L.A. County requires masks indoors. Will people follow the rules?

A woman in a mask folds clothes on a counter in a laundromat

July 18, 2021 Updated 1:41 PM PT

Los Angeles County on Sunday began requiring people to wear masks in indoor public places, drawing a new battle line as the coronavirus is rising significantly among unvaccinated people.

L.A. County is by far the biggest jurisdiction in the nation to require masks again. But with coronavirus cases rising across the nation largely because of the highly infectious Delta variant, officials elsewhere will be watching to see if the effort works.

A big question is whether people will actually follow the rules — especially amid the frustration of those who got their vaccinations to enable a return to pre-pandemic life — and what, if anything, health officials will do if this action does not slow the rise in coronavirus cases.

Under L.A. County’s order, masks will be required to be worn in all indoor public settings, such as theaters, stores, gyms, offices and workplaces, and in restaurants when not eating and drinking. Those exempted include children younger than 2. Indoor restaurant dining is still allowed, but patrons are asked to wear masks when they are not eating or drinking.

As of Saturday night, L.A. County was averaging almost 1,400 new coronavirus cases a day over the past week, up from about 170 cases a day for the week that ended June 15, when California fully reopened. COVID-19 hospitalizations have doubled in the past month.

County public health officials reported that on Sunday there were 1,635 new coronavirus cases and four related deaths, bringing the total number of deaths to 24,583. Currently, there are 507 people hospitalized with COVID-19.

“This is very disturbing. And, of course, as responsible elected officials, we have to do something,” said Hilda Solis, chairwoman of the L.A. County Board of Supervisors.

“I’m not pleased that we have to go back to using the masks in this manner,” she said Sunday on ABC News’ ”This Week.” “But nonetheless, it’s going to save lives. And right now, that to me is what’s most important, and really getting more people to understand that they have to get vaccinated.”

Former Surgeon General Dr. Jerome Adams on Saturday urged the U.S. Centers for Disease Control and Prevention to recommend that communities with surging cases and rising rates of positive tests follow L.A. County’s example and advise masking up again until case numbers fall.

“The emerging data suggests CDC should be advising to vax it AND mask it in areas with [rising] cases and positivity—until we see numbers going back down again,” Adams tweeted.

Federal officials have said it’s reasonable for L.A. County to reimpose a mask mandate for all in indoor public settings. “And I anticipate that will happen in other parts of the country, too,” the current surgeon general, Dr. Vivek Murthy, said on ABC’s “This Week.”

Lilian Zhu, 17, is working at her laptop inside Charlie's Coffee House during the coronavirus pandemic on Sunday

Nationwide, officials are reporting about 29,600 new coronavirus a day over the past week, 158% greater than the rate for the seven-day period that ended June 18, when 11,455 new cases a day were reported. About 3,000 people a day were newly admitted into hospitals nationally for COVID-19 over the past week, up from about 1,800 a day near the end of June.

Deaths still remain at historic lows since the first few weeks of the pandemic but are ticking upward nationally. There have been 238 COVID-19 fatalities a day over the last seven days, up from about 160 a day earlier this month.

A growing number of local health authorities are recommending, if not requiring, mask use indoors by everyone. Health officials for Clark County, including Las Vegas, on Friday urged everyone in crowded indoor spaces to wear masks, including in grocery stores, malls and casinos.

Other California counties have urged people to wear masks indoors — including most counties in the San Francisco Bay Area, as well as Sacramento, Yolo and Fresno — but none have followed L.A. County and mandated the practice.

Elsewhere nationwide, local health authorities in the Missouri counties in and around St. Louis also have recommended universal masking.

The vaccines are extraordinarily protective against severe disease and death. Between Dec. 7 and June 7, unvaccinated people in L.A. County accounted for 99.6% of its coronavirus cases, 98.7% of COVID-19 hospitalizations and 99.8% of deaths.

But officials are asking the vaccinated to wear masks indoors as a way of also forcing unvaccinated people — who are at greatest risk — to do the same. About 53% of L.A. County residents are fully vaccinated, and roughly 60% have had at least one shot. But given the region’s enormous population, that still leaves millions vulnerable.

Israel dropped most mask orders on June 15, the same day California did, but reimposed mandatory mask requirements in indoor public spaces on June 25, reacting to rising infection rates. But the mask rule is not well followed there, and Israeli officials have instructed police to issue fines to people violating the rule, according to the Associated Press.

Federal officials recently expressed hope that hospitalizations would not worsen dramatically. Dr. Anthony Fauci, the U.S. government’s top infectious diseases expert, pointed out that hospitalizations had remained relatively low in Israel, which ordered a resumption in mandatory masking in indoor public settings on June 25

“Although Israel has the same issue with the dominance of the Delta strain, their hospitalizations have dramatically diminished. ... They are very low,” Fauci said at a recent news briefing.

