As COVID-19 cases rise again, who needs to wear a mask?

With the emergence of the new BA.2 SARS-CoV-2 variant, COVID infections have again risen. The good news is that although hospitalizations have increased, they are well below levels seen with previous infection waves. In addition, the increase of SARS-CoV-2 immunity induced by repeated doses of vaccines and infections also appears to be preventing any increase in COVID-19 deaths.

Because of the increases in infections, however, public health authorities have now suggested wearing masks would be valuable in certain areas of the United States, including a number of counties in my own state of Michigan. Given the years of these mandates, however, many individuals are reluctant to go back to these preventive measures. The real question is who needs to wear a mask at this point given the lesser medical impact of COVID-19 in most individuals.

First, I think it’s important to keep in perspective that we do not want to again discontinue the indoor activities such as conferences, concerts, or sporting events that re-started in the past year. If it is a tradeoff between wearing a mask to a large indoor group event or canceling that event, it is much better that we continue the progress, even if organizers require wearing a mask.

It’s also important to be sensitive to the needs of individuals who cannot be adequately protected by medical measures. While most of us feel comfortable, now that a COVID infection would not cause the type of illness that devastated the country two years ago, we certainly do not want to put others at risk.

Therefore, I think there are a couple of groups of people that should definitely wear a mask right now. This includes anyone who may be infected with COVID-19, especially if they have used a self-test that has identified infection. A positive antigen test shows that you are shedding virus and, given the increased transmissibility of Omicron and related SARS-CoV-2 viruses, it is likely that without a face covering, you will infect others. Preventing the spread of the infection remains highly important, so anyone who even suspects they are infected should make an effort to do this.

A second group that should wear a mask includes any individual who has a significant medical condition where infection might result in severe disease. This would include individuals who had heart or lung disease, or an immune problem that might prevent the control of a COVID-19 infection. 

Anyone who is unvaccinated for any reason or has not been boosted also has a higher likelihood of a bad infection, therefore wearing a mask could keep you out of the hospital. Given the high degree of transmissibility of these viruses, you need to do everything you can to protect yourself.

Everyone else is open to make their own decision. If you’re fully vaccinated, otherwise healthy, and understand the limited risk of being infected, you can decide whether wearing a mask is valuable. It is unlikely at this point that you will wind up either hospitalized or seriously ill from COVID-19, but you may get an infection that causes several days of discomfort and flu like symptoms. 

Finally, if you have recently recovered from an infection or had a booster in the past few months, you are highly unlikely to get infected again despite an exposure. So, enjoy yourself without worry!