Update: As of April 3, Alameda County has chosen to follow state guidelines that encourage but don’t require masking in healthcare facilities. In the absence of a state or county mask mandate, large healthcare providers in Oakland have been creating their own policies. Read the latest news here.
It’s unclear how much longer people will be required to wear masks in healthcare facilities and other indoor high-risk settings across Alameda County. Due to a recent state order, California will lift its mask mandate for such places, which include hospitals, doctor’s offices, correctional facilities, homeless shelters, and skilled nursing facilities, beginning on April 3. County health departments, though, can continue requiring masks if they choose to create their own mandates.
On Monday, Alameda County health officials announced one such mandate requiring staff at skilled nursing facilities to be masked when they are working with residents, beginning April 3. County health officials plan to revisit the requirement each month and have not indicated whether they plan to create mandates for other settings. The city of Berkeley, which has its own health department, issued a similar order on Monday.
As the date approaches, an increasing amount of disabled people, seniors, public health advocates, and doctors in Oakland are calling on the Alameda County Health Department to keep requiring masks in healthcare and high-risk locations to protect people from being infected with COVID-19.
“These are settings where people known to have COVID mix with cancer patients, people with autoimmune disorders, senior citizens, and healthcare workers,” said Raia Small, a community organizer with the Bay Area-based nonprofit Senior and Disability Action. “Lifting the masking mandate would have a huge impact on who can access healthcare. The way it could force people to ration care is really disturbing.”
In an email to The Oaklandside, Alameda County Health Department Communications Director Jerry Applegate Randrup stated that the county is currently “evaluating the possible effect of the state’s policy changes on local conditions,” and “weighing the most appropriate strategies to address current public health risk.” Randrup also stated that “in general, COVID-19 prevention policy is moving from strict requirements to recommendations over time as population immunity and clinical outcomes improve.”
If Alameda County were to create a mask mandate for healthcare facilities, it would not be unprecedented. On Feb. 28, shortly before the state’s order, San Francisco County created its own mandate requiring healthcare workers and other personnel to wear “well-fitted masks” when in the same room as patients. Los Angeles County issued a similar order on March 13, requiring providers to wear masks in patient-care areas and while working with patients. Both counties’ mandates will remain in place after the state mandate expires on April 3.
On March 24, Santa Clara County ordered that masks be worn in patient-care areas during a “winter respiratory virus period” between Nov. 1 and March 31 of each year.
Meanwhile, in Oakland, about 30 members and supporters of Senior and Disability Action held a rally downtown on March 20 calling on the Alameda County health department to create its own mask mandate. Many dressed in black and held tombstone-shaped signs to “mourn the end of infection control in California.” The rally wasn’t the only creative action the group has organized to address masking. Last December, demonstrators sang Christmas carols outside of Oakland City Hall with lyrics demanding that the city reinstate its mask mandate in city-owned buildings. Councilmembers reinstated the mandate soon afterward.
During the rally, protesters spoke about the dangers of removing masks from public health facilities and criticized health officials.
“I am deeply disappointed and honestly embarrassed that state and local health departments are ignoring the fact that two-way high-quality masking is our tool for community safety, community care, and community love,” said Senior and Disability Action member Golzar Tehrani.
According to a 2021 study on the efficacy of masking and social distancing published in a peer-reviewed scientific journal, two-way high-quality masking—when two people in close proximity to each other are both wearing a mask—reduces the risk of spreading COVID-19 to a far greater extent than if only one person is masked. The study showed that if an unmasked COVID-positive person stays near a person wearing a KN94 or N95 mask for half an hour, the virus has a 20% chance of spreading. If both the infected and uninfected person wears such a mask, there’s less than a 1% chance of spread.
Tehrani spoke of how such two-way masking is particularly important in “buildings [people] are forced to enter such as ERs, urgent care centers, treatment rooms, long-term care facilities, shelters, jails, and prisons.”
Another Senior and Disability Action member, Beth Kenny, told The Oaklandside that they have an autoimmune disorder requiring frequent medical visits. Despite being vaccinated, Kenny said their doctor had informed them that they would be at high risk for severe symptoms or death if they caught COVID-19, given the disorder.
“The policies they’re enacting right now could likely kill me,” said Kenny. “When you have an autoimmune disorder, you get these weird infections and reactions. If you don’t seek out care for them proactively, they can turn into a big deal.”
When asked how dropping masking requirements in healthcare facilities would affect healthcare access for people with auto-immune disorders, Randrup at the county health department emphasized the importance of vaccines and mask-wearing among high-risk populations.
“COVID-19 will continue to circulate in our communities indefinitely and certain people, including older adults and those with serious underlying health conditions, will continue to be at elevated risk,” Randrup stated. “Staying up to date on COVID-19 vaccination, consistently masking with a high-quality, well-fitting mask, and having a plan to access treatment if sick can all help lower this risk in any setting, even in the absence of stricter strategies used earlier in the pandemic.”