Added Jeff Zients, the White House COVID-19 task force coordinator: “Because we have so many people fully vaccinated, including about 80% of seniors — those who are most vulnerable, those over 65 years of age — we will likely see smaller increases in hospitalizations, similar to the Israel and U.K. experience.”

In France, authorities will soon order mandatory vaccinations for health workers and “COVID-19 passes” for anyone wanting to go to a restaurant, mall or on a train or plane, or inside the recently reopened Eiffel Tower. To get a pass, people must prove they’re fully vaccinated, recently recovered from the virus, or have taken a fresh negative test, the AP reported.

Dr. Peter Chin-Hong, an infectious disease expert at UC San Francisco, agreed it was a good idea to wear masks in crowded indoor settings.

Chin-Hong said he’d heard from other people who found the call for vaccinated people to resume wearing masks a psychological blow, as they had hoped COVID-19 was behind them.

But “we will continue to be in this boat until people get vaccinated,” Chin-Hong said. Chin-Hong said he didn’t think further restrictions, such as reducing capacity at businesses or even business shutdowns, were particularly likely. “I think the economy needs to go on — and there are enough people vaccinated,” Chin-Hong said.

Dr. Robert Kim-Farley, medical epidemiologist and infectious diseases expert at the UCLA Fielding School of Public Health, said he did not expect local officials to restrict business capacity or reimpose physical distancing measures except as a strategy of last resort.

“I do not anticipate we would have to go to those more extreme measures,” Kim-Farley said.

He said he also didn’t expect the hospital system to be as strained as it was earlier in the pandemic, “because of the fact that the vast majority of those who are elderly, and at greatest risk of severe disease and death, have been vaccinated.”

Younger people who are coming down with disease do not have the same high rates of severe illness and death as older people.

Kim-Farley expects that mask requirements will be rescinded for vaccinated people once transmission rates return to lower levels.

Eventually, when everyone is eligible for and has the opportunity to get vaccinated, including those under the age of 12, then “I think that’s when the tables will begin to turn, and people will be saying, ‘All right … we’ve talked to you about the importance of vaccination, and you’re still refusing vaccination. That is your right. But then you have to accept all the responsibility of a bad outcome if you came down with disease.’”

Similar to his previous stance on mandatory masking orders, Los Angeles County Sheriff Alex Villanueva said his agency was asking for voluntary compliance and did not plan to issue citations for those not wearing masks in indoor public settings.

“The Los Angeles County Department of Public Health (DPH) has authority to enforce the order, but the underfunded/defunded Los Angeles County Sheriff’s Department will not expend our limited resources and instead ask for voluntary compliance,” he said in a statement.

Los Angeles County’s mask order goes further than federal or state recommendations, but officials at those levels have expressed support for local health authorities who recommend or require stricter masking measures.

“These decisions have to be made at the local level. If you have areas of low vaccination and high case rates, then I would say local policymakers might consider whether masking at that point would be something that would be helpful for their community until they scale up their vaccination rates,” Dr. Rochelle Walensky, director of the U.S. Centers for Disease Control and Prevention, said at a briefing recently.

Some have questioned whether L.A. County has gone too far and worry the order could have unintended consequences.

There are a lot of complicated issues to sort out, experts say — how to get the unvaccinated to mask up again while also inspiring hope that, when enough people have had the shots, mask mandates for the vaccinated can be lifted once again.

Dr. Monica Gandhi, an infectious disease specialist at UC San Francisco, said it could be a reasonable policy to require masks when more than five people were hospitalized for COVID-19 for every 100,000 residents. L.A. County has surpassed that threshold, and as of Saturday reported 5.2 hospitalizations for every 100,000 residents; a month ago, it was 2.2.

Gandhi added that the federal and statewide approach not to require masks for vaccinated people was sound and demonstrated to vaccine-hesitant people the benefits they could enjoy after getting their shots.

She said she was concerned that taking away the freedom for vaccinated people to be maskless could further discourage those already reluctant to get their shots.

Still, in a tweet Saturday, she pointed to the experience in Israel, which is pursuing what officials there are calling a “soft suppression” strategy with a mandatory mask order in indoor public spaces.

The approach is not about closing the economy again but, by reimposing mask orders for everyone, normalizing mask wearing for the unvaccinated.

“Remember, we are making great strides in the pandemic,” Gandhi tweeted. And although the Delta variant is a challenge, “we are going to get through this.”

Times staff writer Marisa Gerber contributed to this report.