Is It Time to Wear a Mask Again?

With the worst of the COVID-19 pandemic seemingly in the rear-view mirror, most of us have thrown away our paper masks, or stuffed them in our back pocket. These days, it’s common to see only one or two people wearing a mask at the supermarket or riding the light rail.

But just as we’ve gotten used to going unmasked in public, storm clouds have been gathering to give us second thoughts. Hospitalizations for COVID, flu and respiratory syncytial virus (RSV) have been on the rise recently, and now comes word of a rapidly spreading COVID variant, JN.1. This is anticipated to increase following holiday gatherings and travel.

In a recent video posted on social media, Mandy Cohen, the new director of the Centers for Disease Control and Prevention (CDC), advised Americans to get vaccinated and “use additional layers of protection, like avoiding people who are sick, washing your hands, improving ventilation, and wearing a mask.”

So is it time to consider wearing a mask again? For guidance, we turned to Larissa Pisney, MD, an associate professor in the Division of Infectious Diseases at the University of Colorado Department of Medicine. Pisney also is medical director of infection prevention and control at UCHealth University of Colorado Hospital.

With cold, flu and RSV season underway and COVID still a problem, is it time for people to rethink whether they should be wearing masks in public places?

It really comes down to a personal choice. We're not mandating masking for patients and visitors in the hospital, except for very high-risk settings where oncology and transplant patients are.

Consider your own risk factors, like your age, or certain medical conditions that might put you at higher risk, such as heart disease, lung disease, diabetes, or cancer. Or consider it if you’re immunosuppressed for some reason, such as a transplant patient or you’re pregnant, or if you live with or spend a lot of time with someone who has one of those conditions. And some people are just really averse to getting ill, especially after the pandemic.

If you’re going to be in a crowded place for a long time, if it's a tight environment, if there isn't good air circulation, that might be a time you want to wear a mask. And if you plan to gather with high-risk family members, including infants younger than 6 months who cannot be vaccinated yet, you might consider masking in public leading up to that gathering.

How effective are masks against infectious diseases?

A lot of factors go into that, including the type of mask you wear, how crowded the space around you is, and whether everyone in the room is wearing a mask. But really, the point is to wear the most protective mask that fits you and that you can keep on consistently – probably a disposable surgical mask or KN95.

What about wearing masks while traveling? The CDC says respiratory infections are a leading cause for seeking medical care among returning travelers.

Again, that comes down to personal risk tolerance, and what medical conditions and other risk factors for severe illness you have. If my older parents were going to travel by plane, I probably would recommend that they wear masks, at least when they’re in tight settings, like when they’re going through security or getting on the plane. Perhaps once the plane is up in the air and the air is circulating, maybe you don’t need to be as strict.

Besides wearing a mask, what are some other things people should be doing this winter to protect themselves and others?

I wouldn’t rely on a mask as my only protection. The most important protection is vaccination. The CDC just sent an alert on the low rates of vaccination against the “big three”: COVID, influenza, and RSV. For everyone, vaccination should be the cornerstone of your defense against getting ill. For the influenza vaccine and the latest COVID booster, they’re for anyone over 6 months of age. And there’s an RSV vaccine for folks who are 60 and older and pregnant women between 32 and 36 weeks of pregnancy. It’s certainly not too late to get any of those. Also if you are older or have high risk medical conditions, it is important to get tested if you are sick as we have treatments that can prevent severe illness if given early.

Then there are the other steps that we talked about over and over again during the pandemic: Not gathering with people who you know are sick. If you’re going to be out grocery shopping, try to stay 6 feet away from people. If you’re prone to illness, avoid very crowded gatherings. Wash your hands properly. And at gatherings, to quote my boss, no double dipping!

Photo at top: Masked people walk across the CU Anschutz Medical Campus in September 2020, during the height of the COVID-19 pandemic when mask wearing was widespread.