LA Rejects Renewed Mask Mandates for Medical Workers This Fall

Los Angeles County has opted not to reinstate a mask mandate for healthcare workers this fall, diverging from most other counties in the San Francisco Bay Area. Instead, LA County issued a September health order requiring healthcare employees get both the flu and updated COVID-19 vaccines or mask up when in patient areas.

A widespread healthcare mask order would only return if COVID hospitalizations substantially worsen, said county health officer Dr. Muntu Davis on Tuesday. Specifically, new coronavirus hospital admissions per 100,000 residents would need to exceed 20 per week, a threshold last exceeded locally during January-February 2022's Omicron surge. "At that point, we [would be] seeing lots of severe illness...that would tax our healthcare system," Davis explained.

Currently LA County's rate is around 4 new weekly COVID hospitalizations per 100,000 people. When asked why the county wasn't adopting universal healthcare masking like the Bay Area, Davis cited the still-low COVID levels and wanting to encourage autumn booster uptake. "We felt the best thing to do at this moment was to have our healthcare workers...get vaccinated," he stated.

The federal mandate for most healthcare workers to be vaccinated against COVID-19 ended in August. In contrast to LA County, most Bay Area counties have issued orders mandating employees mask in patient care settings this fall/winter season, defined as November 1 to April 30. Santa Clara and Marin counties also require patients mask during a shorter period from November 1 to March 31.

Exemptions include young children, those medically unable to mask, the hearing impaired and situations where masking poses work hazards. San Francisco never rescinded its healthcare masking order. The approach differs in LA County's two independent health departments - Pasadena requires healthcare workers mask and get the latest COVID vaccine, while Long Beach ended its mask order in August.

Even without mandates, individual healthcare facilities can choose to require masking. Unlike most of California, LA County never dropped its mask order for healthcare visitors, only ending the rule for employees in patient care areas in August. It has however issued an annual order since 2013 requiring flu vaccines or masking for healthcare workers.

COVID levels remain comparatively low - wastewater viral concentrations are just 11% of last winter's peak. The county is averaging around 3 daily virus deaths, down from 5 post-summer but above the mid-summer low of 1 per day. Most COVID fatalities are now among the unvaccinated. Officials say flu rates are also still under 2%.

But respiratory syncytial virus (RSV) is rising with 8% of specimens testing positive, up from 5% the prior week. This indicates the start of RSV season, which typically overlaps with flu season beginning when 5% of samples are positive. Flu immunization rates among LA hospital employees rose from 58% to 86% since the county began mandating vaccines or masking in 2013.

Rather than bringing back masking orders, officials hope the new health order spurs healthcare workers to get updated COVID shots. Some Bay Area counties take a similar vaccination-focused approach, while also requiring masks amid expected virus increases this winter. The contrasting policies highlight flexible local control to set health rules, even as statewide mandates receded.

With COVID still evolving and flu/RSV circulating, health directors can enact heightened precautions in higher risk settings like hospitals and clinics. Their aim is protecting vulnerable patients and preventing healthcare systems from becoming overwhelmed. Masking increases safety, but can deter shot uptake without mandates.

Balancing cautions with vaccine incentives is an ongoing challenge. But officials say more targeted measures like staff immunization requirements avoid a one-size-fits-all approach. They allow flexibility amid the virus uncertainties that remain two and a half years into the pandemic.