday.
This month, two local infectious disease experts, Dr. Joshua Schiffer and Dr. Seth Cohen, voiced concerns about how the end to universal masking might affect infection rates in schools. Yet neither had big issues with the timing of the end of masking.
Both plan to continue wearing face coverings in public indoor spaces for now, and encouraged others to do the same, particularly if they’re immunocompromised or unvaccinated.
Schiffer is a clinical research professor of vaccines and infectious diseases at Fred Hutchinson Cancer Research Center, and Cohen is a medical director for infection prevention at the University of Washington Medical Center.
These conversations have been edited for clarity and brevity.
When you heard the mask mandates were ending, what was your initial reaction?
Schiffer: It’s definitely what I’d call a natural experiment. From a purist point of view, if everyone wore masks going forward for the remainder of time, there would be less transmission and fewer hospitalizations and deaths. But I think all of us in the field understand that a pretty substantial segment of the population is sick of masks. So politicians need to be cognizant of that and account for all of these factors.
But purely speaking, it’s a tool that prevents transmission. I’m not advocating for keeping the mandates forever and, in fact, I personally think the timing is just fine, but very purely speaking, they would continue to provide protection against SARS-CoV-2 and other respiratory viruses.
Cohen: It’s a big change for us in health care. We’re fortunate in our own local community that vaccination rates are relatively high in King County and that means the majority of new COVID cases won’t become (severe), which is great.
I think the challenge is that there are still a lot of people out there in the community — including those with underlying medical conditions, people with compromised immune systems, people who are unvaccinated and children — who may be at higher risk of contracting COVID and developing subsequent infections, and so my biggest concern with this new phase is the feeling that we may be leaving behind people.
Even though masks have become a political flashpoint, it’s really easy to forget that they also serve to protect people who may be more vulnerable or may be at risk for developing complications to COVID. And so for that reason, I will personally still be masking up in crowded spaces for the time being.
According to the CDC’s new classifications of risk level by county, different parts of our state have different levels of COVID risk. Is there any particular masking guidance for those traveling between Washington counties?
Cohen: I think it’s really important to point out that the CDC guidance weighs hospital capacity and doesn’t predict individual outcomes. If somebody feels that they’re at risk for acquiring COVID or having complications due to COVID, that should take precedence and make people think very strongly about masking.
Schiffer: I really like the idea of shaping the policy according to the burden of disease in a given community, and I also think the county level is the most appropriate unit to base this on. If you just look at the risk of counties across multiple states, including Washington, it’s not homogeneous. So I think it makes sense to cater the policy toward the level of risk in a given county.
I also think it’s increasingly going to be an individualized decision that’s based on, first of all, the level of risk of getting infected in the first place, which is directly proportional to the number of cases in a community. Also, the level of an individual’s risk of getting infected. So unfortunately people who are immunocompromised due to cancer treatments or transplantation treatments or HIV, for example, might wish to continue to be more careful than someone who’s young and otherwise healthy and has been boosted.
What concerns do you have about the end of mask mandates?
Schiffer: There’s still not a great solution for what to do for children under the age of 5 (who aren’t yet eligible for COVID vaccinations). And I think the other potential problem is that hospitalization makes a lot of sense for a metric to follow, but its one shortcoming is it tends to lag behind cases. So if there was a surge in cases, and we waited to react until there was a surge in hospitalizations, we might lose some of the beneficial effect of masks.
But if you consider the alternatives, there’s almost no way to create a list of policies at this point that don’t fail in one respect or another. So some of these decisions are clearly a bit arbitrary and clearly a bit politically motivated, but I also think there’s not a perfect solution at this point.
Cohen: It’s nice to have one uniform expectation for mask-wearing when you’re in a school. I think it’s harder to get kids to wear masks properly when there’s no way to enforce that behavior, even if there are kids in the class who are at high-risk of COVID-19. So I do worry about peer pressure in schools and having masking behavior slip, and that’s one place where particularly if kids are undervaccinated, we may see more transmission.
Do you think it’s possible mask mandates could return if COVID trends worsen?
Cohen: COVID is completely unpredictable. We have more tools and it’s important to note that masking is just one layer of protection. But it’s possible there will be another variant at this point — we just don’t know.
And if we do see another surge, I certainly hope that people would be open to the possibility of needing to mask back up to protect themselves and protect our community and protect our health care system, which was at a really fragile place in January.
Schiffer: I don’t think there’s really anybody who knows what’s going to happen in the next six months and so if another variant pops up, or if relaxing to this degree allows omicron to reemerge, then I think we have to be flexible.
It’s still an important tool I hope we have the ability to use if there’s a bump in cases that pops up and any time during the next year.
Like everyone else, I hope not. But nobody knows what’s going to happen. There may be a need to, not permanently, reintroduce masking at a broad scale.