But for Kenny, accessing medical care without two-way masking is risky. Although they have taken all the allowable doses of COVID-19 vaccines, they said tests taken through Kaiser have shown that their body has not produced enough antibodies for the vaccines to be effective. If the mask mandate ceases in Alameda County, they said, “every time I consider getting medical care I’ll have to decide whether what I’m dealing with is less of a risk than getting COVID.”
Additionally, Kenny said treatments they need at healthcare facilities can take 4-6 hours, and they have to temporarily take their mask off to take medicine and drink water.
Kenny’s family members limit their indoor activities as a prevention measure, and Kenny only goes to indoor public places in order to seek medical treatment.
“The one place I go to could become no longer accessible to me,” Kenny told The Oaklandside.
Oakland resident Liv Grace, who supports Senior and Disability Action’s goals but could not make it to last week’s rally due to health conditions, created a petition to put pressure on health officials and “demand that masking continue to be required in all medical facilities.” Over 800 people have signed on so far.
Grace’s petition also calls on facilities treating immunocompromised and medically fragile patients to “require workers and staff to wear KN94s, N95s, or better.” Current state masking guidance, which is followed by Alameda County, recommends the use of high-quality masks but doesn’t require it. Grace tested positive for COVID in the past and said they’ve experienced long-term effects. They believe they got it at a medical facility, as those are the only indoor public spaces they enter. But not going to such facilities isn’t an option if they want to stay alive, said Grace.
“I have to take the risk because I get medication to prevent organ damage for my autoimmune diseases,” they wrote in a message to The Oaklandside. “I feel like it’s a no-brainer that vulnerable patients should be especially protected from airborne illnesses.”
Local doctors and community leaders have also been pressuring the county health department to keep a mask mandate. This week, eight local doctors joined 10 community leaders in sending a letter to Dr. Nicholas J. Moss, Alameda County’s top health officer, encouraging him to continue requiring masks in health and correctional facilities, and homeless shelters. Moss has not publicly responded to the letter.
The Oaklandside asked the Alameda County Health Department several times to make Moss available for an interview, but the department hadn’t done so by the time of publication. The Oaklandside also emailed questions to Moss, which he forwarded to Randrup.
When asked why the county would choose to not require masks in healthcare facilities, Randrup referenced the county’s new masking mandate for skilled nursing facility staff members and said that hospitals differ from nursing homes “in their operations and ability to manage acute illness” and that “hospitals have required less support in implementing strong infection prevention programs during the pandemic.”
Randrup added that most hospitals in Alameda County “are members of larger networks that operate across multiple jurisdictions” and that “it is most appropriate for these multi-care entities to develop standardized procedures across their systems.”
Los Angeles and San Francisco counties also both have large health providers, such as Kaiser Permanente and Dignity Health, that operate across multiple jurisdictions, but those counties still enacted mask mandates.
“I don’t think anybody can point to any objective reason why ending mask mandates in healthcare settings would be a good idea,” said Dr. Noha Aboelata, an Oakland-based family physician and founder of Roots Community Health Center, who signed the letter. “We know that you can still catch it, people are still being hospitalized and we’re still losing several hundred people a day to it.”
Nationwide, COVID hospitalizations and deaths have declined as more people become vaccinated and have accessed anti-viral treatments. But the virus continues to claim lives. Over 250 people per day have been dying of COVID on average this year. Locally, the Alameda County Coroner attributed 186 deaths to COVID in Oakland in 2022, which is over 1.5 times more than the number of homicide deaths, and over five times higher than deaths from traffic collisions.
Aboelata told The Oaklandside she’s “pretty worried about almost every population on some level” if masks get removed from healthcare facilities, in part due to concerns that vaccine and booster efficacy wanes over time, that vaccination and booster rates have slowed, and that certain populations, such as very young children, are unable to wear masks. She said many people also lack the information they need to understand the risk involved in visiting hospitals, as those facilities have never been required to publicly report outbreaks.
“That info has not been made public at all,” said Aboelata. “We’ve never had that for the pandemic.”
Aboelata said she and other doctors have been meeting with Moss, and also lobbying Oakland’s City Council to maintain masking in municipal buildings. Last week, the council approved a resolution to extend its mask mandate in such buildings, with only one councilmember, Noel Gallo, voting against it. Advocates in Alameda County and elsewhere in California have also been organizing with residents in Washington and Oregon, two other states with expiring mask mandates, through West Coast COVID Action. The coalition has been using the hashtag #keepmasksinhealthcare to tweet at legislators and health officials.
The California Nurses Association, a labor organization representing thousands of registered nurses and other medical professionals, has also condemned the state’s decision to lift the masking requirement in healthcare settings.
Although Alameda County Health Department has not taken action so far, those pushing for a mask mandate remain hopeful that it will.
“I remain somewhat optimistic,” Kenny said. “Alameda County has been courageous in the past when it comes to masking.”
As cases rose last spring, the county health department temporarily ordered that masking be reinstated in workplaces and indoor public settings. At the time, it was the only county to do so in the Bay Area.
“I think it’s still possible,” said Aboelata. “We’d be in great company with Los Angeles and San Francisco. I think it would be the most prudent thing to do.”